The Enforced Social Dependency Scale (ESDS)

By /

Abstract

The Enforced Social Dependency Scale (ESDS) is a specialized 10-item instrument designed to quantify the level of enforced social dependency experienced by individuals suffering from chronic illness, such as cancer, stroke, or heart attack. Enforced social dependency is defined as the necessary reliance on external support (friends, relatives, or caregivers) for performing activities that would typically be taken for granted (e.g., eating, bathing, walking). The primary goal of the ESDS is to measure the extent of functional impairment and subsequent dependence, providing healthcare professionals with a tool to evaluate patient progress towards regaining pre-illness functionality and improving their quality of life.

Keywords

Enforced Social Dependency, Functional Status, Activities of Daily Living, Chronic Illness, Patient Dependence, Rehabilitation, Quality of Life, Cancer Care, Psychosocial Variables.

Authors

R. McCorkle, S. Tzuh Tang.

Purpose

The primary purpose of the ESDS is to provide a standardized, quantifiable measure of a patient’s functional status and reliance on others following a significant health event or diagnosis. The scale focuses specifically on measuring dependence related to basic self-care and mobility tasks that are fundamental to independent living, such as eating, dressing, walking, travel, bathing, and toileting.

By using a structured interview format, the ESDS helps healthcare providers track changes in a patient’s level of independence over time, facilitating the planning and evaluation of rehabilitation and supportive care interventions aimed at restoring pre-illness capabilities. It helps identify specific areas where external support is required due to illness-related limitations.

Construct

The ESDS measures the construct of Enforced Social Dependency. This term refers to the non-voluntary reliance of a patient on external sources of support—such as family members or professional caregivers—to manage daily activities due to physical or cognitive limitations imposed by a progressing chronic condition or acute illness event.

This dependency is considered “enforced” because it is necessitated by the illness itself, impacting behaviors that define activities of daily living (ADLs) and instrumental roles (home and work activities). The scale therefore assesses the shift from independence to reliance across multiple domains of life, including communication and social roles, allowing healthcare providers to gauge the overall impact of the illness on daily functioning.

Validity

Specific details regarding the empirical validation studies (e.g., criterion, construct, or content validity coefficients) are not explicitly detailed in this entry. The foundational research referenced by the authors suggests that the scale was developed within the context of cancer care research to measure patient responses to psychosocial variables, implying an initial focus on clinical relevance and content alignment with functional deficits associated with progressive illness.

The authors indicate that the complete psychometric properties, including validity evidence, are discussed extensively within the official user manual for the scale. Researchers interested in the detailed validation process should consult the primary reference materials listed below, particularly the 1980 article on the scale’s development.

Reliability

As with validity, precise reliability coefficients (such as internal consistency or test-retest reliability) are not provided in this entry. The scale’s reliability is documented in the comprehensive user manual, which contains detailed information regarding the instrument’s development and evaluation.

The ESDS is designed to enhance reliability through its highly structured format. It utilizes specific interview guides (Form I for initial assessment and Form II for tracking changes over time) and explicit coding instructions (Appendix C) with defined operational levels for each item. This standardization aims to minimize interviewer variability and enhance measurement reliability, particularly when assessing changes in functional dependence longitudinally.

Factor Analysis

The source content does not provide information regarding any formal factor analysis conducted on the ESDS. Given that the ESDS measures ten distinct functional domains (such as eating, dressing, walking, and social roles), it likely functions as a multi-item index designed to capture the breadth of enforced dependency rather than a single latent factor.

The coding scheme, which uses Likert-type responses across multiple items, suggests that the scale is intended to produce a profile of functional deficits. Users requiring detailed factor structure information must refer to the full technical documentation or subsequent academic publications by the authors.

Instrument

Test Type: Performance-based assessment using structured interview and clinical judgment.

