TL;DR: Summary

✅ Available on Bravely Connect

The WSAS is a self-report measure used to assess the levels of impairment in five different areas of a respondent’s life: work, household management, social activities, private leisure activities, and interpersonal relationships. It consists of 5 items asking a client to indicate their levels of impairment using a nine-item Likert-type scale. Total scores are calculated via the summation of each item. Potential scores range from 0 to 40 with higher scores indicating higher levels of impairment in the assessed areas of a respondent’s life. Limitations for the WSAS include its limited scope of assessed topics and inability to diagnose any condition. The WSAS has been validated in a small amount of cross-cultural studies, but extensive further research is needed to assess its efficacy in other cultures and populations with different psychological conditions. Clinicians are cautioned to take into account a client’s cultural background and personal values while using the WSAS. Even with these limitations, the WSAS demonstrates internal consistency and sensitivity to change, making it a potentially helpful tool in tracking client progress towards increased participation in life activities.

Highlights

📏 Length: 5 questions

📋 Administration: Self-administered

🎯 Uses: To assess levels of impairment in occupational, domestic, social, leisure, and interpersonal functioning

⚠️ Important Caveats: Does not diagnose any specific condition; only assesses five areas of functioning while other areas may still be important to clients

✅ Available in Bravely Connect? Yes

🌏 Culturally Applicable? Some preliminary studies suggest yes, but much more research is needed.

The WSAS Question type and length

The client is presented with five questions asking clients to indicate their levels of impairment in areas related to occupational and interpersonal functioning. Each item has the same selection of answers: a 9-point Likert-type scale ranging from 0 (no impairment) to 8 (severe impairment). 

Here are examples of items from the Work and Social Adjustment Scale, and the range of answers:

Because of my [disorder], my home management (cleaning, tidying, shopping, cooking, looking after home or children, paying bills) is impaired. 0 means not at all impaired and 8 means very severely impaired.

Because of my [disorder], my ability to form and maintain close relationships with others, including those I live with, is impaired. 0 means not at all impaired and 8 means very severely impaired.

For the full list of questions check out the measures on Bravely Connect, or follow the following link to the original unautomated version: 

WSAS

What does the WSAS measure

The Work and Social Adjustment Scale (WSAS) is a self-report measure designed to assess the impact of mental health challenges on an individual's ability to perform their daily activities and fulfil their social roles. The items are designed to assess several aspects of a client’s life that may be affected by mental health challenges including ability to work, ability to manage one’s household, participation in social activities, engagement in private leisure activities, and ability to form and maintain interpersonal relationships. The WSAS consists of five items that each target one of these aspects.

In a study of individuals being treated for depression and obsessive-compulsive disorder, WSAS scores higher than 20 appeared to indicated more severe dysfunction while scores between 10 and 20 indicated significant functional impairment, but lower symptom severity in the diagnosed disorders; scores below 10 were considered subclinical (Mundt et al., 2002). The WSAS demonstrates strong internal consistency and is sensitive to changes that occur for clients during treatment (Mataix-Cols et al., 2005).

WSAS Factor structure

The most current and commonly used iteration of the WSAS sets out to assess five areas of functioning: work, household management, social activities, private leisure activities, and interpersonal relationships. When compared to other common measures such as the PHQ–9 and GAD-7, the WSAS appears to be a unidimensional measure which targets a distinct social functioning factor, distinguishing the WSAS as a uniquely useful tool alongside other measures assessing varying types of functioning (Zahra et al., 2014). In another study examining the WSAS factor structure, the proposed unidimensional factor structure appeared consistent across varying patient samples including individuals with HIV, inflammatory conditions, and breast cancer (Thandi et al., 2017).

The history and theory behind the WSAS

The earliest form of the WSAS was developed by anxiety and phobia researcher Isaac M. Marks during a 1966 study on behaviour therapy for people with agoraphobia. The scale was adapted from a previous measure developed by Miles, Barrabee and Finesinger, and it assessed six areas of functioning: work, leisure, sex, family, other relationships, and self-satisfaction (Gelder & Marks, 1966). A later iteration of the WSAS published by Marks in 1986 contained four items assessing work functioning, home management, social activities, private leisure activities. The most current and common version of the WSAS contains five items—all of those from the 1986 version, plus an item assessing impairment in interpersonal relationships (Mundt et al., 2002). Whereas many psychometric measures focus on specific symptoms of different psychological conditions, the WSAS sets out to assess how the presence of those symptoms may interfere with the practical aspects of a client’s life.

WSAS Scoring Interpretation

Scoring for the WSAS is calculated via the summation of item scores. The WSAS is scored using a 9-point Likert-type scale ranging from 0 (no impairment) to 8 (severe impairment). Potential scores range from 0 to 40 with higher scores indicating higher levels of impairment in the assessed areas of a respondent’s life. Scores above 20 are associated with more severe dysfunction and severe psychological symptoms while scores between 10 and 20 indicate some impairment, but lower symptom severity; scores below 10 are typically subclinical (Mundt et al., 2002). The WSAS does not diagnose any particular illness—it is a tool to assess how particular conditions may be interfering with a client’s day-to-day life.

Who developed the measure, licensing and how to obtain the WSAS

The most current and common iteration of the WSAS is published in a 2002 study conducted by James C. Mundt, M. Katherine Shear, John M. Greist, and original WSAS author Isaac M. Marks. Since its inception in the 1960’s, the WSAS has evolved to become a five-item scale that assesses the ways in which psychological disorders may interfere with a person’s everyday life.

To use the WSAS free-of-charge for research purposes, please contact Dr. Isaac M. Marks at SSHC, 303 North End Road, London W14 9NS, UK.

The WSAS is available on Bravely Connect as part of our automated measures. 

• See the WSAS on Bravely Connect →

Limitations, biases and when you should/shouldn’t use the WSAS

The WSAS is a self-report measure that assesses the impact of mental health challenges on an individual's ability to perform their daily activities and fulfil their social roles. The WSAS only assesses impairment in five areas of functioning, which may not capture the full range of daily activities that individuals engage in. Other important domains of functioning, such as physical health or spiritual activities, are not covered by the WSAS.

The WSAS also does not provide information about the symptom severity or specific type of mental health problems that participants may be experiencing, making it unsuitable for use as a diagnostic tool. However, it is sensitive to change (Mataix-Cols et al., 2005), suggesting that it may be useful for tracking progress in how a condition is affecting a client’s external life.

Results for the WSAS may also slightly vary among individuals with different diagnoses and among different genders; one study of the WSAS suggests that item 1 assessing job functioning may vary based on diagnosis while item 5 may vary based on sex with women finding that item more difficult to answer than men (Thandi et al., 2017). In terms of cross-cultural applicability, the WSAS has been successfully validated in a German sample of participants with depression (Heissel et al., 2021), a sample of clients at a community mental health unit in Spain (Vázquez Morejón et al., 2021), and a sample of outpatients with common mental health concerns in Hong Kong (Shih et al., 2021). However, much more research is needed in different cultures and in samples with different mental health conditions to assess for widespread cross-cultural applicability.

As with many measures developed and validated in Western cultures, we recommend that the WSAS be used in conjunction with comprehensive clinical assessments taking a client’s unique sociocultural background into consideration.

As always, if you’ve found a measure you would like adding to Bravely Connect as an automated measure, just drop us a measure request here.