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December 14, 1994, Vol 272, No. 22 >
ARTICLE | December 14, 1994

Common Mental Disorders and Disability Across Cultures: Title and subTitle BreakResults From the WHO Collaborative Study on Psychological Problems in General Health Care FREE

Johan Ormel, PhD; Michael VonKorff, ScD; T. Bedirhan Ustun, MD, PhD; Stefano Pini, MD; Ailsa Korten, BSc; Tineke Oldehinkel, MSc
[+] Author Affiliations

Presented in part at the sixth annual National Institute of Mental Health Research Conference on Classification and Treatment of Mental Disorders in Primary Care Settings, Bethesda, Md, October 19,1992, and at the World Psychiatric Association Section Epidemiology meeting, Groningen, the Netherlands, September 3, 1993.

Reprint requests to Department of Psychiatry, University of Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands (Dr Ormel).


JAMA. 1994;272(22):1741-1748. doi:10.1001/jama.1994.03520220035028
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Article
References

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 25916 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.(JAMA. 1994;272:1741-1748)

REFERENCES

1 +
Wells KB, Steward A, Hays RD, et al.  The functioning and well-being of depressed patients: results from the Medical Outcomes Study. JAMA . 1989;;262:914-919.
2 +
Broadhead WE, Blazer DG, George LK, Kit Tse C.  Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA . 1990;;264:2524-2528.
3 +
VonKorff M, Ormel J, Katon W, Lin EHB.  Disability and depression among high utilizers of health care: a longitudinal analysis. Arch Gen Psychiatry . 1992;;49:91-100.
4 +
Wohlfarth TD, vanden Brink W, Ormel J, Koeter MWJ, Oldehinkel AJ.  The relationship between social dysfunctioning and psychopathology. Br JPsychiatry . 1993;;163:37-44.
5 +
Berkman LF, Berkman C, Kasl S, et al.  Depressive symptoms in relation to physical health and functioning in the elderly. Am J Epidemiol . 1986;; 124:372-389.
6 +
Turner R, Beiser M.  Major depression and depressive symptomatology among the physically disabled: assessing the role of chronic stress. J Nerv Ment Dis . 1990;;178:343-350.
7 +
Hurry J, Sturt E.  Social performance in a population sample: relations to psychiatric symptoms.  In: Wing JK, Bebbington P, Robins LN, eds. What Is a Case? London, England: Grant McIntyre; 1981;.
8 +
Dohrenwend BS, Dohrenwend BP, Link B, Levav I.  Social functioning of psychiatric patients in contrast with community cases in the general population. Arch Gen Psychiatry . 1983;;40:1174-1182.
9 +
Casey PR, Tyrer PJ, Platt S.  The relationship between social functioning and psychiatric symptomatology in primary care. Soc Psychiatry . 1985;;20:5-9.
10 +
Hecht H, Zerssen D, Wittchen HU.  Anxiety and depression in a community sample: the influence of comorbidity on social functioning. J Affect Disord . 1990;;18:137-144.
11 +
Rodin G, Voshart K.  Depression in the medically ill: an overview. Am J Psychiatry . 1986;;143: 696-705.
12 +
Craig TJ, Van Natta PA.  Disability and depressive symptoms in two communities. Am J Psychiatry . 1983;;140:598-601.
13 +
Blumenthal MD, Dielman TE.  Depressive symptomatology and role function in a general population. Arch Gen Psychiatry . 1975;;32:985-991.
14 +
Paykel ES, Weissmann MM.  Social adjustment and depression. Arch Gen Psychiatry . 1973;;28:659-663.
15 +
Ormel J, VonKorff M, vanden Brink W, Katon W, Brilman E, Oldehinkel T.  Depression, anxiety, and disability show synchrony of change. Am J Public Health . 1993;;83:385-390.
16 +
Stoudemire A, Frank R, Hedemark N, Kamlet M, Blazer D.  The economic burden of depression. Gen Hosp Psychiatry . 1986;;8:387-394.
17 +
Shepherd M, Cooper B, Brown AC, Kalton GW. Psychiatric Illness in General Practice . New York, NY: Oxford University Press Inc; 1966;.
18 +