Format: 10-item inventory scored using a modified Likert scale format, typically ranging from 3 to 6 points, depending on the item and coding complexity (e.g., 1=No restrictions to 6=Unable to perform/Confined). The scale uses two forms: Form I (Initial Interview Guide) for baseline assessment and Form II (Follow-up Interview Guide) for evaluating function over time.

Language Available: English (Original development language).

Population Group: Clinical and medical populations experiencing functional decline.

Age Group: Adults (Primarily used with patients dealing with serious or chronic illness).

Population Details: Patients experiencing significant functional decline due to chronic illness (e.g., cancer, stroke, heart attack) who require assistance with activities of daily living (ADLs).

Test Methodology: Interviewer-administered. The interview guide uses general, open-ended questions followed by specific, detailed probes (e.g.) to elicit sufficient information. The interviewer then assigns a dependency code (1 to 6) for each of the 10 items based on the patient’s reported activities and level of need for external support or equipment.

Keywords

ESDS, Activities of Daily Living, Functionality Measurement, Nursing Research, Patient Recovery, Dependency Scale, McCorkle, Functional Impairment.

Authors

Author ORCID Identifier: N/A (Information not provided in source).

Affiliation Email addresses: N/A (Information not provided in source).

Correspondence Address: N/A (Information not provided in source).

Permissions & Fee and Test Year

Specific details regarding current licensing fees or required permissions for clinical or research use are not provided in the source material. The scale was developed and introduced in the early 1980s, based on the foundational research published in 1980 and 1981.

The original PDF User Manual detailing the scale’s administration and scoring is available. The original PDF can be downloaded here: USER’S MANUAL FOR THE ENFORCED SOCIAL DEPENDENCY SCALE.

Reference’s

  • Benoliel, J. Q., McCorkle, R., Young, K. (1980). Development of a social dependency scale. Res Nurs Health, 3(1), 3-10.

  • McCorkle, R., & Benoliel, J.Q. (1981). Cancer patient responses to psychosocial variables. Final Report of project supported by Grant No. NU00730, DHHS, University of Washington.

Items of the The Enforced Social Dependency Scale (ESDS)

Appendix A. Enforced Social Dependency Scale—Initial Interview Guide (Form I)

The Enforced Social Dependency Scale (ESDS) is recommended to be used with people who have recently experienced an illness, such as cancer, stroke, or heart attack. Form I is to be used to evaluate the patient’s function initially after illness. If the scale is administered beyond the initial illness, the questions need to be asked within the last week.

Instructions:

The Enforced Social Dependency Scale was developed to determine the extent to which the patient’s dependence on external sources of support has changed during illness. Dependence is defined in terms of a number of specific functional items, such as bathing and eating. Based on the questions asked in the interview, the interviewers should be able to rate how the patient is faring with respect to these functional activities on the Enforced Social Dependency Scale. To aid you in this effort, verbal descriptions of the levels of the items have been provided along with explicit definitions of how defining terms are being used. You should familiarize yourself with the levels of the Enforced Social Dependency Scale before beginning your interview.

In order to determine the appropriate location on the item codes for a particular person, a set of suggested interview questions has been provided for each scale item (with the exception of the consciousness item). The first question is general and open-ended. It may be that the patient will give enough information in response to this question that no further questions are necessary for that particular item. If this is so, simply record the information and move on to the next item. If more information is needed to make the proper determination, continue with the more detailed questions (marked “e.g.”) are given for some of the items. The general principle is this: Ask as many of the questions as necessary to determine where a patient belongs on a particular code for that item. Then record this information and move on to the next item.

In general, you should notaccept a quick answer that “everything is normal (usual).” The patient may not understand how you are using your terms. This is one reason for using the more specific questions. Consider an example: In response to your general question, a patient says that his bathing is normal (usual). After further probing, however, he reveals that he recently requires grab rails to get in and out of the tub. This might seem perfectly normal (usual) to him. This item would be coded a “3”, bathes with use of equipment, rather than a “1”, usual bathing activity, no change.

