Determining disability due to mental impairment: APA's evaluation of Social Security Administration guidelines.

摘要: Objective: APA evaluated the Social Security Administration’s (SSA’s) medical standards and guidelines for determining disability due to mental impairment determine how well operationalize statutory definition of in a manner consistent with current psychiatric practice. Method: Seventy-two psychiatrists were trained one two procedures: those sequential evaluation condition process forms used by SSA ‘s reviewing consultants, ofdisability application clinical judgment according this standard. Decisions regarding claimants’ ability or inability work recorded on an instrument designed study. Each consisted 12 panels three members. They reviewed 732 actual claims benefits. The panelists independently, then rendered panel judgments. claim was each condition. Results: proportion agreement between conditions decisions (0. 77) higher than chance (kappa= 0.46). high level ofagreement judged have good evidence which confident made (proportion ofagreement=O.96, kappa=O.78) suggests that disagreements largely reflected ambiguities ofthe more complex cases inadequate information. Conclusions: SSA’s revised reflect about based statute and, procedural modifications, should be retained. involved further systematic studies develop field scientific inquiry into disorders. (Am JPsychiatry1991; 148:1037-1043)