Ormel J, vanden Brink W, Koeter MWJ, et al.  Recognition, management, and outcome of psychological disorders in primary care: a naturalistic follow-up study. Psychol Med . 1990;;20:909-923.
19 +
VonKorff M, Shapiro S, Burke JD,  Anxiety and depression in a primary care clinic: comparison of DIS, GHQ, and practitioner assessments. Arch Gen Psychiatry . 1987;;44:152-156.
20 +
Barrett JE, Barrett JA, Oxman TE, Gerber PD.  The prevalence of psychiatric disorders in a primary care practice. Arch Gen Psychiatry . 1988;; 45:1100-1106.
21 +
Hoeper EW, Nycz GR, Cleary PD, Regier DA, Goldberg ID.  Estimated prevalence of RDC mental disorder in primary medical care. Int J Ment Health . 1979;;8:6-15.
22 +
Murphy JM, Olivier DC, Sobol M, Monson RR, Leighton AH.  Diagnosis and outcome: depression and anxiety in a general population. Psychol Med . 1986;;16:117-126.
23 +
Hankin JR, Oktay JS. Mental Disorder and Primary Medical Care: An Analytic Review of the Literature . Washington, DC: US Dept of Health and Human Services; 1979;. Publication ADM 78-661, National Institute of Mental Health series D5.
24 +
Blacker CVR, Clare AW.  Depressive disorder in primary care. Br J Psychiatry . 1987;;150:737-751.
25 +
Mann AH, Jenkins R, Belsey E.  The twelve-month outcome of patients with neurotic illness in general practice. Psychol Med . 1981;;11:535-550.
26 +
Schulberg HC, McClelland M, Gooding W.  Six-month outcomes for medical patients with major depressive disorders. J Gen Intern Med . 1987;;2: 312-317.
27 +
Regier DA, Burke JD, Manderscheid RW, Burns BJ.  The chronically mentally ill in primary care. Psychol Med . 1985;;15:265-273.
28 +
Cooper B, Fry J, Kalton GW.  A longitudinal study of psychiatric morbidity in a general practice population. Br J Preventive Soc Med . 1969;;23:210-217.
29 +
Hankin JR, Locke BZ.  The persistence of depressive symptomatology among prepaid group practice enrollees: an exploratory study. Am J Public Health . 1982;;29:2-10.
30 +
Kessler LG, Cleary PD, Burke JD.  Psychiatric disorders in primary care: results of a follow-up study. Arch Gen Psychiatry . 1985;;42:583-587.
31 +
Leff J, Sartorius N, Jablensky A, Korten A, Ernberg G.  The International Pilot Study of Schizophrenia: five-year follow-up findings. Psychol Med . 1992;;22:131-145.
32 +
Jablensky A, Sartorius N, Ernberg G, et al.  Schizophrenia: manifestations, incidence, and course in different cultures. Psychol Med . 1992;:monograph (suppl 20) .
33 +
Lefley HP.  Culture and chronic mental illness. Hosp Community Psychiatry . 1990;;41:177-286.
34 +
World Health Organization. International Classification of Impairments, Disabilities, and Handicaps . Geneva, Switzerland: World Health Organization; 1980;.
35 +
Susser M.  Disease, illness, sickness: impairment, disability, and handicap. Psychol Med . 1990;;20:471-473.
36 +
VonKorff M, Ustun TB.  Methods of the WHO Collaborative Study of psychological problems in primary care settings.  In: Sartorius N, Ustun BT, eds. Mental Illness in Primary Care: An International Study . New York, NY: John Wiley & Sons Inc; In press.
37 +
Sartorius N, Ustun TB, Costa e Silva JA, et al.  An international study of psychological problems in primary care: preliminary report from the WHO Collaborative Project on Psychological Problems in General Health Care. Arch Gen Psychiatry . 1993;; 50:819-824.
38 +
Goldberg D, Williams P. A User's Guide to the General Health Questionnaire . Windsor, England: NFER/Nelson; 1988;.
39 +
World Health Organization. Composite International Diagnostic Interview . Geneva, Switzerland: World Health Organization, Division of Mental Health; 1989;. Publication MNH/NAT/89.
40 +
Wiersma D, DeJong A, Ormel J.  The Groningen Social Disability Schedule: development, relationship with ICIDH, and psychometric properties. Int J Rehab Res . 1988;;11:213-224.
41 +
VonKorff M, Ustun TB, Ormel J, et al.  Self-report of disability: the reliability and validity in an international primary care study. J Clin Epidemiol . In press.