On the other hand, it may quickly become apparent to you that a particular aspect of the patient’s behavior is normal (usual). A patient who has already told you he plays tennis every day will probably not require assistance in walking (to take an extreme example). Once you have acquired a little experience with the items and codes, observation and inference may be used to reduce the number of questions asked for each item.

TO THE PATIENT:

In general, I would like to know how your present activities differ from your usual patterns prior to your illness. I’m interested in what effects your illness has had on your day-to-day living. To make sure I find out as much about this as I can, I’m going to ask you a number of specific questions about what a typical day is like for you.

(Eating)

  1. What about eating, for exampleHow do your present eating habits differ from what was usually for you before your illness?
    1. Does it take you more time to eat?
    2. Do you eat at the same times as you used to? Do you eat in the same place (e.g., at the table)?
    3. Do people bring food to you more often?
    4. Are you able to cut your own food?
    5. Is pouring milk or coffee a problem for you?

(OPTIONAL)

Are there any special eating utensils, such as enlarged fork handles or non skid plates, that you use and find helpful?

(Dressing)

  1. Do you have problems dressing yourself now that you didn’t have before your illness (e.g., bending to put on shoes, stretching to pull something over your head); has illness made it harder to get dressed?
    1. Does it take more time to get dressed?
    2. Do you need help in putting on some of your clothes—fastening buttons, for example, or lacing your shoes?
    3. Do you wear special clothes, or use special equipment, to make dressing easier?
    4. Are there days you don/t get dressed, but wear your bed clothes? About how many days a week, would you say?

(Walking)

  1. Do you walk and get about in the same way you did before your illness?
    1. Does it take more time to walk somewhere? Is your walking more deliberate (i.e., cautious or careful)?
    2. Are you ever assisted in getting about?

Has the doctor restricted your walking in any way? (e.g., do you need to be accompanied when you go on walks)?

  1. Do you use special equipment to help you walk? g., Do you use a cane or a crutch? Do you wear braces or special shoes?

Do you take elevators more than you used to?

  1. How do your present travel and transportation patterns differ from what was usual for you before your illness?
    1. How do you get to the doctor for your medical appointments?
    2. Do you drive a car or take a bus as often as you used to?
    3. What kinds of places do you drive to (or go to)?
    4. Are there places you used to drive to (or ride to), you don’t go to as often now (non-essential trips, g., going out for dinner, shopping, etc.)?

(Bathing)

  1. How do your present bathing patterns differ from what was usual for you before your illness?
    1. About how often—how many times a week—do you bathe now?
    2. How do you usually bathe? Of the times a week you bathe, how many are tub baths? Showers? Sponge baths?      (g., washing yourself down with a close or sponge)?
    3. Does it take you more time to bathe?
    4. Are you assisted in bathing by other people?
    5. Are there special devices or equipment that you use and find helpful?
    6. What about shaving? Do you shave as often? Or have you changed how you shave (e.g., manual razor to electric)?
    7. How do you care for you hair? Number of times washed? (e.g., barber shop or beauty shop)?

(Toileting)

  1. Are you able to get to the bathroom and use it in the same way as you did before your illness?
    1. Have your habits changed? g., are you having trouble with constipation or diarrhea?
    2. Do you need to get up more often at night?
    3. Do you need help to get up more often at night?

e.g. Does someone assist you in walking to the bathroom or in the bathroom?

  1. Do you need special equipment, such as grab-rails or a raised toilet seat, portable commode, bedpan or urinal?

(Role in the Home)

  1. Can you describe what your primary responsibilities have been in your home? Has this changed since your illness? If yes, in what ways?
    1. Who prepares the meals? If the patient does, ask if the illness has affected this
    2. Who does the shopping? If the patient does, ask if the illness has affected this
    3. Who does the laundry? If the patient does, ask if the illness has affected this
    4. Who cleans the house? If the patient does, ask if the illness has affected this
    5. Who does repairs around the house? If the patient does, ask if the illness has affected this
    6. Who does the yardwork? If the patient does, ask if the illness has affected this
    7. Who runs errands? If the patient does, ask if the illness has affected this

