Abstract
The Caldas Psychosocial Disability Scale (known in its original Spanish validation as the Escala de Discapacidad Psicosocial de Caldas) is a specialized psychometric assessment instrument developed in 2023 by Colombian clinical researchers Felipe Agudelo-Hernández, Edison Andrés Romero, and Yudy Quintero-Pulgar. Constructed to address the acute clinical and epidemiological need for standardized functional evaluation tools within Latin America, the instrument evaluates and quantifies psychosocial disability among adult individuals diagnosed with severe mental disorders. Grounded in the conceptual frameworks of the International Classification of Functioning, Disability and Health (ICF) and the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), the scale captures the complex interplay between psychiatric impairments, daily functional limitations, and environmental participation restrictions.
The scale development trajectory began with an initial pool of 74 candidate items subjected to rigorous qualitative and quantitative content analysis by multidisciplinary panels of mental health experts. Content validity was evaluated using Aiken’s V coefficient; two items (Item 57 and Item 73) were dropped due to inadequate coefficient scores, retaining 73 candidate items. Empirical validation was performed on a sample of Colombian psychiatric patients and their primary caregivers across the Department of Caldas. Subsequent exploratory and confirmatory factor analyses isolated a robust 33-item structure distributed across six distinct operational dimensions: Personal and Emotional Disability, Social Disability, Disability in Family Functioning, Occupational/Work Disability, Adherence to Treatment, and Everyday Autonomy/Civic Engagement. All retained items demonstrated factor loadings surpassing 0.50, satisfied structural overdetermination requirements, displayed negligible cross-loadings, and aligned with core theoretical paradigms. The scale uses a dichotomous response format (presence vs. absence of disability indicator). Criterion-related and concurrent validity were confirmed through statistically significant correlations with established instruments, including the Zarit Burden Interview and the World Health Organization Self-Reporting Questionnaire (SRQ-20).
Keywords
psychosocial disability, mental disorders, psychiatric epidemiology, Caldas Psychosocial Disability Scale, functional impairment, social disability, family functioning, occupational disability, treatment adherence, Latin American psychometrics, ICF framework, Zarit Burden Interview
Authors
The scale was developed and psychometrically validated by a collaborative multidisciplinary research team in Caldas, Colombia:
- Felipe Agudelo-Hernández — Universidad de Manizales, Manizales, Caldas, Colombia. Primary investigator and correspondence author. Email: [email protected]. Address: Universidad de Manizales, Carrera 22 #58-21, Manizales, Caldas, Colombia, 170001.
- Edison Andrés Romero — Dirección Territorial de Salud de Caldas (DTSC), Manizales, Caldas, Colombia. Specialist in public mental health systems and community epidemiology. Email: [email protected].
- Yudy Quintero-Pulgar — United States Agency for International Development (USAID) human rights and community health initiative, Colombia. Specialist in social interventions and psychosocial rehabilitation.
Purpose
The primary purpose of the Caldas Psychosocial Disability Scale is to provide a clinically sound, culturally validated, and operationally feasible metric for quantifying the degree of functional limitation and social participation restriction experienced by adults diagnosed with severe and persistent psychiatric conditions. Historically, clinical psychiatry in low- and middle-income countries has relied heavily on symptom-reduction inventories (such as depression rating scales or brief psychiatric symptom checklists) to determine clinical recovery. However, modern psychiatric epidemiology demonstrates that symptomatic remission frequently dissociates from functional recovery; individuals may exhibit reduced acute symptomatology while remaining severely restricted in their interpersonal, occupational, domestic, and community roles.
To overcome this diagnostic gap, the Caldas Psychosocial Disability Scale was constructed to evaluate disability through a biopsychosocial lens. Specifically, the instrument fulfills three distinct clinical and public health purposes:
- Clinical Diagnosis and Treatment Planning: It allows multidisciplinary teams—comprising psychiatrists, clinical psychologists, psychiatric nurses, and social workers—to map specific domains where psychiatric illness inhibits real-world adaptation. Pinpointing whether an individual experiences primary impairment in occupational productivity, family communication, or self-care directly informs personalized psychosocial rehabilitation programs.
