BACKGROND: Questions exist related to the best way to use medical
evidence relative to self-report as part of the SSA disability determination
process.
OBJECTIVE: To examine concordance between provider and claimant
responses along the four dimensions of work related behavioral health
functioning: Social Interactions, Mood and Emotions, Behavioral Control, and Self-Efficacy.
METHODS: Using secondary data from a larger study, which collected
data on individuals reporting difficulties with work (claimants) due to
mental conditions, 39 items were completed by claimants and their healthcare
provider. Inter-rater agreement was assessed using three techniques: Cohen's
kappa, percent absolute agreement, and folded mountain plots.
RESULTS: A sample of 65 dyads was obtained. Inter-rater agreement
was low for most items (k = 0.0-0.20) with a minority of items having fair
agreement (k = 0.21-0.40) Percent agreement was fair: Mood and Emotions
(46%), Self-Efficacy (44%), Behavioral Control (39%) and Social
Interactions (38%). Overall, providers reported lower functioning
compared to claimants for the Behavioral Control and Self-Efficacy scales;
the reverse trend held for the Mood and Emotions scale.
CONCLUSIONS: Results indicate discordance between provider and
claimant report of behavioral health functioning. Understanding reasons for
and approaches to reconciling the inconsistencies between claimant and
provider perspectives is a complex task. These findings have implications
for how best to assess mental and behavioral-health related work disability
in the absence of an established gold standard measure.