  1. (Work Role) Complete a, b, or c
    1. Do you work? That is , do you receive pay for the work you do? If yes:
      1. Are you presently working? What kind of work are you doing?
      2. Are there some things at work you used to do that you aren’t doing now?
    2. If you don’t work, did you stop working for pay because of your current illness? If yes:
      1. What kind of things do you do now that you think of as work (that is, things you are responsible for, such as chores around the house, volunteer or club duties)?
      2. Are there some things you used to do that you aren’t doing now?
    3. If you have never worked for pay or have not worked for pay for a considerable period of time unrelated to current illness:
      1. What kind of things have you done that you consider work (that is, things you are responsible for, such as chores—yardwork, repairs, cooking, cleaning, shopping— or volunteer work)?
      2. Are there some things you used to do that you aren’t doing now?

9.      (Recreational and Social Role)

  1. What kinds of things do you do for recreation or just for fun? What about TV
  2. Has this changed in any way since your illness?
  3. How much contact do you have with people not a part of your family and where does this occur?
  4. Do you keep in touch with your friends like you used to?
  5. Are there things you’d like to do in the way of recreation or entertainment that you aren’t doing right now?
  6. What do you do (do you plan to do) on the most recent (upcoming) major holiday?
  7. Have there been any changes in your sexual activity/ability?

  1. (Communication—Consciousness scale): Interviewer makes a judgment for this item
    1. Patient responds to interviewer in normal, coherent
    2. Patient responds to interviewer’s questions but adds much tangential or irrelevant
    3. Patient does not respond directly to interviewer; requires much prompting to elicit any answer or maintain attention.

Appendix B. Enforced Social Dependency Scale—Initial Interview Guide (Form II)

The Enforced Social Dependency Scale (ESDS) is recommended to be used with people who have recently experienced an illness, such as cancer, stroke, or heart attack. Form I should be used to evaluate the patient’s function initially after illness. If the scale is administered beyond the initial illness, Forum II should be used to evaluate the patient’s function over time. The questions need to be asked during the last week.

Instructions:

The Enforced Social Dependency Scale was developed to determine the extent to which the patient’s dependence on external sources of support has changed during illness. Dependence is defined in terms of a number of specific functional items, such as bathing and eating. Based on the questions asked in the interview, the interviewer should be able to rate how the patient is faring with respect to these functional activities on the Enforced Social Dependency Scale. To aid you in this effort, verbal descriptions of the levels of the items have been provided along with explicit definitions of how defining terms are being used. You should familiarize yourself with the levels of the Enforced Social Dependency Scale before beginning your interview.

In order to determine the appropriate location on the item codes for a particular person, a set of suggested interview questions has been provided for each scale item (with the exception of the consciousness item). The first question is general and open-ended. It may be that the patient will give enough information in response to this question that no further questions are necessary for that particular item. If this is so, simply record the information and move on to the next item. If more information is needed to make the proper determination, continue with the more detailed questions (marked “e.g.”) are given for some of the items. The general principle is this: Ask as many of the questions as necessary to determine where a patient belongs on a particular code for that item. Then record this information and move on to the next item.

In general, you should notaccept a quick answer that “everything is normal (usual).” The patient may not understand how you are using your terms. This is one reason for using the more specific questions. Consider an example: In response to your general question, a patient says that his bathing is normal (usual). After further probing, however, he reveals that he recently requires grab rails to get in and out of the tub. This might seem perfectly normal (usual) to him. This item would be coded a “3”, bathes with use of equipment, rather than a “1”, usual bathing activity, no change.

On the other hand, it may quickly become apparent to you that a particular aspect of the patient’s behavior is normal (usual). A patient who has already told you he plays tennis every day will probably not require assistance in walking (to take an extreme example). Once you have acquired a little experience with the items and codes, observation and inference may be used to reduce the number of questions asked for each item.