- Caregiver and Dyadic Verification: In recognition of the profound caregiver burden associated with chronic psychiatric illness, the validation process incorporated both patients and their primary caregivers. This dual-perspective approach establishes an objective metric that accounts for functional deficits that patients with limited insight or acute cognitive disorganization may underreport.
- Public Health and Disability Certification: Under statutory legal mandates derived from the UNCRPD, states are required to certify psychosocial disability to grant social protection benefits, workplace accommodations, and community-based support services. The scale provides state institutions, such as the Dirección Territorial de Salud de Caldas and national disability certification boards, with an empirical, standardized inventory tailored to the socioeconomic and cultural realities of Latin American populations.
Psychological Construct
The central psychological construct operationalized by this measurement tool is Psychosocial Disability (discapacidad psicosocial). Psychosocial disability does not refer merely to the presence of a formal Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or International Classification of Diseases (ICD-11) psychiatric diagnosis. Rather, it represents the persistent restriction in an individual’s capacity to execute everyday activities, maintain reciprocal interpersonal relationships, fulfill productive social roles, and participate equally in society, arising from the dynamic transaction between long-term psychological impairments and environmental barriers.
Through empirical factor extraction, this overarching construct is partitioned into six distinct, intercorrelated dimensions:
- 1. Personal and Emotional Disability: This dimension assesses internal functional disruption, characterized by severe emotional dysregulation, chronic subjective distress, diminished self-efficacy, and the inability to manage basic personal routines independently. It captures the psychological paralysis that prevents individuals from initiating goal-directed behaviors or coping with everyday stressors.
- 2. Social Disability: Reflecting the interpersonal domain, this factor evaluates profound barriers in establishing, navigating, and sustaining social networks outside the home. It encompasses social withdrawal, avoidance of communal spaces, conversational deficits, feelings of alienation, and the impact of public stigma that causes the individual to detach from community life.
- 3. Disability in Family Functioning: Chronic psychiatric disorders invariably perturb systemic family ecology. This subscale measures communicative breakdown, role reversal, domestic conflict, withdrawal from household responsibilities, and emotional strain within the immediate nuclear or extended family constellation.
- 4. Occupational and Work Disability: This dimension gauges vocational and economic functioning. It measures the extent to which psychiatric morbidity compromises the ability to obtain, maintain, or productively engage in formal employment, informal income generation, educational advancement, or structured daily labor.
- 5. Adherence to Treatment: Unique to this psychosocial disability inventory, this dimension captures functional compliance with prescribed psychotherapeutic, psychosocial, and pharmacological interventions. It evaluates non-adherence behaviors, missed medical appointments, resistance to support networks, and ambivalence toward sustained psychiatric recovery pathways.
- 6. Everyday Autonomy and Civic Engagement: This factor measures higher-order community living skills, including independent mobility, civic participation, financial management, navigation of public administrative systems, and execution of legal rights as autonomous citizens.
Theoretical Framework
The structural and conceptual architecture of the Caldas Psychosocial Disability Scale is anchored in the convergence of two foundational theoretical paradigms: George Engel’s Biopsychosocial Model and the World Health Organization’s International Classification of Functioning, Disability and Health (ICF), integrated with the rights-based philosophy of the Social Model of Disability.
Engel (1977) posited that biomedical reductionism fails to account for the holistic reality of medical illnesses, asserting that somatic or neurobiological alterations are invariably mediated by individual cognitive-affective processes and embedded within complex sociocultural systems. The Caldas instrument operationalizes this holistic premise by moving beyond neurochemical and symptomatic markers of psychiatric disorder to evaluate how psychiatric vulnerability manifests in real-world sociological contexts.
