Assessing functional impairment in university students seeking psychological help: a psychometric study of the Portuguese Work and Social Adjustment Scale

Sofia Caetano, Marisa Marques, Ana Carvalhal de Melo, Andreia Ferreira, Sandra Xavier, António Queirós, Maria João Martins


Background: It has been advocated that higher education settings should promote a supportive environment devoted to improving several dimensions of the well-being of their communities. Assessing functional impairment is of utmost importance, particularly in clinical services.

Goals: The present study aimed at analyzing factor structure and psychometric properties of the Work and Social Adjustment Scale (WSAS), a 5-item scale developed to assess the patient’s perceived functional impairment resulting from a health problem in five dimensions: work, social leisure activities, private leisure activities, and relationships with others.

Methods: A non-probabilistic sample of university students who sought mental health support answered a set of self-report questionnaires, including the WSAS and measures of anxiety, depression, and quality of life.

Results: Overall, 207 university students participated in the study (22 years old of mean age; 74,9% female and 69,2% undergraduate). Confirmatory factor analysis indicated an adequate fit to the single-factor structure, and the scale presented very good reliability. Concurrent, convergent, and incremental validity were also found, and the WSAS differentiated groups with different levels of anxiety and depressive symptoms.

Discussion: Overall, our results corroborate that WSAS is a brief, reliable, and valid measure, and, therefore, useful in research and clinical settings. Further research is needed, particularly regarding temporal stability, discriminative power between clinical and nonclinical populations, and clinical samples between different diagnoses.


Psychosocial adjustment; Psychometric properties; Factor analysis; University community

Full Text:

View article


Cella, M., Sharpe, M., & Chalder, T. (2011). Measuring Disability in Patients with Chronic Fatigue Syndrome: Reliability and Validity of the Work and Social Adjustment Scale. Journal of Psychosomatic Research, 71 (3), 124-128.

Cohen J. (1988). Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates.

Echezarraga, A., Calvete, E., & Hayas, C. (2018). Validation of the Spanish Version of the Work and Social Adjustment Scale in a Sample of Individuals With Bipolar Disorder. Journal of Psychosocial Nursing and Mental Health Service, 57 (5).

Ferreira, T., Sousa, M., & Salgado, J. (2018). Brief assessment of depression: Psychometric properties of the Portuguese version of the Patient Health Questionnaire (PHQ-9). The Psychologist: Practice & Research Journal 1(2).

Field, A. (2013). Discovering Statistics Using IBM SPSS Statistics: And Sex and Drugs and Rock “N” Roll. Los Angeles: Sage.

Hair, J., Anderson, R., Tatham, R. and Black, W. (1998) Multivariate data analysis (5th ed.). Prentice Hall.

Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariate data analysis (7th ed.). Prentice-Hall.

Husted, J. A., Cook, R. J., Farewell, V. T., & Gladman, D. (2000). Methods for Assessing Responsiveness: A Critical Review and Recommendations. Journal of Clinical Epidemiology, 53 (5). 459–468.

Jassi, A., Lenhard, F., Krebs, G., Gumpert, M., Jolstedt, M., Andrén, P., Nord, M., et al. (2020). The work and social adjustment scale, youth and parent versions: psychometric evaluation of a brief measure of functional impairment in young people. Child Psychiatry & Human Development, 1-8.

Kenny, D. A., Kaniskan, B., & McCoach, D. B. (2015). The Performance of RMSEA in Models with Small Degrees of Freedom. Sociological Methods & Research, 44 (3), 486–507.

Korkmaz, S., Goksuluk, D., & Zararsiz, G. (2014). MVN: An R Package for Assessing Multivariate Normality. The R Journal, 6 (2), 151–162.

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a Brief Depression Severity Measure. Journal of General Internal Medicine, 16 (9), 606–613.

Leamy, M., Bird, V., Le Boutillier, C., Williams, J., & Slade, M. (2011). Conceptual framework for personal recovery in mental health: Systematic review and narrative synthesis. British Journal of Psychiatry, 199(6), 445-52.

Lervik, L. V., Knapstad, M., & Smith, O. (2020). Process Evaluation of Prompt Mental Health Care (PMHC): The Norwegian Version of Improving Access to Psychological Therapies. BMC Health Services Research, 20 (1), 437.

Lipson, S., Lattie, E., & Eisenberg, D. (2019). Increased Rates of Mental Health Service Utilization by U.S. College Students: 10-Year Population-Level Trends (2007-2017). Psychiatry Services, 70(1):60.

Marks, I. (1986). The Work and Social Adjustment Scale. In Behavioural Psychotherapy, Bristol: John Wright.