TO THE PATIENT:

In general, I would like to know how your present activities differ from your usual patterns prior to your illness. I’m interested in what effects your illness has had on your day-to-day living. To make sure I find out as much about this as I can, I’m going to ask you a number of specific questions about what a typical day is like for you.

(Eating)

  1. What about eating, for exampleHow are your present eating habits?
    1. Does it take you more time to eat during the last week?
    2. Do you eat at the same times as you used to? Do you eat in the same place (e.g., at the table)?
    3. Do people bring food to you more often?
    4. Are you able to cut your own food?
    5. Is pouring milk or coffee a problem for you?

(OPTIONAL)

Are there any special eating utensils, such as enlarged fork handles or non skid plates, that you use and find helpful?

(Dressing)

  1. What about dressing (e.g., bending to put on shoes, stretching to pull something over your head).
    1. Does it take more time to get dressed within the last week?
    2. Do you need help in putting on some of your clothes—fastening buttons, for example, or lacing your shoes?
    3. Do you wear special clothes, or use special equipment, to make dressing easier?
    4. Are there days you don/t get dressed, but wear your bed clothes? About how many days a week, would you say?

(Walking)

  1. Do you walk and get about?
    1. Does it take more time to walk somewhere? Is your walking more deliberate (i.e., cautious or careful)?
    2. Are you ever assisted in getting about?

Has the doctor restricted your walking in any way? (e.g., do you need to be accompanied when you go on walks)?

  1. Do you use special equipment to help you walk? g., Do you use a cane or a crutch?

Do you wear braces or special shoes?

Do you take elevators more than you used to?

  1. What about your travel and transportation patterns within the last week?
    1. How do you presently get to the doctor for your medical appointments?
    2. Do you drive a car or take a bus as often as you used to?
    3. What kinds of places do you drive to (or go to)?
    4. Are there places you used to drive to (or ride to), you don’t go to as often now (non- essential trips, g., going out for dinner, shopping, etc.)? within the last week?

(Bathing)

  1. How about your present bathing patterns within the last week?
    1. About how often—how many times a week—do you bathe now?
    2. How do you bathe? Of the times a week you bathe, how many are tub baths? Showers? Sponge baths?    (g., washing yourself down with a close or sponge)?
    3. Does it take you more time to bathe?
    4. Are you assisted in bathing by other people? g., Are water and equipment brought to you? Do you need help in getting in and out of the tube or shower?

Do you need help in washing hard-to-reach areas, such as your back?

  1. Are there special devices or equipment that you use and find helpful?
  2. What about shaving? Do you shave as often? Or have you changed how you shave (e.g., manual razor to electric)?
  3. How do you care for you hair? Number of times washed? (e.g., barber shop or beauty shop)?

(Toileting)

  1. What about your present bath room habits?
    1. Have your habits changed within the last week? e.g., are you having trouble with constipation or diarrhea?
    2. Do you need to get up more often at night?
    3. Do you need help to get up more often at night?

e.g. Does someone assist you in walking to the bathroom or in the bathroom?

  1. Do you need special equipment, such as grab-rails or a raised toilet seat, portable commode, bedpan or urinal?

(Role in the Home)

  1. Can you describe what your primary responsibilities have been in your home now?
    1. Who prepares the meals? If the patient does, ask if within the last
    2. Who does the shopping? If the patient does, ask if within the last
    3. Who does the laundry? If the patient does, ask if within the last
    4. Who cleans the house? If the patient does, ask if within the last

Who does repairs around the house? If the patient does, ask if within the last week.

  1. Who does the yardwork? If the patient does, ask if within the last
  2. Who runs errands? If the patient does, ask if within the last
  3. Are there some things you used to do that you are not doing now?

