Social Psychiatry and Psychiatric Epidemiology

, Volume 32, Issue 7, pp 379–386 | Cite as

Psychopathology and the development of disability

  • A. C. Kouzis
  • W. W. Eaton
Original Paper


The objective was to determine the effect of preexisting psychopathology on days missed from work or usual activities (“disability days”) in a large community sample (N=3481). Logistic regression analyses were performed, with the presence or absence of disability days (wave 2) as the dependent variable. The effects of sociodemographic variables, six psychiatric disorders, a high distress score, and chronic physical conditions (wave 1) were studied. Separate analyses were conducted for, the total sample and four subgroups (labor force participants, homemakers, men, and women). The adjusted odds ratios and 95% confidence intervals (95% CI) for subjects with onset of panic disorder, were 7.3 (95% CI=1.8,28.7); for those with chronic major depressive disorder, 7.2 (95% CI=0.3,160.6); and for those, with chronic high distress, 5.0 (95% CI=2.6,9.9). The relative, odds for developing a disability were greater for those with either type of psychiatric disorder or high distress than for those with any prior physical illness or those with a prior disability day. Disability days experienced by persons with psychopathology result in diminished quality of life, economic losses, and increased need for health services. Improved health services and educational and work adjustments for emotionally disabled persons are recommended.