Mataix-Cols, D., Cowley, A., Hankins, M., Schneider, A., Bachofen, M., Kenwright, M., Gega, L., Cameron, R., & Marks, I. (2005). Reliability and Validity of the Work and Social Adjustment Scale in Phobic Disorders. Comprehensive Psychiatry, 46. 223-228.

Monteiro, S., Bártolo, A., Torres, A., Pereira, A., & Albuquerque, E. (2019). Examinando a Validade de Construto da Versão Portuguesa do Patient Health Questionnaire-9 Entre Estudantes Universitários. PSICOLOGIA, 33 (2), 1–8.

Mundt, J.C., Marks, I.M., Shear, M.K., & Greist, J.H. (2002). The Work and Social Adjustment Scale: A Simple Measure of Impairment in Functioning. British Journal of Psychiatry, 180, 461-464. https://doi:10.1192/bjp.180.5.461

Muthén, L.K., & Muthén, B.O. 1998-2012. Mplus User’s Guide. Los Angeles, CA: Muthén & Muthén.

Nunnally, J.C. (1978). Psychometric theory. New York: McGraw-Hill.

Pedersen, G., Kvarstein, E. H., & Wilberg, T. (2017). The Work and Social Adjustment Scale: Psychometric Properties and Validity Among Males and Females and Outpatients With and Without Personality Disorders. Personality and Mental Health, 11 (4), 215–228.

Reavley, N., & Jorm, A. (2010). Prevention and early intervention to improve mental health in higher education students: a review. Early Intervention in Psychiatry, 4(2), 132.

Richards, D., Enrique, A., Eilert, N., Franklin, M., Palacios, J., Duffy, D., Earley, C. et al. (2020). A Pragmatic Randomized Waitlist-controlled Effectiveness and Cost-Effectiveness Trial of Digital Interventions for Depression and Anxiety. NPJ Digital Medicine, 85.

Seekles, W., van Straten, A., Beekman, A., van Marwijk, H., & Cuijpers, P. (2011). Stepped care treatment for depression and anxiety in primary care: a randomized controlled trial. Trials, 12, 171.

Sheldon, E., Simmonds-Buckley, M., Bone, C., Mascarenhas, T., Chan, N., Wincott, M., Gleeson, H., Sow, K., Hind, D., & Barkham, M. (2021). Prevalence and risk factors for mental health problems in university undergraduate students: A systematic review with meta-analysis. Journal of Affective Disorders, 287, 282-292.

Schumacker, R. E., & Lomax, R. G. (2010) A beginner's guide to structural equation modeling. New York: Routledge.

Skevington, S. M., Lotfy, M., & O'Connell, K. A. (2004). The World Health Organization's WHOQOL-BREF Quality of Fife Assessment: Psychometric Properties and Results of the International Field Trial. A report from the WHOQOL group. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 13 (2), 299–310.

Sousa, T. V., Viveiros, V., Chai, M. V., Vicente, F. L., Jesus, G., Carnot, M. J., Gordo, A. C., & Ferreira, P. L. (2015). Reliability and validity of the Portuguese version of the Generalized Anxiety Disorder (GAD-7) Scale. Health and Quality of Life Outcomes, 13, 50.

Spitzer, R.L., Kroenke, K., Williams, J.B., & Löwe, B. (2006). A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7. Archives of Internal Medicine, 166, 1092-1097.

Tabachnick, B. G., & Fidell, L. S. (2007). Using Multivariate Statistics. New York: Allyn and Bacon.29.

Thandi, G., Fear, N. T., & Chalder, T. (2017). A comparison of the Work and Social Adjustment Scale (WSAS) Across Different Patient Populations Using Rasch Analysis and Exploratory Factor Analysis. Journal of Psychosomatic Research, 92, 45–48.

Tolchard B. (2016). Reliability and Validity of the Work and Social Adjustment Scale in Treatment-Seeking Problem Gamblers. Journal of Addictions Nursing, 27(4), 229-233.

Torres, A., Monteiro, S., Pereira, A., & Albuquerque, E. (2016). Reliability and Validity of the PHQ-9 in Portuguese Women with Breast Cancer. Available from:

Vaz-Serra, A., Canavarro, M.C., Simões, M., Pereira, M., Gameiro, S., Quartilho, M.J., Rijo, D., Carona, C., & Paredes, T. (2006). Estudos Psicométricos do Instrumento de Avaliação da Qualidade de Vida da Organização Mundial de Saúde (WHOQOL-BREF) para Português de Portugal. Psiquiatria Clínica, 27 (1), 41-49.

Zahra, D., Qureshi, A., Henley, W., Taylor, R., Quinn, C., Pooler, J., Hardy, G., Newbold, A., & Byng, R. (2014). The Work and Social Adjustment Scale: Reliability, Sensitivity and Value. International Journal of Psychiatry in Clinical Practice, 18 (2), 131–138.



  • There are currently no refbacks.