Skip to main content
SpringerLink
Log in

The 36-Item Short Form Health Survey (SF-36) and Work Productivity and the Impairment (WPAI) Questionnaire in Panic Disorder

  • Original Research Article
  • Published:
Disease Management & Health Outcomes

Summary

Available evidence suggests that panic disorder causes severe degradation in quality of life and work productivity (WP). There is growing interest in evaluating pharmacotherapy in panic disorder, but its effects on quality of life or WP have not been assessed, perhaps because appropriate scales have not been validated specifically in panic disorder.

This study examines the internal consistency, test/retest reliability, construct validity and responsiveness of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Work Productivity and Activity Impairment (WPAI) questionnaire when used in panic disorder. Clinical evaluations were performed at baseline and at weeks 4 and 8. Patients self-administered the SF-36 and WPAI at weeks 4 and 8.

The SF-36 performed well in terms of internal consistency and test/retest reliability, with the exception of the ‘role limits due to emotional health’ scale. For the other scales, Cronbach’s α ≥ 0.83 and correlations between week 4 and 8 scores were significant (p < 0.01) for patients with a stable clinical condition. There were no significant differences in mean SF-36 scores obtained at weeks 4 and 8 for stable patients. Construct validity was also supported. As hypothesised, we detected significant correlations between the SF-36 Mental Health Component Summary (MCS) and clinical measures of disease severity. Evidence of responsiveness was also obtained: patients with fewer panic attacks during the second month of follow-up improved on the MCS, while those with a stable or increased frequency of panic attacks did not (8 point versus 1 point improvement, p < 0.01).

The WPAI did not perform as well, perhaps due to a combination of limited sample size and high variability in WPAI scores. Only 44 of 77 individuals were employed at baseline and completed WPAI items. The standard deviation for the measure ‘overall work productivity’ was more than half the mean score. Neither test/retest reliability nor construct validity were demonstrated. Although WPAI scores improved for patients showing clinical improvement, this result is incongruous with the lack of evidence supporting its validity.

The SF-36 is a valid, reliable and responsive measure of QOL in panic disorder. It is unclear whether the WPAI possesses these properties when used in panic disorder.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Marks IM. Fears and phobias. London: Heinemann, 1969

    Google Scholar 

  2. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry 1994; 51: 8–19

    Article  PubMed  CAS  Google Scholar 

  3. Ormel J, VonKorff M, Ustun TB, et al. Common mental disorders and disability across cultures. JAMA 1994; 272: 1841–8

    Article  Google Scholar 

  4. Markowitz JS, Weissman MM, Ouellette R, et al. Quality of life in panic disorder. Arch Gen Psychiatry 1989; 46: 984–92

    Article  PubMed  CAS  Google Scholar 

  5. Edlund MJ, Swann AC. The economic and social costs of panic disorder. Hosp Community Psychiatry 1987; 38: 1277–9, 1288

    PubMed  CAS  Google Scholar 

  6. Taylor CB, King R, Margraf J, et al. Use of medication and in vivo exposure in volunteers for panic disorder research. Am J Psychiatry 1989; 146: 1423–6

    PubMed  CAS  Google Scholar 

  7. Coryell W, Noyes R, Clancy J. Excess mortality in panic disorder. A comparison with primary unipolar depression. Arch Gen Psychiatry 1982; 39: 701–3

    Article  PubMed  CAS  Google Scholar 

  8. Weissman MM, Klerman GL, Markowitz JS, et al. Suicidal ideation and suicide attempts in panic disorder and attacks. N Engl J Med 1989; 321: 1209–14

    Article  PubMed  CAS  Google Scholar 

  9. Allgulander C, Lavori PW. Excess mortality among 3302 patients with ‘pure’ anxiety neurosis. Arch Gen Psychiatry 1991; 48: 599–602