Concurrently, the scale directly translates the WHO ICF framework into operational psychometric indicators. Under the ICF schema, human functioning is conceptualized across three interconnected levels: Body Functions and Structures (physiological and psychological functions), Activities (the execution of tasks by an individual), and Participation (involvement in life situations). Psychosocial disability specifically materializes as activity limitations and participation restrictions. Rather than attributing functional incapacity solely to intrapsychic pathology, the scale conceptualizes disability as an emergent property generated when an individual with psychological differences encounters structural, cultural, and environmental barriers.
Furthermore, the scale incorporates the social justice perspective articulated by the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD, 2006). The UNCRPD framework recognizes individuals with long-term mental impairments as persons with psychosocial disabilities who possess an inalienable right to full community inclusion, legal capacity, and social participation. Consequently, the Caldas scale evaluates the systematic erosion of social citizenship and autonomous functioning, positioning the resulting psychometric profile not as a measure of biological defect, but as an index of unmet support needs in the patient’s immediate ecosystem.
Validity
The psychometric development of the Caldas Psychosocial Disability Scale followed a multi-stage empirical validation process to confirm content, construct, and concurrent validity:
Content Validity
Initial item generation yielded 74 preliminary quantitative items capturing manifestations of psychosocial disability across varied daily domains. These items were submitted to independent expert evaluation panels consisting of clinical psychiatrists, psychometricians, psychiatric social workers, and clinical psychologists. Experts reviewed each item for semantic clarity, cultural resonance within the Colombian context, theoretical relevance, and domain representation.
Quantitative content validity was evaluated using Aiken’s V coefficient. A rigorous statistical cutoff was established: items were retained only if their Aiken’s V score was statistically significantly greater than 0.80. Following this evaluation, two items—Item 57 and Item 73—demonstrated inadequate Aiken’s V coefficients below the acceptable threshold and were eliminated due to ambiguity and content redundancy. The remaining 73 items exhibited high consensus values (V > .80), validating content coverage across all target domains.
Concurrent and Criterion-Related Validity
Concurrent validity was established by administering the scale alongside independent, standardized, and internationally validated psychometric instruments in a clinical sample of psychiatric patients and their caregivers:
- Correlation with Zarit Caregiver Burden Scale: The Zarit Burden Interview (adapted for Spanish-speaking populations by Rodríguez et al., 2016) was administered to primary caregivers. Bivariate correlation analyses revealed strong, statistically significant positive correlations between the Zarit total burden score and the Caldas scale domains of Disability in Family Functioning and Social Disability. This empirically confirms that elevated disability scores in familial and social realms directly correlate with the objective and subjective strain experienced by familial caregivers.
- Correlation with the Self-Reporting Questionnaire (SRQ-20): Developed by the World Health Organization (Beusenberg & Orley, 1994) to screen for non-psychotic and common mental disorders, the SRQ-20 was administered to patient cohorts. Significant positive correlations were found between high SRQ-20 emotional distress scores and the Caldas Personal and Emotional Disability dimension, confirming that subjective neurotic distress and emotional symptomatology converge with measured psychosocial functional limitation.
Reliability
In classical test theory and psychiatric item analysis, the evaluation of scales utilizing dichotomous response structures requires specific estimation procedures. While the preliminary 2023 validation report prioritized content validity coefficients (Aiken’s V) and structural factor extraction, standard measurement indices for dichotomous instruments—such as the Kuder-Richardson Formula 20 (KR-20) and composite reliability coefficients (Cronbach’s alpha adapted for binary indicators)—were systematically applied across the retained 33 items.
The stringent factor selection protocol—which required all retained items to exhibit primary factor loadings greater than 0.50 without cross-loadings—ensured high latent internal consistency across each of the six identified dimensions. By eliminating items with low discriminative capacity during the reduction from 73 to 33 items, the authors minimized measurement error variance and established strong internal consistency across the final subscales.
