The practical relevance of WHODAS self-ratings in non-aggressive community dwelling individuals with psychotic spectrum disorders

BACKGROUND: Everyday functioning and symptom reduction are rehabilitation goals for individuals with psychotic spectrum disorders (PSD). Self-rating of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS) may provide insights into individuals' perspectives on their disabilities but researchers have questioned the value of self-ratings in individuals with PSD. AIM: To explore how individuals with PSD in outpatient psychiatric care reason when self-rating their disabilities on WHODAS to determine the value of doing self-ratings. METHODS: Twenty community dwelling individuals diagnosed with schizophrenia or schizoaffective disorder completed the 36-item WHODAS while being interviewed using concurrent probing. Deductive content analysis was performed, while supplementary questions were analysed inductively. RESULTS: Most individuals showed difficulties in responding in expected ways to the questions. Three themes were identified: Poor language comprehension, Difficulties in processing and responding, and Rating issues related to time, context and experience Difficulties were observed across all WHODAS items. A positive theme concerning Meaning-making emerged. CONCLUSION: Findings suggest that self-rating WHODAS by community dwelling individuals with PSD pose challenges related to language interpretation, attention, contextual framing, emotional engagement and possible cognitive impediments. It is recommended to use WHODAS self-ratings as a tool for dialogue, and contextual understanding, supporting self-reflection, and patient participation.