  1. (Work Role) Complete a, b, or c
    1. Do you work? That is, do you receive pay for the work you do? If yes:
      1. Are you presently working? What kind of work are you doing?
      2. Are there some things at work you used to do that you aren’t doing now?
    2. If you don’t work, did you stop working for pay because of your current illness? If yes:
      1. What kind of things do you do now that you think of as work (that is, things you are responsible for, such as chores around the house, volunteer or club duties)?
      2. Are there some things you used to do that you aren’t doing now?
    3. If you have never worked for pay or have not worked for pay for a considerable period of time unrelated to current illness:
      1. What kind of things have you done that you consider work (that is, things you are responsible for, such as chores—yardwork, repairs, cooking, cleaning, shopping— or volunteer work)?
      2. Are there some things you used to do that you aren’t doing now?

9.      (Recreational and Social Role)

  1. What kinds of things do you do for recreation or just for fun? What about TV
  2. What have you done within the last week?
  3. How much contact do you have with people not a part of your family within the last week, and where does this occur?
  4. Do you keep in touch with your friends?
  5. Are there things you’d like to do in the way of recreation or entertainment that you aren’t doing right now?
  6. What do you do (do you plan to do) on the most recent (upcoming) major holiday?

  1. (Communication—Consciousness scale): Interviewer makes a judgment for this item
    1. Patient responds to interviewer in normal, coherent
    2. Patient responds to interviewer’s questions but adds much tangential or irrelevant
    3. Patient does not respond directly to interviewer; requires much prompting to elicit any answer or maintain attention.

Appendix C. Coding Instructions for Enforced Social Dependency Scale (ESDS)

1. Eating/Feeding

         1           Feeds self without help of any kind—No restrictions.

         2           Feeding involves some minor pre-existing restriction (not severe enough to be coded 3-6) or some minor change since illness (also not severe enough to be coded 3-6).

         3           Feeds self with help of a device or equipment.

         4           Feeds self with help of another person or major changes in pattern of eating.

         5           Spoon fed (unable to participate).

         6           Does not eat or is tube fed.

2.  Dressing

         1           Dresses regularly in street clothes without help of any kind or use of special equipment.

         2           Dressing involves some minor pre-existing restriction (not severe enough to be coded 3-6) or some minor change since illness (also not severe enough to be coded 3-6).

         3           Dresses with help of equipment or device; loose clothing.

         4           Dresses with help of another person in street clothes or by self, but with major changes in the pattern of dressing, designed to maintain some degree of independence.

         5           Is regularly dressed in street clothes only by the help of another person, is unable to participate in dressing.

         6           Is usually not dressed in street clothes.

3.  Walking

         1           Walks without help of any kind—No restrictions.

         2           Walking involves some minor pre-existing restriction (not severe enough to be coded 3-6) or some minor change since illness (also not severe enough to be coded 3-6).

         3           Walks with help of equipment or device.

         4           Walks by self or with help of another person (s) (may include equipment or device); walking is definitely limited, e.g. only to bathroom, room to room, or to car.

         5           Does not walk, can take a few steps with help (also using equipment or person).

         6           Unable to take any steps at all (when this activity disrupts comfort).

4.  Travel

         1           Travel freely without help, drives car or takes bus—No restrictions.

         2           Travel involves some minor pre-existing restriction (not severe enough to be coded 3-6) or some minor change since illness (also not severe enough to be coded 3-6).

         3           Travel freely with help from another person. Takes a taxi, but not a bus.

         4           Takes occasional non-essential trips out of home, relies on self or requires help from another person. Major change from driving patterns.

         5           Take only necessary trips ( medically-related; grocery shopping) away from the home; relies on self or requires the help of another person.

         6           Confined to home.

5.  Bathing

         1           Bathes without any help—No restrictions.

         2           Bathes involves some minor pre-existing restriction (not severe enough to be coded 3-6) or some minor change since illness (also not severe enough to be coded 3-6).

         3           Bathes with help of equipment.

         4           Bathes with help of another person, or by self but with major changes in the pattern of bathing, designed to maintain some degree of independence.

