Disability Mediates the Impact of Common Conditions on Perceived Health

Abstract

BackgroundWe examined the extent to which disability mediates the observed associations of common mental and physical conditions with perceived health.Methods and FindingsWHO 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.ConclusionsMore 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.

Severe role impairment associated with mental disorders: Results of the WHO World Mental Health Surveys International College Student Project

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Cognitive remission: a novel objective for the treatment of major depression?

“…Major depressive disorder (MDD) is a prevalent and disabling condition with a high frequency of non-recovery and recurrence, leading to substantial mortality and morbidity [ 1 – 3 ]. Only a subset of individuals with MDD (30–40 %) reach symptomatic remission after adequate treatment with a first-line antidepressant, and many patients do not reach premorbid levels of psychosocial functioning, such that a significant proportion of patients present residual symptoms.…”

Perspectives on “Disease” and “Disability” in Child Health: The Case of Childhood Neurodisability

“…It emerges as a natural consequence of all that we have argued thus far about imbalance and neglect of the disability perspective in current practice, policy, education, and research. It is made even more compelling by an increasing body of evidence that demonstrates how, for children and adults affected by chronic health conditions, the presence of disability demarcates differences in impact and needs in a very robust way (93–96). The task ahead is to disentangle conflation, to recognize the complementarity of the disease and disability perspectives in the context of childhood neurodisability (as well as child health, and human health, more generally), and to see how each contributes to a deeper understanding of both individuals with impairments and to the field in which we work.…”