    Article  PubMed  CAS  Google Scholar 

  10. Hornig CD, McNally RJ. Panic disorder and suicide attempt: a reanalysis of data from the Epidemiologic Catchment Area Study. Br J Psychiatry 1995; 167: 76–9

    Article  PubMed  CAS  Google Scholar 

  11. Hollander E, Simeon D, Gorman JM. Anxiety disorders. In: Hales RE, Yudofsky SC, Talbott JA, editors. The American psychiatric press textbook of psychiatry. Washington, DC: American Psychiatric Press, 1994

    Google Scholar 

  12. Sherbourne CD, Wells KB, Judd LL. Functioning and well-being of patients with panic disorder. Am J Psychiatry 1996; 153: 213–8

    PubMed  CAS  Google Scholar 

  13. Spitzer RL, Kroenke K, Linzer M, et al. Health-related quality of life in primary care patients with mental disorders. JAMA 1995; 274: 1511–7

    Article  PubMed  CAS  Google Scholar 

  14. Tesar GE, Rosenbaum JE. Successful use of clonazepam in patients with treatment-resistant panic disorder. J Nerv Ment Dis 1986; 174: 477–82

    Article  PubMed  CAS  Google Scholar 

  15. Spier SA, Tesar GE, Rosenbaum JF, et al. Treatment of panic disorder and agoraphobia with clonazepam. J Clin Psychiatry 1986; 47: 238–42

    PubMed  CAS  Google Scholar 

  16. Liebowitz MR, Fyer AJ, Gorman JM, et al. Alprazolam in the treatment of panic disorders. J Clin Psychopharmacol 1986; 6: 13–20

    Article  PubMed  CAS  Google Scholar 

  17. Dunner DL, Ishiki D, Avery DH, et al. Effect of alprazolam and diazepam on anxiety and panic attacks in panic disorder: a controlled study. J Clin Psychiatry 1986; 47: 458–60

    PubMed  CAS  Google Scholar 

  18. Pyke RE, Greenberg HS. Double-blind comparison of alprazolam and adinazolam for panic and phobic disorders. J Clin Psychopharmacol 1989; 9: 15–21

    Article  PubMed  CAS  Google Scholar 

  19. Sheehan DV, Raj AB, Harnett-Sheehan K, et al. The relative efficacy of high-dose buspirone and alprazolam in the treatment of panic disorder: a double-blind placebo-controlled study. Acta Psychiatr Scand 1993; 88: 1–11

    Article  PubMed  CAS  Google Scholar 

  20. Wilkinson G, Balestrieri M, Ruggeri M, et al. Meta-analysis of double-blind placebo-controlled trials of antidepressants and benzodiazepines for patients with panic disorders. Psychol Med 1991; 21: 991–8

    Article  PubMed  CAS  Google Scholar 

  21. Rizley R, Kahn RJ, McNair DM, et al. A comparison of alprazolam and imipramine in the treatment of agoraphobia and panic disorder. Psychopharmacol Bull 1986; 22: 167–72

    PubMed  CAS  Google Scholar 

  22. Klerman GL. Treatments for panic disorder. J Clin Psychiatry 1992; 53 Suppl.: 14–9

    PubMed  Google Scholar 

  23. Sheehan DV. Monoamine oxidase inhibitors and alprazolam in the treatment of panic disorder and agoraphobia. Psychiatr Clin North Am 1985; 8: 49–62

    PubMed  CAS  Google Scholar 

  24. Tiffon L, Coplan JD, Papp LA, et al. Augmentation strategies with tricyclic or fluoxetine treatment in seven partially responsive panic disorder patients. J Clin Psychiatry 1994; 55: 66–9

    PubMed  CAS  Google Scholar 

  25. Gorman JM, Liebowitz MR, Fyer AJ, et al. An open trial of fluoxetine in the treatment of panic attacks. J Clin Psychopharmacol 1987; 7: 329–32

