Psychometric evaluation of the Sheehan Disability Scale in adult patients with attention-deficit/hyperactivity disorder

Abstract

Inattention and impulsivity symptoms are common among adults with attention-deficit/hyperactivity disorder (ADHD), which can lead to difficulty concentrating, restlessness, difficulty completing tasks, disorganization, impatience, and impulsiveness. Many adults with ADHD find it difficult to focus and prioritize. Resulting outcomes, such as missed deadlines and forgotten engagements, may ultimately impact the ability to function at work, school, home, or in a social environment. The European Medicines Agency guidelines for evaluating medicinal products for ADHD recommend inclusion of both functional outcomes, such as school, social, or work functioning, and outcomes related to symptoms of ADHD in clinical studies of novel medication primary efficacy endpoints. Due to its performance in other disease areas and the relevance of its items as evidenced by content validity analyses, the Sheehan Disability Scale (SDS) was chosen to assess functional impairment in ADHD. The aim of this study was to investigate the psychometric properties of the SDS, used as a brief measure of functional impairment in a number of psychiatric disorders, in adult patients with ADHD. To the authors’ knowledge, this is the first study to evaluate the reliability of the SDS (based on Cronbach’s coefficient alpha and test-retest reliability), its validity (construct and known-groups validity), and its ability to detect change in this patient population. This study also established a preliminary responder definition for the SDS in this study population to determine when change can be considered clinically beneficial in a clinical trial setting. The psychometric results support the use of the SDS subscales (items 1–3) and total score (sum of items 1–3) in an ADHD population. In addition, the evaluation provides evidence for a three-point preliminary responder definition for the SDS and further evidence of its responsiveness in adults with ADHD. Altogether, the results indicate that the SDS is a simple and easy-to-score scale that would have great utility in future clinical trials for monitoring functional impairment in adults with ADHD.

Validation of Chinese Multidimensional Depression Assessment Scale (MDAS) in Inner Mongolia pregnant women and risk factors of antenatal depression in Inner Mongolia in the era of one-child policy

“…The Sheehan's Disability Scale (SDS) is a 3-item selfreport instrument measures impairments from the domains of work, family life/home responsibilities and social/leisure activities [45]. It has been tested with adequate reliability(0.79-0.91 95% Confidence Interval) [46] and validity [46][47][48]. The Chinese version has also been validated with adequate psychometric performances with intra-class correlation coefficient 0.89 (0.82-0.93 95% CI) and Cronbach's alpha 0.9 [49].…”

The effect of vortioxetine on overall patient functioning in patients with major depressive disorder

“…To account for previously identified issues related to the SDS work score (Arbuckle et al., 2009; Coles et al., 2014; i.e, missing patient values due to unemployment during the study), sensitivity analyses were conducted in which scores on this individual item were calculated using three methods: (A) worst case I (“Case Report Form [CRF] Worst Case Score”, where work‐related information within the CRF is used to impute a missing work score); (B) imputed average non‐missing score (“Imputed Average Score”, where the average of the two available items—social and family—is used to impute the missing work item); and (C) worst case II (“Assumed Worst Case Score”, where a worst case score of 10 is assumed and imputed for all missing work items). Method A did not provide any additional information since no imputations were made with this rule in the entire database; therefore, it was identical to the nonimputation method used for the primary meta‐analysis.…”

Cognitive behavioral therapy in pharmacoresistant obsessive–compulsive disorder

“…Sheehan Disability Scale (SDS) 62 is a visual analog scale for assessing subjectively perceived disabilities. The instrument is often used to evaluate disabilities in anxiety disorders, 63 – 65 including OCD. 66 Its three items are complemented by a fourth dimension to which the patient records the levels of stress in the same visual analog scale as above three items.…”