Validation of a work capacity evaluation for individuals with psychiatric disorders

Vocational disability is frequently associated with psychiatric disorders, and comprises an important element in the diagnostic criteria for many mental disorders (Diagnostic and Statistical Manual of Mental Disorders, 4th ed., p. xxi; 1994). Anthony and Blanch (1987) found that less than 15% of individuals with serious mental illness receiving community treatment were engaged in gainful employment. A review of longitudinal studies revealed rates of gainful employment ranging from 6%, to 41% for individuals with schizophrenia (McGlashan, 1988), with most rates between 10% and 20%. It has been estimated that between 1.7 to 2.4 million Americans have secondary disabilities accompanying severe psychiatric impairments (Goldman, Gattozzi, & Taube, 1981). Moreover, individuals with severe mental disorders are notorious for having the worst employment outcomes of the various disability groups served by state and federal rehabilitation programs (Marshak, Bostich, & Turton, 1990). Despite the broad scope of psychiatric disability, there have been few instruments validated to measure the capacity of individuals with psychiatric disorders to perform entry level work (Bell & Lysaker, 1995; Bell, Milstein, & Lysaker, 1993; Goldman, Skodol, & Lave, 1992; Holstein & Harding, 1992; Institute of Medicine, 1991; Strauss & Carpenter, 1974). Nor has there been a systematic examination of the specific nature of work disability in individuals with serious mental disorders (Lysaker et al., 1993). Studies of the work capacity of psychiatric patients have relied mainly on global ratings of work, post-hospital employment (Cheadle & Morgan, 1972; Di Stefano & Pryer, 1970; Griffiths, 1974), or psychiatrists' ratings of clinical reports (Pincus & Kennedy, 1991). Such ratings may lack sensitivity to the diverse character of work capacity present in patients with various mental disorders, symptom severity, work histories, or work disincentives. The lack of a standardized (i.e., normalized, reliable, and valid) and operationalized method for measuring the ability of people with mental impairments to perform entry level work has hampered professionals and public agencies in making diagnoses, conducting functional assessments, determining disability, and designing effective rehabilitation programs. In 1984, the Social Security Administration revised its method of determining psychiatric disability, using a two step criteria: (1) psychiatric impairment as evaluated through diagnosis by DSM-III (1980) and (2) functional disabilities in activities of daily living, work and stress tolerance, and social functioning. The question arose whether these most recent standards and procedures were valid measures of determining disability in persons with psychiatric disorders. This research was designed to answer that question. A range of work-related measures, taken during actual or simulated work sessions, has been considered the preferred mode for obtaining an objective evaluation of work capacity (Anthony & Jansen, 1984; Bond, 1992). These measures include productivity level, quality of output, work tolerance, responses to work place stressors, promptness, attendance, and the ability to solve work-related and interpersonal problems. The current investigators developed an objective and operationalized protocol for the functional evaluation of entry level work capacity for individuals with psychiatric impairments (Massel et al., 1990). Termed the Work Capacity Evaluation (WCE), this instrument was implemented in a naturalistic work setting and included direct observations of relevant job skills and deficits. The WCE was developed as a central component of a study addressing the relationship between psychiatric symptoms and the capacity to perform entry level work. In that study the tasks on which participants worked were designed to coincide with Social Security Administration's (SSA) description of "basic work activities" for jobs that are available in the community. …