42 +
Stewart AL, Hays RD, Ware JE.  The MOS Short-Form General Health Survey: reliability and validity in a patient population. Med Care . 1988;; 26:724-732.
43 +
Ustun TB, Sartorius N, eds. Mental Illness in Primary Care: An International Study . New York, NY: John Wiley & Sons Inc; In press.
44 +
Barsky AJ, Goodson JD, Lane RS, Cleary PD.  The amplification of somatic symptoms. Psychosom Med . 1988;;50:510-519.
45 +
Katon W, Sullivan M.  Depression and chronic medical illness. J Clin Psychiatry . 1990;;51:3-11.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Wells KB, Steward A, Hays RD, et al.  The functioning and well-being of depressed patients: results from the Medical Outcomes Study. JAMA . 1989;;262:914-919.
2 +
Broadhead WE, Blazer DG, George LK, Kit Tse C.  Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA . 1990;;264:2524-2528.
3 +
VonKorff M, Ormel J, Katon W, Lin EHB.  Disability and depression among high utilizers of health care: a longitudinal analysis. Arch Gen Psychiatry . 1992;;49:91-100.
4 +
Wohlfarth TD, vanden Brink W, Ormel J, Koeter MWJ, Oldehinkel AJ.  The relationship between social dysfunctioning and psychopathology. Br JPsychiatry . 1993;;163:37-44.
5 +
Berkman LF, Berkman C, Kasl S, et al.  Depressive symptoms in relation to physical health and functioning in the elderly. Am J Epidemiol . 1986;; 124:372-389.
6 +
Turner R, Beiser M.  Major depression and depressive symptomatology among the physically disabled: assessing the role of chronic stress. J Nerv Ment Dis . 1990;;178:343-350.
7 +
Hurry J, Sturt E.  Social performance in a population sample: relations to psychiatric symptoms.  In: Wing JK, Bebbington P, Robins LN, eds. What Is a Case? London, England: Grant McIntyre; 1981;.
8 +
Dohrenwend BS, Dohrenwend BP, Link B, Levav I.  Social functioning of psychiatric patients in contrast with community cases in the general population. Arch Gen Psychiatry . 1983;;40:1174-1182.
9 +
Casey PR, Tyrer PJ, Platt S.  The relationship between social functioning and psychiatric symptomatology in primary care. Soc Psychiatry . 1985;;20:5-9.
10 +
Hecht H, Zerssen D, Wittchen HU.  Anxiety and depression in a community sample: the influence of comorbidity on social functioning. J Affect Disord . 1990;;18:137-144.
11 +
Rodin G, Voshart K.  Depression in the medically ill: an overview. Am J Psychiatry . 1986;;143: 696-705.
12 +
Craig TJ, Van Natta PA.  Disability and depressive symptoms in two communities. Am J Psychiatry . 1983;;140:598-601.
13 +
Blumenthal MD, Dielman TE.  Depressive symptomatology and role function in a general population. Arch Gen Psychiatry . 1975;;32:985-991.
14 +
Paykel ES, Weissmann MM.  Social adjustment and depression. Arch Gen Psychiatry . 1973;;28:659-663.
15 +
Ormel J, VonKorff M, vanden Brink W, Katon W, Brilman E, Oldehinkel T.  Depression, anxiety, and disability show synchrony of change. Am J Public Health . 1993;;83:385-390.
16 +
Stoudemire A, Frank R, Hedemark N, Kamlet M, Blazer D.  The economic burden of depression. Gen Hosp Psychiatry . 1986;;8:387-394.
17 +
Shepherd M, Cooper B, Brown AC, Kalton GW. Psychiatric Illness in General Practice . New York, NY: Oxford University Press Inc; 1966;.
18 +
Ormel J, vanden Brink W, Koeter MWJ, et al.  Recognition, management, and outcome of psychological disorders in primary care: a naturalistic follow-up study. Psychol Med . 1990;;20:909-923.
19 +
VonKorff M, Shapiro S, Burke JD,  Anxiety and depression in a primary care clinic: comparison of DIS, GHQ, and practitioner assessments. Arch Gen Psychiatry . 1987;;44:152-156.
20 +
Barrett JE, Barrett JA, Oxman TE, Gerber PD.  The prevalence of psychiatric disorders in a primary care practice. Arch Gen Psychiatry . 1988;; 45:1100-1106.
21 +
Hoeper EW, Nycz GR, Cleary PD, Regier DA, Goldberg ID.  Estimated prevalence of RDC mental disorder in primary medical care. Int J Ment Health . 1979;;8:6-15.