Psychiatric Disorder Adjust Odds Ratio Usual Activity Major Depressive Disorder Panic Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Aboraya AS (1991) Determinants of disabling injuries. Dissertation, Johns Hopkins University School of Hygiene and Public Health, BaitimoreGoogle Scholar
  2. Aneshensel CS, Frerichs RR, Huba GJ (1984) Depression and physical illness: A multiwave, nonrecursive causal model. J Health Soc Behav 25: 350Google Scholar
  3. American Psychiatric Association (1987) Diagnostic and Statistical manual of mental disorders (DSM-III) 3rd edn (revised). APA, Washington, D.C.Google Scholar
  4. Ashbaugh J, Leaf PJ, Manderscheid R, Eaton WW (1983) Estimates of the size and selected characteristics of the adult chronically mentally ill population living in US household. Res Community Ment Health J 3: 3Google Scholar
  5. Barker PR, Manderscheid RW, Hendershot GE, Jack, SS, Schoenborn CA, Goldstrom I (1992) Serious mental illness and disability in the adult household population: United States, 1989. Advance data from vital and health statistics no.218 National Center for Health Statistics, HyattsvilleGoogle Scholar
  6. Bartel A, Taubman P (1986) Some economic and demographic consequences of mental illness. J Labor Econ 4: 243Google Scholar
  7. Barth PS (1990) Workers' compensation for mental stress cases. Behav Sci Law 8: 349Google Scholar
  8. Berkman LF, Berkman CS, Kasl S, Freeman DF, Leo L, Ostfeld AM, et al. (1986) Depressive symptoms in relation to physical health and functioning in the elderly. Am J Epidemiol 124: 372Google Scholar
  9. Boyd JH (1986) Use of mental health services for the treatment of panic disorder. Am J Psychiatry 43: 1569Google Scholar
  10. Boyd JH, Burke JD, Gruenberg E, et al (1984) Exclusion criteria of DSM-III: A study of co-occurrence of hierarchy-free syndromes. Arch Gen Psychiatry. 41: 983Google Scholar
  11. Broadhead WE, Blazer DG, George LK, Tse CK (1990) Depression, disability days, and days lost from work in a prospective epidemiologic survey. J Am Med Assoc 264: 2524Google Scholar
  12. Brown JB, Adams ME (1992) Patients as reliable reporters of medical care process: Recall of ambulatory encounter events. Med Care 30: 400Google Scholar
  13. Bruce ML, Seeman TE, Merril SS, Blazer DG (1994) The impact of depressive symptomatology on physical, disability: MacArthur studies of successful aging. Am J Pubic Health 84: 1796Google Scholar
  14. Cassileth BR, Lusk EJ, Strouse TB et al (1984) Psychosocial status in chronic illness: A comparative analysis of six diagnostic groups. N Engl J Med 31: 506Google Scholar
  15. Cleary PD, Angel R (1984) The analysis of relationship involving dichotomous dependent variables. J Health Soc Behav 25: 334Google Scholar
  16. Craig TJ, Van Natta P (1983) Disability and depressive symptoms in two communities. Am J Psychiatry 140: 598Google Scholar
  17. Crown S, Crown JM (1973) Personality in early rheumatoid disease. J Psychosom Res 189Google Scholar
  18. Earle JR, Perricone PJ, Maultsby DM, Perricone N, Turner RA, Davis J (1979) Psychosocial adjustment of rheumatoid arthritis patients from two alternative treatment settings. J Rheum 6: 80Google Scholar
  19. Eaton WW, Kessler LG (1985) Epidemiologic field methods in psychiatry: The NIMH epidemiologic catchment area program. Academic Press, OrlandoGoogle Scholar
  20. Eaton WW, Regier DA, Locke BZ, Taube CA (1981) The Epidemiologic Catchment Area program in the National Institute of Mental Health. Public Health Rep 96: 319Google Scholar
  21. Eaton WW, Holzer CE, Von Korff M, Anthony JA, Helzer JE, George LK, et al (1984) The design of the Epidemiologic Catchment Area surveys. Arch Gen Psychiatry 41: 942Google Scholar
  22. Eaton WW, Anthony JC, Tepper S, Dryman A (1992) Psychopathology and attrition in the Epidemiologic Catchment Area surveys. Am J Epidemiol 135: 1951Google Scholar
  23. Fleiss JL, Williams JB, Dubro AF (1986) The logistic regression analysis of psychiatric data. J Psychiatr Res 20: 145Google Scholar
  24. Frank R, Gertler P (1987) The effect of, mental distress on income: results from a community survey. Working paper no. 2433. National Bureau of Economic Research, Cambridge, Mass.Google Scholar
  25. Frerichs RR, Aneshensel CS, Yokopenic PA, Clark VA (1982) Physical health and depression: An epidemiologic survey. Prev Med 11: 639Google Scholar
  26. Gardiner BM (1980) Psychological aspects of rheumatoid arthritis. Psychol Med 10: 159Google Scholar
  27. Goldberg D (1972) The detection of psychiatric illness by question naire. Oxford University Press, LondonGoogle Scholar
  28. Golden PM (1986) Health, United States, 1986 (prevention profile). DHHS publication PHS 87-1232. US Government Printing Office, Washington, D.C.Google Scholar
  29. Greenberg PE, Stiglin LE, Finkelstein SN, Berndt ER (1993) The economic burden of depression in 1990. J Clin Psychiatry 54: 405Google Scholar
  30. Holt PL (1981) Stressful life events preceding, road traffic accidents. Injury 13: 111Google Scholar
  31. Jenkins R (1985) Minor psychiatric morbidity in employed men and women and its contribution to sickness absence. Br J Ind Med 42: 147–154Google Scholar
