WHODAS as a strategy to enable the application of the biopsychosocial model in clinical settings: a systematic review

Barreto, Marina Carvalho Arruda; Camerino, Cristine Mayara Cavalcante; Leite, Camila Ferreira; Castro, Shamyr Sulyvan de

doi:10.1590/1809-2950/e23014724en

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SYSTEMATIC REVIEW • Fisioter. Pesqui. 32 • 2025 • https://doi.org/10.1590/1809-2950/e23014724en linkcopy

WHODAS as a strategy to enable the application of the biopsychosocial model in clinical settings: a systematic review

WHODAS como estrategia para la aplicación del modelo biopsicosocial en la práctica clínica: revisión sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

This study aimed to identify how WHODAS 2.0 is being used in clinical trials. This is a systematic review that selected clinical trials in Portuguese, English, and Spanish that used WHODAS 2.0. The search was conducted in the following databases: MEDLINE, Embase, LILACS, and PEDro. Data were collected on country, year, population, objectives, version of WHODAS 2.0, and variables evaluated. This study found 206 references, after analysis and evaluation of the inclusion criteria, 32 articles were selected. Most studies were conducted in Asia (n=10), followed by America (n=9). Of the 32 studies, four used the 36-item version, 17 used the 12-item version, the others did not report or used results from specific domains. Regarding study population, most articles (n=24) included individuals with mental disorders as their target population. Among the health professionals who participated in the research, most were physicians and nurses. It was observed that despite being an instrument recommended by the WHO to assess functioning, only 32 studies used it. It was possible to observe that the instrument is disseminated worldwide and despite being a generic instrument, most studies used it to evaluate the population with mental disorders.