    Article  PubMed  CAS  Google Scholar 

  26. Schneier FR, Liebowitz MR, Davies SO, et al. Fluoxetine in panic disorder. J Clin Psychopharmacol 1990; 10: 119–21

    Article  PubMed  CAS  Google Scholar 

  27. Leonard BE. The comparative pharmacology of new antidepressants. J Clin Psychiatry 1993; 54 Suppl.: 3–15

    PubMed  Google Scholar 

  28. Louie AK, Lewis TB, Lannon RA. Use of low-dose fluoxetine in major depression and panic disorder. J Clin Psychiatry 1993; 54: 435–8

    PubMed  CAS  Google Scholar 

  29. Shear MK, Maser JD. Standardized assessment for panic disorder research. A conference report. Arch Gen Psychiatry 1994; 51: 346–54

    Article  PubMed  CAS  Google Scholar 

  30. Ware JE, Sherbourne CD. The MOS 36-item short form health survey (SF-36): I. Conceptual framework and item selection. Med Care 1992; 30: 473–83

    Article  PubMed  Google Scholar 

  31. McHorney CA, Ware JE, Raczek AE. The MOS 36-item short form health survey: II. Psychometric and clinical tests of validity in measuring physical and mental constructs. Med Care 1993; 31: 247–63

    Article  PubMed  CAS  Google Scholar 

  32. Brazier JE, Harper R, Jones NM, et al. Validating the SF-36 health questionnaire: new outcome measure for primary care. BMJ 1992; 305: 160–4

    Article  PubMed  CAS  Google Scholar 

  33. McHorney CA, Ware JE, Rogers W, et al. The validity and relative precision of MOS short- and long-form health scales and Dartmouth COOP charts. Results from the medical outcomes study. Med Care 1992; 30 Suppl.: MS253–65

    Article  PubMed  CAS  Google Scholar 

  34. Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and impairment instrument. Pharmacoeconomics 1993; 4: 353–65

    Article  PubMed  CAS  Google Scholar 

  35. Ware JE. SF-36 Health Survey: manual and interpretation guide. Boston (MA): The Health Institute, 1993

    Google Scholar 

  36. Ware JE. SF-36 Physical and Mental Health Summary Scales: a user’s manual. Boston (MA): The Health Institute, 1994

    Google Scholar 

  37. Kazis LE, Andersen JJ, Meenan RF. Effect sizes for interpreting changes in health status. Med Care 1989; S178–89

    Google Scholar 

  38. Cohen T. Statistics in medicine. Boston (MA): Little Brown & Co. Inc., 1974

    Google Scholar 

  39. Helmstadter CG, Principles of psychological measurement. New York (NY): Appleton-Century-Croft, Inc., 1964

    Google Scholar 

  40. Stephens MA. EDF statistics for goodness of fit and some comparisons. J Am Stat Assoc 1974; 69: 730–7

    Article  Google Scholar 

  41. Miller Jr RG, Simultaneous statistical inference. New York (NY): McGraw-Hill, 1960

    Google Scholar 

  42. Stewart AL, Greenfield S, Hays RD, et al. Functional status and well-being of patients with chronic conditions: results from the Medical Outcomes Study. JAMA 1989; 262: 907–13

    Article  PubMed  CAS  Google Scholar 

  43. Gelberg L, Linn LS. Psychological distress among homeless adults. J Nerv Ment Dis 1989; 177: 291–5

    Article  PubMed  CAS  Google Scholar 

  44. Cleary PD, Epstein AM, Oster G, et al. Health-related quality of life among patients undergoing percutaneous transluminal coronary angioplasty. Med Care 1991; 29: 939–50

    Article  PubMed  CAS  Google Scholar 

  45. Wu AW, Rubin HR, Mathews WC, et al. A health status questionnaire using 30 items from the Medical Outcomes Study: preliminary validation in persons with HIV infection. Med Care 1991; 29: 786–98