Furthermore, because the scale is designed for parallel or collaborative completion by patients and primary caregivers, inter-rater concordance serves as a critical reliability dimension. The alignment of caregiver reporting with patient performance metrics across the family and occupational subscales provides a high degree of inter-informant stability, minimizing common rater biases such as social desirability and selective memory recall.
Factor Analysis
The empirical transition from the preliminary 73-item pool to the finalized 33-item scale was achieved through rigorous exploratory and confirmatory factor analysis techniques tailored for categorical/dichotomous data:
The factor extraction process utilized robust estimation methods appropriate for binary item correlation matrices (such as tetrachoric correlation estimation). Factor retention was strictly governed by four pre-established criteria:
- Magnitude of Factor Loadings: Every candidate item was required to demonstrate a primary factor loading exceeding λ > 0.50 on its designated latent dimension. Items with loadings below this threshold were systematically eliminated to ensure that each indicator explained a substantial proportion of shared variance.
- Absence of Substantial Cross-Loadings: Items exhibiting secondary cross-loadings greater than 0.30 on competing factors were excised, ensuring strong discriminant validity among the latent dimensions.
- Overdetermination of Factors: In alignment with standard structural equation modeling guidelines, each factor was required to be overdetermined by retaining a sufficient cluster of highly loading indicators (at least 3 to 6 items per factor), preventing weak or unstable factor identification.
- Theoretical Coherence: Statistically clustering items had to display rigorous conceptual alignment with established psychiatric rehabilitation and ICF functional definitions.
Application of these strict psychometric criteria led to the elimination of 40 redundant or weakly loading items, distilling the instrument into a clean, 33-item structure grouped into six stable factors. The resulting six-factor configuration accounted for a substantial proportion of the total explained variance, demonstrating construct validity and structural parsimony.
Instrument / Measurement Tool
- Test Type: Standardized Clinical Questionnaire / Psychosocial Functional Assessment Inventory.
- Original Language: Spanish (Escala de Discapacidad Psicosocial de Caldas).
- Construct Assessed: Psychosocial Disability across multi-systemic domains.
- Administration Format: Paper-and-pencil questionnaire, structured clinical interview, or clinical hetero-applied inventory administered to patients and/or primary caregivers.
- Target Population: Adult individuals (aged 18 years and older) diagnosed with psychiatric or mental disorders, and their family caregivers.
- Item Count: 33 finalized items (distilled from an initial 74-item draft).
- Number of Subscales: 6 dimensions:
- Personal and Emotional Disability
- Social Disability
- Disability in Family Functioning
- Occupational and Work Disability
- Adherence to Treatment
- Everyday Autonomy and Civic Engagement
- Response Scale: Dichotomous format (e.g., 0 = Absence of impairment / No, 1 = Presence of disability indicator / Yes).
- Scoring and Interpretation: Subscale scores are derived by summing affirmative responses within each domain. Higher cumulative scores reflect greater functional impairment and more severe participation restrictions. A total global score can be calculated to indicate overall psychosocial disability severity for clinical stratification and social support authorization.
- Administration Time: Approximately 15 to 20 minutes.
Permissions & Fee and Test Year
Test Publication Year: 2023.
Commercial Fee: The Caldas Psychosocial Disability Scale is non-commercial. It was developed through academic and public health funding provided by the Universidad de Manizales and the Dirección Territorial de Salud de Caldas to strengthen mental health assessment in Colombia. There are no licensing fees for non-profit clinical practice, public health monitoring, or academic research.
Permissions and User Access: While non-commercial, the instrument and its specific item formulations are copyrighted by the original authors and the publishing journal. Researchers and clinicians wishing to implement the scale, adapt it cross-culturally, or integrate it into institutional protocols should request formal permission from the corresponding author, Dr. Felipe Agudelo-Hernández, at the Universidad de Manizales ([email protected]).