         5           Is bathed (unable to participate except for face and hands).

         6           Is not bathed (when this activity disrupts comfort).

6.  Toileting

         1           Use toilet room without help of any kind—No restrictions.

         2           Use of toilet involves some minor pre-existing restriction (not severe enough to be coded 3-6) or some minor change since illness (also not severe enough to be coded 3-6).

         3           Use toilet room with help of another person (may include use of special equipment).

         4           Uses portable commode by self or with help of another person.

         5           Use bedpan or urinal by self or with help of another person.

         6           Incontinent, uses catheter, or uncontrolled, frequent urination (colostomy not under control).

7.  Activities in the Home

         1           Usual activities—no change in quantity or quality of activities characterizing usual household role performance.

         2           Modified activity—all activities continue as before but with some limitations in degree.

         3           Restricted activity—some activities characterizing usual household role can no longer be performed.

         4           No activity—major activities defining role are no longer being performed.

  1. Activities in the Work

8A. Work Activities for Person Employed Outside Home

         1           Usual activities—no change in quantity or quality of activities characterizing work role; continues to work.

         2           Modified activity—all activities continue as before but with some limitations in degree;

continues to work.

         3           Restricted activity—some activities characterizing work role can no longer be performed; work half as much time as before or less.

         4           No activity—major activities defining role are no longer being performed.

Note: Taking occasional time off or one to two days off each month is coded as two if work is still being done. Coded as 4 even if person continues to be paid

8B. Work-Type Activities if Forced to Retire Because of Illness

         1           Usual activities—no change in quantity or quality of activities characterizing work role.

         2           Modified activity—all activities continue as before but with some limitations in degree.

         3           Restricted activity—some activities characterizing work role can no longer be performed; work half as much time as before or less.

         4           No activity—major activities defining role are no longer being performed.

8C. Work-Type Activities for Retired Person (before illness) or Homemaker

         1           Usual activities—no change in quantity or quality of activities characterizing work role.

         2           Modified activity—all activities continue as before but with some limitations in degree.

         3           Restricted activity—some activities characterizing work role can no longer be performed; work half as much time as before or less.

         4           No activity—major activities defining role are no longer being performed.

9.  Recreational and Social Activities

         1           Usual activities—no change in quantity or quality of recreation and socializing.

         2           Modified activity—all recreational and social activities continue as before but with some limitations in degree.

         3           Restricted activity—some recreational and social activities have ceased altogether.

         4           No activity—no recreational or social activities at all.

10.  Communication

         1           Responds to interviewer in normal, coherent fashion.

         2           Responds to interviewer’s questions but adds much tangential or irrelevant information; has occasional lapses of attention or memory.

         3           Does not respond directly to interviewer, requires much prompting to elicit any answer or

maintain attention.

Cite this article

Mohammed looti (2025). The Enforced Social Dependency Scale (ESDS). Psychological Scales & Instruments Database. Retrieved from https://db.arabpsychology.com/scales/the-enforced-social-dependency-scale-esds/

Mohammed looti. "The Enforced Social Dependency Scale (ESDS)." Psychological Scales & Instruments Database, 23 Oct. 2025, https://db.arabpsychology.com/scales/the-enforced-social-dependency-scale-esds/.

Mohammed looti. "The Enforced Social Dependency Scale (ESDS)." Psychological Scales & Instruments Database, 2025. https://db.arabpsychology.com/scales/the-enforced-social-dependency-scale-esds/.

Mohammed looti (2025) 'The Enforced Social Dependency Scale (ESDS)', Psychological Scales & Instruments Database. Available at: https://db.arabpsychology.com/scales/the-enforced-social-dependency-scale-esds/.

[1] Mohammed looti, "The Enforced Social Dependency Scale (ESDS)," Psychological Scales & Instruments Database, vol. X, no. Y, ص Z-Z, October, 2025.

Mohammed looti. The Enforced Social Dependency Scale (ESDS). Psychological Scales & Instruments Database. 2025;vol(issue):pages.

Scroll to Top