Examining the Network Structure of Functional Disability As Measured By the 12-Item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) within the Clubhouse Model of Psychosocial Rehabilitation for Serious Mental Illness

Background: The Clubhouse Model (CM) for serious mental illness (SMI) is a recovery-oriented and member-driven program that aims to eliminate social isolation and promote functional improvement. The evidence base of the CM is growing but is limited by inconsistent outcome assessment and lack of knowledge of how domains of functional disability interrelate. Prior psychometric analyses indicate that the 12-item WHODAS 2.0 is a valid and reliable measure within the CM and supports a revised 5-factor structure over the generic 6-factor (Wojtalik et al., 2024). This research now examines the network structure of the 12-item WHODAS 2.0 to elucidate how individual-level items are connected in the presentation of functional disability among CM members.

Methods: This research used the same retrospective administrative dataset as Wojtalik et al., 2024 that includes baseline 12-item WHODAS 2.0 assessments from 339 adults with SMI enrolled at an accredited Clubhouse. The interview-administered version was conducted by trained staff. Items assess degree of functional difficulty in the past 30 days on a 5-point Likert scale (1: no impairment to 5: extreme impairment) across six domains (2 items each) of mobility, life activities, cognition, participation in community, self-care, and getting along with others. The measure demonstrates good reliability in this sample (α = 0.81) with no missing data. Network analysis was conducted in R using the qgraph package to evaluate and depict the partial correlations and centrality among the 12 item nodes.

Results: The sample on average was 47.4 (SD = 15) years old, 43% male, 56% Black/African American, and 49% had a schizophrenia-spectrum diagnosis (22% depressive disorder, 15% bipolar). The network structure was consistent with the previously identified 5-factor model, with items clustering within their expected domains (Wojtalik et al., 2024). The strongest connections were between items 1 (standing for 30 min) and 7 (walking for a long distance) of the mobility domain and items 8 (washing your whole body) and 9 (getting dressed) of the self-care domain. Item 12 (day-to-day work/school) emerged as the most central node, suggesting that day-to-day work has the most direct and indirect influence on the strength of the network as a whole.

Conclusion and Implications: The findings support the revised 5-factor structure of the 12-item WHODAS 2.0 within the CM (Wojtalik et al., 2024). The observed network suggests that day-to-day work is highly interconnected with multiple domains of disability and may represent a central component of functional recovery among individuals with SMI. These findings align with the CM’s intentional community approach and its emphasis on replicating real-world functioning within a safe and supportive environment. Future longitudinal research is needed to examine the impact of the CM on this observed network, with implications for identifying key therapeutic targets of recovery and advancing CM’s recent efforts to establish measurement-based care through patient-identified outcomes.

Wojtalik, J.A., Kotwani, A., Honarvar, R.L., Eack, S.M., D’Angelo, L., Whiting-Madison, C.,

Brown, W.J. (2024). Confirmatory factor analysis of the 12-item WHODAS 2.0 within the Clubhouse Model of psychosocial rehabilitation for serious mental illness. Psychiatric Rehabilitation Journal, 47(3), 229-239. doi: 10.1037/prj0000594