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JAMA. 1994 Dec 14;272(22):1741-8.

Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care.

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  • 1Department of Psychiatry, University of Groningen, The Netherlands.

Abstract

OBJECTIVE:

To examine the impact of common mental illness on functional disability and the cross-cultural consistency of this relationship while controlling for physical illness. A secondary objective was to determine the level of disability associated with specific psychiatric disorders.

DESIGN:

A cross-sectional sample selected by two-stage sampling.

SETTING:

Primary health care facilities in 14 countries covering most major cultures and languages.

PATIENTS:

A total of 25,916 consecutive attenders of these facilities were screened for psychopathology using the General Health Questionnaire (96% response). Screened patients were sampled from the General Health Questionnaire score strata for the second-stage Composite International Diagnostic Interview administered to 5447 patients (62% response).

MAIN OUTCOME MEASURES:

Patient-reported physical disability, number of disability days, and interviewer-rated occupational role functioning.

RESULTS:

After controlling for physical disease severity, psychopathology was consistently associated with increased disability. Physical disease severity was an independent, although weaker, contributor to disability. A dose-response relationship was found between severity of mental illness and disability. Disability was most prominent among patients with major depression, panic disorder, generalized anxiety, and neurasthenia; disorder-specific differences were modest after controlling for psychiatric comorbidity. Results were consistent across disability measures and across centers.

CONCLUSIONS:

The consistent relationship of psychopathology and disability indicates the compelling personal and socioeconomic impact of common mental illnesses across cultures. This suggests the importance of impairments of higher-order human capacities (eg, emotion, motivation, and cognition) as determinants of functional disability.

PMID:
7966922
[PubMed - indexed for MEDLINE]
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