    Article  PubMed  CAS  Google Scholar 

  46. Katz JN, Larson MG, Phillips CB, et al. Comparative measurement sensitivity of short and longer health status instruments. Med Care 1992; 30: 917–25

    Article  PubMed  CAS  Google Scholar 

  47. Kurtin PS, Davies AR, Meyer KB, et al. Patient-based health status measures in outpatient dialysis: early experiences in developing an outcomes assessment program. Med Care 1992; 30 Suppl.: MS136–49

    Article  PubMed  CAS  Google Scholar 

  48. Wachtel T, Piette J, Mor V, et al. Quality of life in persons with human immunodeficiency virus infection: measurement by the Medical Outcomes Study instrument. Ann Intern Med 1992; 116: 129–37

    PubMed  CAS  Google Scholar 

  49. Jenkinson C, Coulter A, Wright L. The Short Form 36 (SF-36) Health Survey Questionnaire: normative data for adults of working age. BMJ 1993; 306: 1437–40

    Article  PubMed  CAS  Google Scholar 

  50. Garratt AM, Ruta DA, Abdalla MI, et al. The SF-36 Health Profile: An outcome measure suitable for routine use within the NHS? BMJ 1993; 306: 1440–4

    Article  PubMed  CAS  Google Scholar 

  51. McHorney CA, Ware JE, Lu JFR, et al. The MOS 36-Item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 1994; 32: 40–66

    Article  PubMed  CAS  Google Scholar 

  52. McHorney CA, Kosinski M, Ware JE. Comparison of the costs and quality of norms for the SF-36 survey by mail versus telephone interview: results from a national survey. Med Care 1994; 32: 551–67

    Article  PubMed  CAS  Google Scholar 

  53. Thalji L, Haggerty CC, Rubin R, et al. 1990 Survey of Functional Health Status: final report. Chicago (IL): National Opinion Research Center, 1991

    Google Scholar 

  54. Nerenz DR, Repasky DP, Whitehouse FW, et al. Ongoing assessment of health status in patients with diabetes mellitus. Med Care 1992; 30 Suppl.: MS112–24

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Cambridge Hospital, Boston, Massachusetts, USA

    John T. Chirban

  2. Capitol Outcomes Research Inc., Fairfax, Virginia, USA

    R. Jake Jacobs & Allen S. Meyerhoff

  3. Active Psychotherapeutics, Menlo Park, California, USA

    Jerry Warren

  4. Panic, Anxiety & Depression Center of Virginia, Richmond, Virginia, USA

    Prakash Ettigi

  5. Private Practice, Tucson, Arizona, USA

    Martin E. Sodomsky

  6. Private Practice, Reno, Nevada, USA

    Jack F. Clarke

  7. Private Practice, Chapel Hill, North Carolina, USA

    R. Reid Wilson

  8. Behavioural Consultants, St Louis, Missouri, USA

    Monica Frank

  9. Anxiety and Phobia Treatment Center, St Louis, Missouri, USA

    Y. M. Abramson

Authors
  1. John T. Chirban
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Jake Jacobs
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jerry Warren
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Prakash Ettigi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Martin E. Sodomsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jack F. Clarke
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Allen S. Meyerhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. R. Reid Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Monica Frank
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Y. M. Abramson
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Mr Jacobs serves as Research Director for Capitol Outcomes Research, Inc., a Washington, DC based contract research organisation specialising in health economics and quality of life studies. He is the author of more than 20 peer review articles on technology assessment, medication compliance and cost of illness. His current research interests include mental health issues and organ transplantation.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chirban, J.T., Jacobs, R.J., Warren, J. et al. The 36-Item Short Form Health Survey (SF-36) and Work Productivity and the Impairment (WPAI) Questionnaire in Panic Disorder. Dis Manage Health Outcomes 1, 154–164 (1997). https://doi.org/10.2165/00115677-199701030-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-199701030-00005

Search

Navigation