References
- Agudelo-Hernández, F., Romero, E. A., & Quintero-Pulgar, Y. (2023). Diseño y validez de un instrumento para determinar discapacidad psicosocial asociada a trastornos mentales. Revista Iberoamericana de Diagnóstico y Evaluación Psicológica, 69(3), 161–171. https://doi.org/10.21865/RIDEP69.3.14
- Beusenberg, M., & Orley, J. (1994). A user’s guide to the Self Reporting Questionnaire (SRQ). World Health Organization. https://apps.who.int/iris/handle/10665/61113
- Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136. https://doi.org/10.1126/science.847460
- Rodríguez, A., Crespo, M., & Olazarán, J. (2016). Adaptación española de la escala de sobrecarga del cuidador de Zarit: Guía para su uso e interpretación. Instituto de Salud Carlos III.
- United Nations. (2006). Convention on the Rights of Persons with Disabilities (CRPD). United Nations Treaty Series, 2515, 3. https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html
- World Health Organization. (2001). International Classification of Functioning, Disability and Health: ICF. World Health Organization. https://apps.who.int/iris/handle/10665/42407
Items of the Scale
The complete, official 33-item inventory of the Escala de Discapacidad Psicosocial de Caldas is protected by academic copyright and is not reproduced in the open public domain. Clinicians and researchers must obtain the complete verbatim Spanish questionnaire directly from the original published study (Agudelo-Hernández, Romero, & Quintero-Pulgar, 2023, Table 1, pages 164–165) or via correspondence with the lead author.
To assist clinical evaluators in understanding the operational format of the test, the 33 items are distributed across the six validated psychometric factors using a standardized dichotomous response system:
Response Format
Every item is presented as an objective behavioral or functional statement evaluated over the preceding 30 days, scored using a two-point binary scale:
- 0 = No / Ausente (Indicator absent; no significant functional disability in this task)
- 1 = Sí / Presente (Indicator present; verified functional limitation or barrier observed)
Structural Dimension Distribution
The 33 items systematically assess functional performance across six operational dimensions:
- Personal and Emotional Disability Domain (Items assessing internal self-regulation and individual autonomy):
- Evaluates severe motivational inhibition and apathy toward personal goals.
- Assesses chronic emotional dysregulation interfering with self-care routines.
- Measures subjective feelings of helplessness in organizing immediate personal environments.
- Social Disability Domain (Items assessing interpersonal networks and community interaction):
- Evaluates social isolation and avoidance of informal or public social gatherings.
- Measures difficulty initiating or maintaining reciprocal conversations with non-family members.
- Assesses feelings of discomfort, alienation, or perceived rejection in community spaces.
- Disability in Family Functioning Domain (Items assessing systemic domestic relationships):
- Assesses verbal conflict, tension, or communication breakdown with household members.
- Measures disengagement from domestic chores, shared duties, and family responsibilities.
- Evaluates emotional detachment from close family members and dependence on primary caregivers.
- Occupational and Work Disability Domain (Items assessing vocational functioning):
- Assesses inability to maintain structured work schedules or complete work-related tasks.
- Measures job termination, absenteeism, or abandonment of productive vocational activities.
- Evaluates severe performance drop-offs attributable to cognitive fatigue or psychiatric symptoms.
- Adherence to Treatment Domain (Items assessing clinical compliance and self-management):
- Assesses inconsistent adherence to or abandonment of prescribed psychotropic medication.
- Evaluates refusal to attend scheduled psychiatric, psychological, or psychosocial appointments.
- Measures active resistance toward therapeutic recommendations from mental health professionals.
- Everyday Autonomy and Civic Engagement Domain (Items assessing community life skills):
- Assesses difficulty managing personal finances, budgeting, or handling money independently.
- Measures inability to independently utilize public transportation or navigate municipal environments.
- Evaluates barriers to exercising legal rights, obtaining public documentation, or accessing social benefits.
To access the exact wording of all 33 items, consult Table 1 (pp. 164–165) in the original journal article by Agudelo-Hernández, Romero, and Quintero-Pulgar (2023).