The Usability of WHODAS Self-Rating for Forensic Psychiatric Inpatients with Schizophrenia

Inpatient forensic psychiatric rehabilitation is based on patient symptoms, life activities performance and perceived risks to self and others. Self-ratings provide insights into patients’ perspectives. We have found differences between self-ratings and staff-ratings using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS). To understand rating differences, we performed a qualitative study exploring patients’ reasoning when self-rating WHODAS. Eighteen participants with a psychotic disorder and a history of aggression, cared for at a low to medium secure forensic psychiatric inpatient clinic in Sweden, were interviewed using verbal concurrent probing when self-rating the WHODAS. Participants’ responses during the concurrent probing interview were summarised under three central themes: difficulties understanding and expressing language associated with the questionnaire; cognitive difficulties; and contextual rating difficulties. The analysis of two additional questions, about meaningfulness and validity, resulted in one further theme: Value of doing the rating. The usability of the questionnaire and of the self-rating process was not uniform, given differences in participants’ language-related and cognitive abilities, as well as some questions not being readily applicable to an inpatient setting. Overall, the questions may prompt self-reflection, which could increase patient participation and self-awareness.