Williams C. Donald. Disability and Occupational Assessment: Objective Diagnosis and Quantitative Impairment Rating. Harvard Review of Psychiatry 2010; 18: 336–352. Industrial insurance originated in Europe in the 19^th century, and replaced the old system of negligence liability in the United States between 1910 and 1940. Today psychiatric disability assessments are performed by psychiatrists in the context of social security disability applications, workers’ compensation claims, private disability insurance claims management, and fitness for duty evaluations. There is a need for expertise in the performance of psychiatric disability evaluations but general psychiatric residency programs provide experience with only treatment evaluations which differ fundamentally from independent medical evaluations (IME’s) as to role boundaries and assessment focus. Psychiatrists offer opinions regarding psychiatric impairments, but the determination of disability is an administrative or judicial decision made administratively or by judicial tribunals. The distinction between diagnoses which are categorical and impairment ratings which are dimensional is discussed. Social Security Disability Evaluations (SSDI) and workers’ compensations evaluations are discussed. Inconsistency in impairment ratings has been problematic in the U.S. and elsewhere in the workers’ compensation arena. A protocol for more achieving more consistent impairment ratings is proposed correlating 3 commonly used global rating scales in a 3X5 grid, supplemented by objective psychological test data.

The April 2008 Journal of Occupational and Environmental Medicine is titled "Special Issue: Depression in the Workplace." Two AOOP members contributed articles. If you would like a reprint, please contact Dr. Couser or Dr. Williams. You may contact the authors directly for reprints, or access reprints on the internet through your university library affiliation.

"Challenges and Opportunities for Preventing Depression in the Workplace: A Review of the Evidence Supporting Workplace Factors and Interventions" by Gregory P. Couser MD MPH reviews the current state of preventive measures for workplace depression and suggests numerous avenues for improving individual, organizational, and societal outcomes through depression prevention. (Couser G. "Challenges and Opportunities for Preventing Depression in the Workplace: A Review of the Evidence Supporting Workplace Factors and Interventions." J Occup Environ Med. 2008:50:411-427).

"Assessment of Occupational Impairment and Disability from Depression" by C. Donald Williams MD and Ron Schouten MD JD examines the relationship of impairment and disability in the occupational context, proposes strategies for indentifying the level of impairment present and assessing its impact on employment, discusses selection and titration of treatment to severity of the condition and patient characteristics, and recommends practices that minimize the occurrence and effects of role and  boundary confusion. (Williams CD and Schouten R. "Assessment of Occupational Impairment and Disability from Depression." J Occup Environ Med. 2008;50:441-450).