Disability Mediates the Impact of Common Conditions on Perceived Health

Author(s):Show less -

Alonso, Jordi ^{[1, 2, 3]} ; Vilagut, Gemma ^[2] ; Adroher, Nuria D. ^{[1, 2]} ; Chatterji, Somnath ^[4] ; He, Yanling ^[5] ; Andrade, Laura Helena ^[6] ; Bromet, Evelyn ^[7] ; Bruffaerts, Ronny ^[8] ; Fayyad, John ^{[9, 10]} ; Florescu, Silvia ^[11] ; de Girolamo, Giovanni ^[12] ; Gureje, Oye ^[13] ; Maria Haro, Josep ^{[14, 15]} ; Hinkov, Hristo ^[16] ; Hu, Chiyi ^{[17, 18]} ; Iwata, Noboru ^[19] ; Lee, Sing ^[20] ; Levinson, Daphna ^[21] ; Lepine, Jean Pierre ^[22] ; Matschinger, Herbert ^[23] ; Elena Medina-Mora, Maria ^[24] ; O'Neill, Siobhan ^[25] ; Hormel, J. ^[26] ; Posada-Villa, Jose A. ^[27] ; Taib, Nezar Ismet ; Xavier, Miguel ^[28] ; Kessler, Ronald C. ^[29]

Affiliation:Show less -

^[1] CIBER Epidemiol & Salud Publ, Barcelona - Spain

^[2] IMIM Inst Hosp Mar Invest Med, Barcelona - Spain

^[3] Pompeu Fabra Univ, Barcelona - Spain

^[4] WHO, CH-1211 Geneva - Switzerland

^[5] Shangai Mental Hlth Ctr, Shanghai - Peoples R China

^[6] Univ Sao Paulo, Sch Med, Inst Psychiat, Sao Paulo - Brazil

^[7] SUNY Stony Brook, Stony Brook, NY 11794 - USA

^[8] Katholieke Univ Leuven, Univ Psychiat Ctr, Louvain - Belgium

^[9] Inst Dev Res Advocacy & Appl Care, Beirut - Lebanon

^[10] St George Hosp Univ Med Ctr, Beirut - Lebanon

^[11] Natl Sch Publ Hlth Management & Profess Dev, Bucharest - Romania

^[12] IRCCS Ctr S Giovanni Dio Fatebenefratelli, Brescia - Italy

^[13] Univ Coll Hosp, Ibadan - Nigeria

^[14] CIBERSAM, Barcelona - Spain

^[15] Parc Sanitari St Joan de Deu, Barcelona - Spain

^[16] Natl Ctr Publ Hlth Protect, Sofia - Bulgaria

^[17] Shenzhen Inst Mental Hlth, Shenzhen, Guangdong - Peoples R China

^[18] Shenzhen Kangning Hosp, Shenzhen, Guangdong - Peoples R China

^[19] Hiroshima Int Univ, Higashihiroshima - Japan

^[20] Chinese Univ Hong Kong, Shatin, Hong Kong - Peoples R China

^[21] Minist Hlth, Jerusalem - Israel

^[22] Hop St Louis Lariboisiere Fernand Widal, Paris - France

^[23] Univ Leipzig, D-04109 Leipzig - Germany

^[24] Inst Nacl Psiquiatria Ramon de la Fuente, Mexico City, DF - Mexico

^[25] Univ Ulster, Coleraine BT52 1SA, Londonderry - North Ireland

^[26] Univ Groningen, Univ Med Ctr Groningen, NL-9713 AV Groningen - Netherlands

^[27] Pontificia Univ Javeriana, Bogota - Colombia

^[28] Univ Nova Lisboa, P-1200 Lisbon - Portugal

^[29] Harvard Univ, Sch Med, Boston, MA - USA

• Document type: Journal article
• Source: PLoS One; v. 8, n. 6 JUN 6 2013.
• Web of Science Citations: 18

Abstract

Background: We examined the extent to which disability mediates the observed associations of common mental and physical conditions with perceived health. Methods and Findings: WHO World Mental Health (WMH) Surveys carried out in 22 countries worldwide (n = 51,344 respondents, 72.0% response rate). We assessed nine common mental conditions with the WHO Composite International Diagnostic Interview (CIDI), and ten chronic physical with a checklist. A visual analog scale (VAS) score (0, worst to 100, best) measured perceived health in the previous 30 days. Disability was assessed using a modified WHO Disability Assessment Schedule (WHODAS), including: cognition, mobility, self-care, getting along, role functioning (life activities), family burden, stigma, and discrimination. Path analysis was used to estimate total effects of conditions on perceived health VAS and their separate direct and indirect (through the WHODAS dimensions) effects. Twelve-month prevalence was 14.4% for any mental and 51.4% for any physical condition. 31.7% of respondents reported difficulties in role functioning, 11.4% in mobility, 8.3% in stigma, 8.1% in family burden and 6.9% in cognition. Other difficulties were much less common. Mean VAS score was 81.0 (SD = 0.1). Decrements in VAS scores were highest for neurological conditions (9.8), depression (8.2) and bipolar disorder (8.1). Across conditions, 36.8% (IQR: 31.2-51.5%) of the total decrement in perceived health associated with the condition were mediated by WHODAS disabilities (significant for 17 of 19 conditions). Role functioning was the dominant mediator for both mental and physical conditions. Stigma and family burden were also important mediators for mental conditions, and mobility for physical conditions. Conclusions: More than a third of the decrement in perceived health associated with common conditions is mediated by disability. Although the decrement is similar for physical and mental conditions, the pattern of mediation is different. Research is needed on the benefits for perceived health of targeted interventions aimed at particular disability dimensions. (AU)

• FAPESP's process: 03/00204-3 - Epidemiological study of psychiatric disorders in the São Paulo Metropolitan Region: prevalence, risk factors, and social and economical burden
• Grantee: Laura Helena Silveira Guerra de Andrade
• Support Opportunities: Research Projects - Thematic Grants