22 +
Murphy JM, Olivier DC, Sobol M, Monson RR, Leighton AH.  Diagnosis and outcome: depression and anxiety in a general population. Psychol Med . 1986;;16:117-126.
23 +
Hankin JR, Oktay JS. Mental Disorder and Primary Medical Care: An Analytic Review of the Literature . Washington, DC: US Dept of Health and Human Services; 1979;. Publication ADM 78-661, National Institute of Mental Health series D5.
24 +
Blacker CVR, Clare AW.  Depressive disorder in primary care. Br J Psychiatry . 1987;;150:737-751.
25 +
Mann AH, Jenkins R, Belsey E.  The twelve-month outcome of patients with neurotic illness in general practice. Psychol Med . 1981;;11:535-550.
26 +
Schulberg HC, McClelland M, Gooding W.  Six-month outcomes for medical patients with major depressive disorders. J Gen Intern Med . 1987;;2: 312-317.
27 +
Regier DA, Burke JD, Manderscheid RW, Burns BJ.  The chronically mentally ill in primary care. Psychol Med . 1985;;15:265-273.
28 +
Cooper B, Fry J, Kalton GW.  A longitudinal study of psychiatric morbidity in a general practice population. Br J Preventive Soc Med . 1969;;23:210-217.
29 +
Hankin JR, Locke BZ.  The persistence of depressive symptomatology among prepaid group practice enrollees: an exploratory study. Am J Public Health . 1982;;29:2-10.
30 +
Kessler LG, Cleary PD, Burke JD.  Psychiatric disorders in primary care: results of a follow-up study. Arch Gen Psychiatry . 1985;;42:583-587.
31 +
Leff J, Sartorius N, Jablensky A, Korten A, Ernberg G.  The International Pilot Study of Schizophrenia: five-year follow-up findings. Psychol Med . 1992;;22:131-145.
32 +
Jablensky A, Sartorius N, Ernberg G, et al.  Schizophrenia: manifestations, incidence, and course in different cultures. Psychol Med . 1992;:monograph (suppl 20) .
33 +
Lefley HP.  Culture and chronic mental illness. Hosp Community Psychiatry . 1990;;41:177-286.
34 +
World Health Organization. International Classification of Impairments, Disabilities, and Handicaps . Geneva, Switzerland: World Health Organization; 1980;.
35 +
Susser M.  Disease, illness, sickness: impairment, disability, and handicap. Psychol Med . 1990;;20:471-473.
36 +
VonKorff M, Ustun TB.  Methods of the WHO Collaborative Study of psychological problems in primary care settings.  In: Sartorius N, Ustun BT, eds. Mental Illness in Primary Care: An International Study . New York, NY: John Wiley & Sons Inc; In press.
37 +
Sartorius N, Ustun TB, Costa e Silva JA, et al.  An international study of psychological problems in primary care: preliminary report from the WHO Collaborative Project on Psychological Problems in General Health Care. Arch Gen Psychiatry . 1993;; 50:819-824.
38 +
Goldberg D, Williams P. A User's Guide to the General Health Questionnaire . Windsor, England: NFER/Nelson; 1988;.
39 +
World Health Organization. Composite International Diagnostic Interview . Geneva, Switzerland: World Health Organization, Division of Mental Health; 1989;. Publication MNH/NAT/89.
40 +
Wiersma D, DeJong A, Ormel J.  The Groningen Social Disability Schedule: development, relationship with ICIDH, and psychometric properties. Int J Rehab Res . 1988;;11:213-224.
41 +
VonKorff M, Ustun TB, Ormel J, et al.  Self-report of disability: the reliability and validity in an international primary care study. J Clin Epidemiol . In press.
42 +
Stewart AL, Hays RD, Ware JE.  The MOS Short-Form General Health Survey: reliability and validity in a patient population. Med Care . 1988;; 26:724-732.
43 +
Ustun TB, Sartorius N, eds. Mental Illness in Primary Care: An International Study . New York, NY: John Wiley & Sons Inc; In press.
44 +
Barsky AJ, Goodson JD, Lane RS, Cleary PD.  The amplification of somatic symptoms. Psychosom Med . 1988;;50:510-519.
45 +
Katon W, Sullivan M.  Depression and chronic medical illness. J Clin Psychiatry . 1990;;51:3-11.

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