Examining conceptual and measurement challenges in mental health related work disability

Abstract

According to the World Health Organization in 2000, mental health conditions accounted for five of the ten leading causes of disability worldwide. In the United States, the Social Security Disability Insurance (SSDI) program is the primary federal program that provides financial assistance to workers who are unable to participate in US workforce due to disability. In 2010, 34% of the SSDI benefits awarded to individuals were attributable to a mental condition. Three studies were conducted to examine various aspects of mental health related work disability. Study One: Measuring Interpersonal Interactions and Work Disability: Framework and Item Pool Development presented a novel conceptual framework and new set of items for measuring interpersonal interactions in the context of work. This paper discussed the utility of measuring mental health related work disability based on the proposed conceptual framework. Study Two: Mental Health Profiles among Persons Applying for SSDI used secondary data to examine mental health functional profiles among persons applying for SSDI benefits (claimants). The focus of this paper was to characterize claimants along four dimensions of mental health functioning (Depression/Anxiety, Confidence/Conscientiousness, Social Interactions, and Behavioral Control). Subgroup analysis was performed to examine the relationship between various demographic/clinical factors and mental health functioning. Study Three: Claimant-Provider Agreement for Mental Health Functioning related to Work Disability expanded on Study Two by including healthcare provider assessments of the claimant's mental health functioning. Analysis examined the extent to which provider and claimant responses were consistent and in agreement along the four dimensions of mental health functioning. These studies contribute to existing literature by conceptually expanding notions of mental health disability, applying that framework to develop meaningful profiles in mental health functioning among SSDI claimants, and illustrating important challenges with work related mental health functioning assessment. Claimants' mental health functioning scores were one standard deviation lower across all four scales as compared to a normative US adult sample. Results indicated that concordance between provider and claimant report of mental health functioning was poor. Systematic differences in agreement patterns of provider versus claimant responses were observed. Implications for future descriptive and validation work are discussed.