From the Research
To apply the Sheehan Disability Scale to a patient, first explain that it's a brief self-report tool measuring functional impairment across three domains: work/school, social life, and family life/home responsibilities. Give the patient the form where they'll rate each domain on a 0-10 scale (0 = not at all impaired, 10 = extremely impaired) 1. The scale uses visual-spatial anchors with interlocking circles to help patients conceptualize their impairment levels. Ask them to consider how their symptoms have disrupted each area over the past month and mark their ratings accordingly. Once completed, add the three domain scores for a total score ranging from 0-30, with higher scores indicating greater functional impairment. Clinically significant impairment is typically indicated by scores of 5 or higher in any domain, as suggested by studies assessing treatment effects and responsiveness of the SDS 2, 3. The scale takes only 1-2 minutes to complete and can be administered at initial assessment and follow-up visits to track treatment progress. This tool is valuable because functional impairment often persists even after symptom improvement, providing a more comprehensive view of recovery than symptom measures alone 4, 5. Some studies have also suggested that a cut-off point of 8 in the SDS adequately discriminates between patients with and without depression 4, and scores of 4 or more on all 3 subscales indicate sufficient impairment for a strict diagnosis of major depressive disorder 5. However, the most recent and highest quality study should be prioritized, which in this case is the 2014 study 1 that validated the Persian version of the SDS, showing good internal consistency and known group validity. Therefore, the Sheehan Disability Scale should be applied by following the standardized procedure and interpreting the results based on the most recent and highest quality evidence.
Some key points to consider when applying the Sheehan Disability Scale include:
- The scale is a brief self-report tool that measures functional impairment across three domains
- The patient rates each domain on a 0-10 scale, with higher scores indicating greater functional impairment
- Clinically significant impairment is typically indicated by scores of 5 or higher in any domain
- The scale can be administered at initial assessment and follow-up visits to track treatment progress
- The tool is valuable because functional impairment often persists even after symptom improvement, providing a more comprehensive view of recovery than symptom measures alone.
Overall, the Sheehan Disability Scale is a useful tool for assessing functional impairment in patients, and its application should be based on the most recent and highest quality evidence.