Keywords
Biopsychosocial Model; Review

Authors/year	Objective	Sample	Country	WHODAS version	Type of intervention	Health professionals involved in the intervention	Area/Specialty
Von Korff et al. (2011) ¹⁰	To evaluate the effectiveness of integrated care for chronic physical diseases and depression in reducing disability and improving quality of life.	Individuals with diabetes or coronary heart disease, or both, and depression	USA.	15 items	Self-management support	Physicians and nurses	Diabetes or cardiovascular diseases
Jenkins et al. (2013) ¹¹ the rate of accurate routine clinic detection of mental disorder was greater than 0 in 5% versus 0% of the intervention and control groups respectively, in both the intention to treat analysis (p = 0.50	To examine the impact of mental health in service training on routine detection of mental disorder in the clinics and on client outcomes.	Adults treated at a primary health care unit.	Kenya	36 items	Training for healthcare professionals	Local health workers	Mental disorders
Choi et al. (2014) ¹²	To report longer term outcomes of tele-PST for both depression and disability.	Non-Hispanic White, Black/African American, and Hispanic homebound adults (age≥50) with depression	USA.	12 items	Monitoring by telerehabilitation or face-to-face	Social workers	Depression
Alegría et al. (2014) ¹³	To evaluate treatment effectiveness of telephone or face-to-face delivery of a cognitive behavioral therapy and care-management intervention for low-income Latinos with depression.	Latino primary care patients with moderate or severe depressive symptoms	USA and Puerto Rico	No information	Engagement and Counseling (telephone and face to face); usual care	Physicians	Depression
Kang et al. (2015) ¹⁴ 300 were randomized to a 24-week double-blind trial of escitalopram or placebo, while the remaining 146 received conventional medical treatment only (MTO	To evaluate the result of screening for treatment and subsequent treatment of depression on one-year psychiatric outcomes in ACS.	Individuals who developed acute coronary syndrome, resulting in hospitalization	Korea	12 items	Escitalopram; Placebo.	Physicians and nurses	Depression
Jordans et al. (2015) ¹⁵	To evaluate the effectiveness of adding community-based counsellor-delivered psychological interventions for adults who initiated mhGAP-based primary care services for depression and alcoholism in Nepal.	Adults (age≥16 years) with depression and suffering from alcoholism.	Nepal	12 items	mhGAP-based intervention; Additionally received HAP or CAP.	Local health professionals and counselors	Depression and alcoholism
Kästner et al. (2015) ¹⁶	To evaluate the effect of a previously implemented AO model using patient- and clinician-ratings.	Adult patients with a schizophreniform disorder and a maximum of 60 points on the Global Assessment of Functioning Scale.	Germany	12 items	Assertive Community Treatment, Intensive Case Management, Integrated Care, or Assertive Outreach; Treatment as usual.	Nurses and physicians	Schizophrenia
Robinson et al. (2015) ¹⁷	To investigate the value of exergaming using the Wii Fit™ for people with Multiple Sclerosis.	Adults with clinical diagnosis of multiple sclerosis, self-reported ability to walk 100 meters with or without resting with the use of a walking stick or crutch.	UK	12 items	Balance training using Nintendo Wii Fit™ (exergaming); Traditional balance training (no exergaming); No intervention.	Physical Therapist	Multiple sclerosis
Rahman et al. (2016) ¹⁸ SETTING, AND PARTICIPANTS: A randomized clinical trial was conducted from November 1, 2014, through January 28, 2016, in 3 primary care centers in Peshawar, Pakistan, that included 346 adult primary care attendees with high levels of both psychological distress and functional impairment according to the 12-item General Health Questionnaire and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0	To tests the effectiveness of a multicomponent behavioral intervention delivered by lay health workers to adults with psychological distress in primary care settings.	Adult primary care attendees with high levels of both psychological distress and functional impairment.	Pakistan	12 items	Empirically supported problem-solving strategies, behavioral activation, strengthening social support, and stress management; Treatment as usual.	Physicians and other unspecified healthcare professionals	Post-traumatic stress disorder
Medina Vidales et al. (2017) ¹⁹	To evaluate the efficacy of Brief Psychoeducation Intervention to reduce time being ill, prevent relapses, and alleviate symptoms for people with bipolar disorder.	Adults (aged 18–29 years), who had been diagnosed with bipolar disorder.	Mexico	No information	Psychoeducation plus medication; Treatment as usual – pharmacological	Graduate research students of the last year of Psychology.	Bipolar disorder
Nadkarni et al. (2017) ²⁰ only a small fraction of people globally receive these treatments because of poor access in routine primary care. We assessed the effectiveness and cost-effectiveness of Counselling for Alcohol Problems (CAP)	To evaluate the effects of the intervention on alcohol consumption 12 months after enrollment, the cost-effectiveness of the intervention, for whom and under what circumstances the intervention works, and mediation of these results by the patient’s ‘’readiness to change’’ evaluated at three months.	Males aged 18 to 65 who binge drink.	India	No information	Consultation with the PHC physician and information on when and where to find psychiatric service; Manual psychological treat ment delivered in three phases in a maximum of four sessions.	Physicians and counselors (no mental health experience and high school graduate)	Alcoholism
