Reliability and Validity of the Thai Version of the Work and Social Adjustment Scale in Non-Psychotic Psychiatric Outpatients
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Abstract
Objective: To develop and evaluate the reliability, validity, and sensitivity to change of the Thai version of the Work and Social Adjustment Scale (WSAS) in non-psychotic psychiatric outpatients.
Methods: This study used secondary data derived from 159 non-psychotic psychiatric outpatients (age 18 - 65 years) who visited the psychiatric outpatient clinics at Ramathibodi Hospital and Chakri Naruebodindra Medical Institute. The participants completed the WSAS, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and World Health Organization-5 Well-Being Index (WHO-5) at their first visit to the clinics and 6 - 8 weeks later. Internal consistency was assessed using Cronbach’s alpha. Construct validity was assessed using confirmatory factor analysis (CFA). Convergent validity was examined using Spearman’s rank correlations between WSAS and measures of depression (PHQ-9), anxiety (GAD-7), and well-being (WHO-5). Sensitivity to change was evaluated by comparing the changes in WSAS scores between treatment responders, defined as those with ≥50% reduction in PHQ-9 or GAD-7 scores, and non-responders, using the Mann–Whitney U test.
Results: The mean age (standard deviation, SD) of participants was 33.9 (12.8) years. Most were female (73.0%). The WSAS demonstrated excellent internal consistency (Cronbach’s α = 0.897). CFA revealed an excellent fit for a modified one-factor model, allowing correlated errors between Items 3 (social leisure activities) and 5 (close relationship) (χ² (4) = 2.12, p = .714, CFI = 1.000, TLI = 1.010, RMSEA = 0.000 [90% CI: 0.000, 0.089], SRMR = 0.010), and large standardized factor loadings of all 5 items (range: .709 - .838, all ps < .001). The total scores of WSAS were strongly positively correlated with depressive symptoms (PHQ-9: ρ = 0.717, p < .001) and anxiety symptoms (GAD-7: ρ = 0.662, p < .001), and moderately negatively correlated with well-being (WHO-5: ρ = -0.552, p < .001). Assessing sensitivity to changes showed that treatment responders showed greater reductions in WSAS scores from baseline compared with non-responders (p < .001).
Conclusion: The WSAS is a reliable, valid, and clinically sensitive measure of functional impairment in Thai non-psychotic psychiatric outpatients. Its strong psychometric properties and responsiveness to clinical change support its use in routine outcome monitoring and evaluation of treatment-related functional recovery in Thai mental health settings.
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