Birth Order and Sibling Gender Ratio of a Clinical Sample

Original Article

The Translation and Psychometric Assessment of the Persian Version of the Sheehan Disability Scale Masoumeh Amin-Esmaeili, MD 2 Abbas Motevalian, MD 3 Afarin Rahimi-Movaghar, MD 4 Ahmad Hajebi, MD 3 Mitra Hefazi, MD 3 Reza Radgoodarzi, MD 5 Vandad Sharifi, Md


1 Department for Mental Health and Substance Abuse, Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran 2 School of Public Health, Iran University of Medical Sciences, Tehran, Iran 3 Iranian National Center for Addiction Studies (INCAS), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran 4 Mental Health Research Centre, Tehran Psychiatric Institute, Iran University of Medical Sciences, Tehran, Iran 5 Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran

Objective: The Sheehan Disability Scale (SDS) assesses disability in four domains of home management, work responsibilities, close relationships and social life. The main objective of this study was to develop the Persian version of the SDS. Method: Two steps of field work followed the Persian translation and cultural adaptation of the tool: First, the internal consistency and convergent validity was examined in 104 clinical cases recruited from inpatient and outpatient psychiatric services, using 36-item Short Form Health Survey (SF-36) and Global Assessment of Functioning (GAF). Then 88 individuals were randomly selected from the adult general population to assess internal consistency, inter-rater reliability and known group validity. Results: In the clinical settings, Cronbach’s α coefficient was 0.88 and item-total correlation ranged from 0.71 to 0.78 in various domains. The correlation between SDS and SF-36 (P 0.80) indicates that each area is consistent with the other areas and represents a single construct, which is similarly shown in other studies. The study on patients with bipolar disorders reported Cronbach’s α coefficient of 0.89 for the English version of the SDS (20). The Spanish version of the SDS met a strong internal consistency (α = 0.83) in the primary care setting as well (5). World Mental Health Survey replicated the same findings (Cronbach’s α coefficient 0.82 to 0.92) for the general population across the participating countries (1). The SDS is significantly correlated with all the subscales of the SF36 as a self-reported instrument, as well as “days out of role” in the expected direction, supporting the convergent validity of the SDS. These findings are consistent with previous studies that reported a moderate correlation between the SDS and SF-36 in bipolar patients (20). “Severe or very severe scores” in at least two domains of the SDS had the highest correlation with mental and general health subscales of the SF-36. We also found a satisfactory


correlation (0.52) between “severe or very severe scores” in at least two domains of the SDS and the mean of “days out of role.” However, the SDS was not correlated with GAF in the clinical sample. A majority of the clinical sample consisted of patients with severe mental disorders such as bipolar disorder and schizophrenia. Authors believe that this might have led to the fact that these patients had unintentionally reported a better functional status with the self-administered tools. On the other hand, GAF is a clinician-rated scale and has a scoring system based on observations, interviews and reviews of the medical records which provide a more comprehensive information on functioning and psychiatric symptoms. This finding suggests the lower applicability of the SDS in severe cases in the acute phase of the illness. According to our knowledge, this was the first time that test-retest reliability of the SDS has been assessed in the general population. One previous reliability study on the clinical cases found acceptable reliability for social life/ leisure activity (20). However, our assessment of reliability showed a strong agreement between the two rounds on work and school functional status, but it was not acceptable in other domains. This difference might be the result of the cultural variations in the perception of major life domains. The known group validity analysis showed that individuals with a psychiatric disorder could be distinguished from people without a psychiatric illness by the SDS; therefore, the SDS shows a good discriminative validity. In other studies on social phobia and post-traumatic stress disorder, a similarly good discriminative validity has also been reported using the SDS (21, 22). Validating an instrument, which has originally been developed in a different culture, is generally a difficult

Iranian J Psychiatry 9:3, July 2014

Psychometric Assessment of the Sheehan

task. Moreover, the multistage design of the current study added to the complexity. However, the results might be considered of significant value because of several reasons. First, this study incorporated the assessments of the samples from both clinical settings and the general population. Moreover, in the general population, the sampling frame included urban areas from both large and small cities as well as rural areas presenting different subcultures. The study also assessed multiple indicators of validity and reliability. However, the sample in our study was not large enough to enable us to explore the effect of demographic variations on the validity and reliability of the instrument.




Conclusion Validating an internationally standardized tool to evaluate the magnitude of the functional impairment of psychiatric disorders would provide an opportunity for the direct comparison of information across countries. Overall, the SDS seems to be a valid scale for the measurement of disability in clinical settings and the Iranian general population. It is a short, simple and easy to use instrument for large scale population surveys.



Acknowledgement This study as a part of the Iran Mental Health Survey has been financially supported by the Ministry of Health through the contract number of 132-1491 of Tehran University of Medical Sciences and the contract number of 89-D-432-143 of Mental Health Research Network. The authors acknowledge the contribution of Dr. Samaneh Kariman, Reza Davasaz Irani, Dr. Behrang Shadlou and Fahima Farrahi in conducting the study.




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Iranian J Psychiatry 9:3, July 2014

The translation and psychometric assessment of the persian version of the sheehan disability scale.

The Sheehan Disability Scale (SDS) assesses disability in four domains of home management, work responsibilities, close relationships and social life...
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