Richard et al. (2017) ²¹	To test the effectiveness of a new five-session behavioral treatment called Problem Management Plus that lay community workers can be taught to deliver.	Female adults who had experienced gender-based violence.	Kenya	12 items	Problem Management Plus (PM+); Usual care with nurses.	Nurses and community workers	Post-traumatic stress disorder
Teixeira-Machado et al. (2017) ²²	To investigate the effect of dance in the functioning and psychosocial adjustment of young subjects with cerebral palsy.	Young subjects with cerebral palsy.	Brazil	No information	Kinesiotherapy; Dance.	Physical Therapists	Cerebral Palsy
Weobong et al. (2017) ²³ a brief behavioural intervention delivered by lay counsellors, enhanced remission over 3 months among primary care attendees with depression in peri-urban and rural settings in India. We evaluated the sustainability of the effects after treatment termination, the cost-effectiveness of HAP over 12 months, and the effects of the hypothesized mediator of activation on clinical outcomes. Methods and findings: Primary care attendees aged 18–65 years screened with moderately severe to severe depression on the Patient Health Questionnaire 9 (PHQ-9	To assess the stability of HAP’s effects on depression at 12 months post-enrolment, the mediation of the clinical outcomes by patient activation assessed at three months, and the cost-effectiveness of the intervention.	Adult patients at a primary health center with a probable diagnosis of moderately severe to severe depression.	India	No information	Enhanced routine care; Healthy activity programmed.	Physicians, community counselors	Depression
Alegría et al. (2019) ²⁴	To test the acceptability and effectiveness of a disability prevention intervention, Positive Minds-Strong Bodies, offered by paraprofessionals to mostly immigrant older adults in four languages.	Adults, not seeking disability prevention services but eligible per elevated mood symptoms and minor to moderate physical dysfunction.	USA and Puerto Rico	No information	Routine care; Cognitive-behavioral therapy plus strengthening exercises.	Exercise trainers and clinical supervisors	Post-traumatic stress disorder
Anjara et al. (2019) ²⁵	To compare patient outcomes following primary care in mental health treatment by GPs and Nurses additionally trained in the WHO mhGAP or a Clinical Psychologist co-located in a Puskesmas.	Adult primary care patients	Indonesia	36 items	Psychosocial and/or pharmacological interventions; Psychosocial interventions.	General practitioners and nurses	Mental disorders
Hounsome et al. (2019) ²⁶	To test the hypothesis that community-based treatment of podoconiosis lymphoedema reduces the frequency of acute dermato-lymphangio-adenitis episodes and secondarily that it improves other clinical, social, and economic outcomes.	Adults with a diagnosis of at least stage 2 podoconiosis (persistent lymphoedema).	Ethiopia	12 items	Training in foot hygiene, skin care, dressings, exercise, and use of socks and shoes; Followed quarterly for data collection but did not receive intervention for 12 months (delayed intervention).	Not specified	Podoconiosis lymphoedema
Khan et al. (2019) ²⁷	The feasibility trial was to evaluate the feasibility and acceptability of the locally adapted Problem Management Plus Group intervention for women in the conflict affected settings in Swat, Pakistan.	Female adults with suspected psychological distress.	Pakistan	12 items	Problem management plus (PM+); Treatment as usual.	Psychiatrists and psychologists	Mental disorders
Rahman et al. (2019) ²⁸	To establish the effectiveness of a brief psychological intervention group for women in a conflict-affected setting in rural Swat, Pakistan.	Female adults in the community	Pakistan	12 items	Problem management plus (PM+); Treatment as usual.	Graduates	Post-traumatic stress disorder
Choi et al. (2020) ²⁹	To test the acceptability and effectiveness of a lay-coach-facilitated, videoconference, short-term behavioral activation (Tele-BA) intervention for improving social connectedness among homebound older adults.	Individuals with ≥50 years and confirmation of loneliness and no-to-mild depressive symptoms.	USA	12 items	Tele-BA as Treatment Condition; Tele-Friendly Visiting as Active Control.	Not specified	Older people
Kladnitski et al. (2020) ³⁰	To examine the efficacy of transdiagnostic internet-delivered cognitive behavioral therapy (iCBT), mindfulness-enhanced iCBT, and stand-alone online mindfulness training compared with a usual care control group (TAU) for clinical anxiety and depression.	Adult individuals with a diagnosis of depressive and/or anxiety disorder.	Australia	12 items	The iCBT program; The Mindfulness-Enhanced iCBT program; The Mindfulness Training (iMT) program; The TAU group.	Psychiatrists	Depression and anxiety
Maurus et al. (2020) ³¹	To evaluate the feasibility and efficacy of a newly developed 12-week resistance program according to current recommendations of the WHO and the American College of Sports Medicine.	Adult individuals with diagnosis of schizophrenia.	Germany (Munich)	36 items	Resistance training for schizophrenia patients; Balance and tone training.	Not specified	Schizophrenia
Shaili et al. (2020) ³²	To assess the efficacy of a five-session version of Skills Training in Affective and Interpersonal Regulation (STAIR) among veterans obtaining treatment in primary care.	Patients receiving treatment at a large Veterans Affairs medical center in the Western United States.	USA	WHODAS domains: Getting along with people, Life activities, and Participation in society	STAIR-PC; Usual treatment.	Mental health professionals, health technicians	War veterans
