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Disability Certification in India: Indian Disability Evaluation and Assessment

Scale versus World Health Organization Disability Assessment Schedule

Article  in  Indian Journal of Psychological Medicine · October 2017

DOI: 10.4103/IJPSYM.IJPSYM_166_17

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 Vol 39 Issue 5 September-October 2017
Indian Journal of Psychological Medicine • Volume 39 • Issue 4 • July-August 2017 • Pages 389-***
 Letters to Editor

Address for correspondence: Dr. Sundar Gnanavel,
35, St. Anns Close, Newcastle Upon Tyne, NE1 2QP, UK
E‑mail: sundar221103@yahoo.com
REFERENCES
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This is an open access article distributed under the terms of the
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DOI:
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How to cite this article: Gnanavel S. Biomarkers in autism spectrum
disorders: An illusion or promising reality?. Indian J Psychol Med
2017;39:714-5.
© 2017 Indian Psychiatric Society | Published by Wolters Kluwer - Medknow

Disability Certification in India: Indian Disability

Evaluation and Assessment Scale versus World
Health Organization Disability Assessment Schedule
Sir, Table 1: Classification functions
The International Classification of Functioning, a) IDEAS cutoff=7; WHODAS cutoff=23
Disability and Health (ICF) has shifted the Disabled in Not disabled Total
focus of disability from cause to impact. While IDEAS (%) in IDEAS (%)
measuring disability, interaction of impairment with Disabled in WHODAS A ‑ 20 (40) B ‑3 (6) 23
environment is considered.[1] India has agreed to adopt Not disabled in WHODAS C ‑ 7 (14) D ‑ 20 (40) 27
Total 27 23 50
the ICF and thereby the World Health Organization
Disability Assessment Schedule (WHODAS). [2] b) IDEAS cutoff=6;WHODAS cutoff=24
In India, disability is certified when the disability Disabled in Not disabled Total
IDEAS (%) in IDEAS (%)
score is  ≥40%. WHODAS has no such cutoff. In
Disabled in WHODAS E ‑ 16 (32) F ‑ 6 (12) 22
a recent study involving fifty patients with mental Not disabled in WHODAS G ‑ 4 (8) H ‑ 24 (48) 28
illness, we found that a score of 23 in WHODAS Total 20 30 50
corresponded to the score of 7 (40%) in the Indian
WHODAS – World Health Organization Disability Assessment Schedule;
Disability Evaluation and Assessment Scale (IDEAS), IDEAS – Indian Disability Evaluation and Assessment Scale
the official tool to certify disability due to mental
illness.[3] Using the same data, here we highlight the
Seven (14%) would not be certified as per WHODAS,
possible implications of using WHODAS vis‑à‑vis
but disabled as per IDEAS (false negatives; cell C).
IDEAS.

Table 1a shows classification functions of the current
method of using IDEAS and WHODAS with a cutoff
score of 23. Three patients (6%) would be certified
as disabled as per WHODAS, though they were
not disabled as per IDEAS (false positives; cell B).
WHODAS assesses disability over the previous
1 month. There is no such time frame in IDEAS;
most clinicians consider functioning over the past few
weeks for assessing disability. Moreover, while IDEAS
gives 20% weightage for duration of illness (DOI),

Indian Journal of Psychological Medicine | Volume 39 | Issue 5 | September-October 2017 715

 WHODAS does not have any weightage for DOI. We
explored the impact of DOI on disability scores. If only
severity of disability was considered in IDEAS (i.e., if
DOI was not considered), the total score would have
been 16 and 40% of cutoff would be ~6. Ignoring DOI
would make the receiver operating characteristic curve
more accurate (area under the curve: 0.85 vs. 0.83).
The cutoff in WHODAS would then be 24. Table 1b
shows classification function with 6 as cutoff. Six (12%)
would be false positives (cell F) and four (8%) would
be false negatives (cell G). Seven patients (14%) who
were certified as disabled when the IDEAS cutoff was
7 would not be certified if DOI is not considered.
A shift from IDEAS, which is unduly influenced by
DOI, to WHODAS would have reduced the number of
persons classified as disabled from 27 to 22 (a reduction
of 10%). This shift would better identify patients, whose
disability status is influenced by the degree of disability
rather than by DOI: three patients would have been
labeled as “not disabled” as per IDEAS, even when their
disability was above the cutoff, as per WHODAS (cell
B). With the use of WHODAS, these also would get
certified. As a corollary, this shift would deny benefits
to patients, whose disability status is influenced more
by DOI rather than by the degree of disability: seven
patients would have been labeled as “disabled” as per
IDEAS, even when their disability was below the cutoff
as per WHODAS (cell C). With the use of WHODAS,
these would lose their disability status, as this shift would
remove the undue influence of DOI on certification.
We wish to highlight two important issues through
this letter:
1. WHODAS is an instrument which can be used to
assess disability across various medical conditions
including psychiatric illnesses. Since there is
discrepancy in the present study, we urge for a larger
field trial across all disabilities
2. DOI would not be a direct measurement of a person’s
disability. The initial proposal of IDEAS had “months
of illness in the last 2 years” in place of DOI.[4] But,
duration of disability might be ideal. Time frame for
measuring disability would also be required.[5]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
716 © 2017 Indian Psychiatric Society | Published by Wolters Kluwer - Medknow
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Chethan Basavarajappa,
Urvakhsh M. Mehta, Thanapal Sivakumar,
Naveen Channaveerachari Kumar,
Jagadisha Thirthalli
Department of Psychiatry, National Institute of Mental Health
and Neurosciences, Bengaluru, Karnataka, India
Address for correspondence: Dr. Chethan Basavarajappa
Department of Psychiatry, National Institute of Mental Health and
Neurosciences, Hosur Road, Bengaluru ‑ 560 029, Karnataka, India.
E‑mail: drchethanraj@gmail.com
REFERENCES
1. World Health Organization. International Classification
of Functioning, Disability and Health: ICF. Geneva: World
Health Organization; 2001.
2. World Health Organization. Towards a Common Language
for Functioning, Disability and Health: ICF. Geneva: World
Health Organization; 2002.
3. Basavarajappa C, Kumar KS, Suresh VC, Kumar CN,
Ravishankar V, Vanamoorthy U, et al. What score in
WHODAS 2.0 12‑item interviewer version corresponds to
40% psychiatric disability? A comparative study against
IDEAS. J Psychosoc Rehabil Ment Health 2016;3:21‑6.
4. The Rehabilitation Committee of the Indian Psychiatric
Society. IDEAS (Indian Disability Evaluation and Assessment
Scale). Kolkata: IPS; 2002.
5. Department of Psychiatry, NIMHANS and Indian Psychiatric
Society. Recommendations Based on National‑Level Expert
Consensus Meet on Disability Due to Mental Illness and
Future Directions Recommendations. Bengaluru: NIMHANS,
Department of Psychiatry; 2016.
This is an open access article distributed under the terms of the
Creative Commons Attribution-NonCommercial-ShareAlike 3.0
License, which allows others to remix, tweak, and build upon the
work non-commercially, as long as the author is credited and the
new creations are licensed under the identical terms.
Access this article online
Quick Response Code
Website:
www.ijpm.info
DOI:
10.4103/IJPSYM.IJPSYM_166_17
How to cite this article: Basavarajappa C, Mehta UM, Sivakumar T,
Kumar NC, Thirthalli J. Disability certification in India: Indian Disability
Evaluation and Assessment Scale versus World Health Organization Disability
Assessment Schedule. Indian J Psychol Med 2017;39:715-6.
© 2017 Indian Psychiatric Society | Published by Wolters Kluwer - Medknow