Alonso J., Vilagut G., Adroher N.D., Chatterji S., He Y., Andrade L.H., Bromet E., Bruffaerts R., Fayyad J., Florescu S., de Girolamo G., Gureje O., Haro J.M., Hinkov H., Hu C., Iwata N., Lee S., Levinson D., Lépine J.P., Matschinger H., Medina-Mora M.E.,
Alonso, J., IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain, Pompeu Fabra University, Barcelona, Spain, CIBER en Epidemiología y Salud Pública, Barcelona, Spain; Vilagut, G., IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; Adroher, N.D., IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain, CIBER en Epidemiología y Salud Pública, Barcelona, Spain; Chatterji, S., World Health Organization, Geneva, Switzerland; He, Y., Shangai Mental Health Center, Shangai, China; Andrade, L.H., Institute of Psychiatry University of São Paulo Medical School, São Paulo, Brazil; Bromet, E., State University of New York at Stony Brook, Stony Brook, NY, United States; Bruffaerts, R., Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven, Leuven, Belgium; Fayyad, J., Institute for Development Research, Advocacy, and Applied Care, Beirut, Lebanon, St. George Hospital University Medical Center, Beirut, Lebanon; Florescu, S., National School of Public Health Management and Professional Development, Bucharest, Romania; de Girolamo, G., IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy; Gureje, O., University College Hospital, Ibadan, Nigeria; Haro, J.M., Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain; Hinkov, H., National Center for Public Health Protection, Sofia, Bulgaria; Hu, C., Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Guangdong Province, China; Iwata, N., Hiroshima International University, Higashi-Hiroshima, Japan; Lee, S., The Chinese University of Hong Kong, Shatin, Hong Kong; Levinson, D., Ministry of Health, Jerusalem, Israel; Lépine, J.P., Hôpital Saint-Louis Lariboisière Fernand Widal, Paris, France; Matschinger, H., Universität Leipzig, Leipzig, Germany; Medina-Mora, M.E., Instituto Nacional de Psiquiatria Ramon de la Fuente, Mexico City, Mexico; O'Neill, S., University of Ulster, Londonderry, United Kingdom; Hormel, J., University Medical Center Groningen, Groningen, Netherlands; Posada-Villa, J.A., Pontificia Universidad Javeriana, Bogota D.C, Colombia; Ismet Taib, N., Mental Health Center-Duhok, Kurdistan Region, Iraq; Xavier, M., Universidade Nova de Lisboa, Lisbon, Portugal; Kessler, R.C., Harvard Medical School, Boston, MA, United States
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. © 2013 Alonso et al.