Akhtar et al. (2021) ³³	To test the safety and acceptability of GroupPM+ in a refugee camp and to identify areas for adaptation in preparation for a definitive RCT.	Syrian adults, parent of a child aged 10–16 years, experiencing psychological distress.	Jordan	12 items	Problem management plus (PM+); Enhanced treatment as usual.	Bachelor’s degree in Psychology or a Health-related field	Post-traumatic stress disorder
Hamdani et al. (2021) ³⁴	To evaluate the effectiveness of adding PM+ for CMDs to routine care in a specialized mental health care facility in Pakistan.	Adult outpatient department attendees, referred for psychological support for depression, anxiety, and stress.	Pakistan	12 items	Problem Management plus (PM+); Treatment‑as‑Usual (TAU).	Master’s degree in Psychology and Psychiatry	Mental disorders
de Pinho et al. (2021) ³⁵ 1-week post-treatment and at follow-up 3 months after treatment. The primary outcome measure was psychotic symptoms based on the Psychotic Symptom Rating Scales (PSYRATS	To evaluate the efficacy of metacognitive group training in reducing psychotic symptoms and improving cognitive insight and functions in people with schizophrenia.	Adult patients with schizophrenia	Portugal	12 items	Metacognitive training; Treatment as usual.	Psychiatric and mental health nurses	Schizophrenia
Asher et al. (2022) ³⁶ masked to the intervention or control label, used a computer programme to randomly choose the allocation sequence from the set of optimal ones. We recruited adults with disabling illness as a result of schizophrenia. The subdistricts were eligible for inclusion if they included participants that met the eligibility criteria. Researchers recruiting and assessing participants were masked to allocation status. Facility-based care was a task-shared model of mental health care integrated within primary care. CBR was delivered by lay workers over a 12-month period, comprising of home visits (psychoeducation, adherence support, family intervention, and crisis management	To evaluate the effectiveness of CBR plus facility-based care compared with facility-based care alone at reducing disability at 12 months in people with schizophrenia.	Adults with a diagnosis of schizophrenia, schizoaffective disorder, or schizophreniform disorder and who had one or more markers of severe, disabling, or enduring illness.	Ethiopia	36 items	Community-based rehabilitation plus facility-based care; Establishment-based service only.	Nurses and health officers	Schizophrenia
Bryant et al. (2022) ³⁷	To investigate the potential impact of gPM+ on refugees’ parenting behavior and also how this may benefit their children’s mental health.	Adult participants comprised refugees in Azraq Refugee Camp and had a child or dependent aged 10-16 years who is living in the household.	Jordan	12 items	Problem Management plus (PM+); Treatment as usual	Bachelor’s degree in Social Sciences or a Health-related discipline	Post-traumatic stress disorder
Catto et al. (2022) ³⁸ but it is unclear whether total intracorporeal surgery improves recovery compared with open radical cystectomy for bladder cancer. Objectives: To compare recovery and morbidity after robot-assisted radical cystectomy with intracorporeal reconstruction vs open radical cystectomy. Design, Setting, and Participants: Randomized clinical trial of patients with nonmetastatic bladder cancer recruited at 9 sites in the UK, from March 2017-March 2020. Follow-up was conducted at 90 days, 6 months, and 12 months, with final follow-up on September 23, 2021. Interventions: Participants were randomized to receive robot-assisted radical cystectomy with intracorporeal reconstruction (n = 169	To compare recovery and morbidity after robot-assisted radical cystectomy with intracorporeal reconstruction vs open radical cystectomy.	Adult patients’ with nonmetastatic bladder cancer.	U.K.	No information	Robot-assisted radical cystectomy with intracorporeal reconstruction; Open radical cystectomy.	Physician	Cancer
Cuijpers et al. (2022) ³⁹ and their access to care has deteriorated during the Coronavirus Disease 2019 (COVID-19	To examine the effects of a WHO guided digital mental health intervention, Step-by-Step, supported by a non-specialist helper in Lebanon, in the context of concurring economic, humanitarian, and political crises, a large industrial disaster, and the COVID-19 pandemic.	Syrian displaced people, above eight years of age with moderate or severe depressive symptoms and who experienced functional impairment.	Lebanon (Syrian refugees).	12 items	Step-by-Step; Enhanced treatment as usual.	Not specified	Depression
Javaherirenani et al. (2022) ⁴⁰	To evaluate the effectiveness of virtual reality exposure and response prevention in the treatment of the obsessive-compulsive disorder contamination subtype.	Patients aged 18-50 years, with a clinical diagnosis of obsessive-compulsive disorder.	Iran	No information	Cognitive Behavior Therapy and virtual reality exposure and response prevention; Cognitive Behavior Therapy.	Psychiatrist and clinical psychologists	Obsessive compulsive disorder
Richerson et al. (2023) ⁴¹	To assess the therapeutic and economic benefits of service dogs versus emotional support dogs for veterans with posttraumatic stress disorder.	Veterans with post-traumatic stress disorder.	USA	No information	Service dogs; Emotional support dogs.	Not specified	War veterans with post-traumatic stress disorder

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