The Sheehan Disability Scale (Sheehan 1983) is a composite of three self-rated items designed to measure the extent to which three major sectors in the patient’s life are impaired by panic, anxiety, phobic, or depressive symptoms. This scale has been used widely in psychopharmacology randomized controlled trials. This anchored visual analog scale uses visual-spatial, numeric, and verbal descriptive anchors simultaneously to assess disability across three domains: work, social life, and family life. The scale was thus designed because some people rate numerically (“he was 1.9 m tall”), others use verbal descriptive anchors (“he was very tall”), and still others communicate their rating spatio-visually (using their hands to point while commenting “he was this tall”). Some choose a combination of two or all three methods.

The Sheehan Disability Scale was developed as a treatment outcome measure that would be sensitive to change and to drug placebo differences over time. It may also be useful for identifying primary care patients with mental health-related functional impairment. It is not intended to substitute for a comprehensive diagnostic procedure but rather to supplement symptom assessments.

Overview

The patient rates the extent to which his or her 1) work, 2) social life or leisure activities, and 3) home life or family responsibilities are impaired by his or her symptoms on a 10-point visual analog scale. There are verbal descriptors for the points on the scale as well as numerical scores that provide more precise levels of the verbal descriptors. (Consequently, there are more numerical points than there are verbal descriptor anchors.) The Sheehan Disability Scale also provides a visual-spatial layout to accommodate those with spatial rating preferences. Example 8-7 provides items from the scale.

The numerical ratings of 0-10 can be translated into a percentage if desired. The three items may be summed into a single dimensional measure of global functional impairment that ranges from 0 (unimpaired) to 30 (highly impaired). Typically 4 scores are derived from the scale in research studies- one for each of the work, social life and family life disability measures and an aggregate total score of these three scores combined. It is recommended that clinicians pay special attention to patients who score ?5 on any of the three scales, because such high scores are associated with significant functional impairment.

The scale may be used as a self-report, administered by a clinician, or rated by both independently. Because of this flexibility of administration, it is useful with both outpatients and inpatients. The scale is quite straightforward, and no scoring manual is necessary. It takes only 1-2 minutes to rate the scale.
Translations are available in 41 languages and in 36 dialects of 9 of these languages. In 32 of the 41 languages it is available in one form only. Altogether it is available in 66 languages or language dialect variants. View more language translation information.

Reliability

In a study of 1,001 primary care patients, the inter-item correlations of the three Sheehan Disability Scale items were fairly high (0.70 for work and family impairment, 0.72 for work and social impairment, and 0.79 for family and social impairment). As a consequence of the strong relationships among the items, the internal consistency was also high (alpha = 0.89 for the three-item scale).

Validity

In the study of 1,001 patients mentioned in the preceding section, the construct validity was substantiated in two ways. Overall, more than 80% of the patients with mental disorder diagnoses had an elevated Sheehan Disability Scale score, and nearly 50% of those with elevated scale scores had at least one disorder. Also, patients with any of six mental disorders (alcohol dependence, drug dependence, generalized anxiety disorder, major depressive disorder, obsessive-compulsive disorder, and panic disorder) had significantly higher impairment scores than those who did not have the disorders.

Validity was also indicated by the fact that the scores of subjects who reported “problems getting along with partner” were higher on both the family impairment item and the total score than the scores of subjects who denied having this type of problem. Likewise, those who reported “missing work in the past month due to emotional problems” had significantly higher scores on both the work impairment item and the total score.
An elevated Sheehan Disability Scale score (?5) was also found to be associated with increased risk of mental disorder. Using any of the six mental disorders listed earlier as the standard, the sensitivity (0.83), specificity (0.69), positive predictive value (0.47), and negative predictive value (0.92) were respectable for helping to identify psychiatrically impaired patients with the three-item scale.

The Sheehan Disability Scale appears to reflect change over time with effective treatment. In addition, it has been shown to discriminate between active drug and placebo and even between two active treatments.

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