  32. Kasl SV, Cobb S (1969) The intrafamilial transmission of rheumatoid arthritis. V. Differences between rheumatoid arthritis and controls on selected personality variables. J Chron Dis 22: 239Google Scholar
  33. Kathol RG, Petty F (1981) Relationship of depression of medical illness: A critical review. J Affect Disord 3: 111Google Scholar
  34. Kessler LG, Felson R, Royall R, et al (1985) Parameter and variance estimation. In: Eaton WW., Kessler LG (eds) Epidemiologic field methods in psychiatry: the NIMH Epidemiologic Catchment Area program. Academic Press, OrlandoGoogle Scholar
  35. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen H-U, Kendler KS (1994) Lifetinte and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry 51: 8Google Scholar
  36. Kouzis AC, Eaton WW (1994) Emotional disability days: prevalence and predictors. Am J Public Health 84: 1304Google Scholar
  37. Langer TS, Michael ST (1963) Life stress and mental health, vol 2. Free Press of Glencoe, LondonGoogle Scholar
  38. Leaf PJ, Myers JK, McEvoy LT (1991) Procedures used in the Epidemiologic Catchment Area study. In: Robins LN, Regier DA (eds) Psychiatric disorders in America: the Epidemiologic Catchment Area studies. Free Press, New YorkGoogle Scholar
  39. Mason JH, Weener J, Gertman PM, Meenan RF (1983) Health status in chronic disease: a comparative study of rheumatoid arthritis. J Rheum 10: 763Google Scholar
  40. Mintz J, Mintz LI, Arruda MJ, Hwang SS (1992) Treatment of depression and the functional capacity to work. Arch Gen Psychiatry 49: 761Google Scholar
  41. Mullahy J, Sindelar JL (1994) Alcoholism and income: the role of indirect effects. Milbank O 92: 359Google Scholar
  42. Neff JA, Husaini BA, McCorkel J (1980) Psychiatric and medical problems in rural communities. Soc Sci Med 14A: 331Google Scholar
  43. Nelson M, Gruver NN (1978) Self-esteem and body-image concept in paraplegics. Rehab Couns Bull 21: 108Google Scholar
  44. Okpaku SO, Sibulkin AE, Schenzler C (1994) Disability determination for adults with mental disorders: Social Security Administration vs. Independent Judgments. Am J Public Health 84: 1791Google Scholar
  45. Ormel J, Von Korff M, Van Den Bink W, Katon W, Brilman E, Oldehinkel T (1993) Depression, anxiety, and social disability show synchrony of change in primary care patients. Am J Public Health 83: 385Google Scholar
  46. Patrick DL, Stein J, Porta M, Porter CQ, Ricketts TC (1988) Poverty, health services, and health status in rural America. Milbank O 66: 105Google Scholar
  47. Public Health Newsletter (1992) Baltimore receives, $2 million grant for community-based public health program. Public Health Newsletter 6: 1Google Scholar
  48. Revicki DA, Irwin D, Reblando J, Simon GE (1994) The accuracy of self-reported disability days. Med Care 32: 401Google Scholar
  49. Rice DP, Kelman S, Miller LS, Dunmeyer S (1990) The economic costs of alcohol and drug abuse and mental illness: 1985. Report submitted to the Office of Financing and Coverage Policy of the Alcohol, Drug Abuse, and Mental Health Administration, US Department of Health and Human Services. Institute for Health and Aging, University of California, San FranciscoGoogle Scholar
  50. Richardson M (1994) The impact of the Americans with Disabilities Act on employment opportunity for people with disabilities. Ann Rev Public Health 15: 91Google Scholar
  51. Robins LN, Regier DA (eds) (1991) Psychiatric disorders in America: The Epidemiologic Catchment Area Study. Free Press, New YorkGoogle Scholar
  52. Robins LN, Helzer JE, Croughan J, Ratcliff KS (1981) The National Institute of Mental Health Diagnostic Interview Schedule: Its history, characteristics, and validity. Arch Gen Psychiatry 38: 381Google Scholar
  53. Rosenbaum M, Raz D (1977) Denial locus of control and depression among physically disabled and nondisabled men. J Clin Psychiatry 33: 672Google Scholar
  54. Rutter BM (1977) Some psychological concomitants of chronic bronchitis. Psychol Med 129: 403Google Scholar
  55. Satin MS, Morrett CH (1985) Census tract predictors of physical, psychological and social functioning for needs assessment. Health Serv Res 20: 342Google Scholar
  56. Scholes D, LaCroix AZ, Wagner EH, Grothaus LC, Hecht JA (1991) Tracking progress, toward national health objectives in the elderly: What do restricted activity days signify? Am J Public Health 81: 485Google Scholar
  57. Selzer ML, Rogers JE, Kern S (1968) Fatal accidents: The role of psychopathology, social stress, and acute disturbance. Am J Psychiatry 124: 1028Google Scholar
  58. Shaffer JW, Nussbaum K, Little JM (1972) MMPI profiles, of disability insurance claimants. Am J Psychiatry 129: 403Google Scholar
  59. Stanfield S, Feeney A, Head J, Canner R, North F (1995) Sickness absence for psychiatric illness: the Whitehall II Study. Soc Sci Med 40: 189–197Google Scholar
  60. Stern MJ, Pascale L, McLoone JR (1976) Psychosocial adaptation following an acute myocardial infarction. J Chron Dis 513Google Scholar
  61. Stewart AL, Greenfield S, Hays RD, Rogers WH, Berry SD, et al (1989) Functional status and well-being of patients with chronic conditions: results from the Medical Outcomes Study. J Am Med Assoc 262: 907Google Scholar
  62. Stoudemire A, Frank R, Hedemark N, Kamlet M, Blazer D (1986) The economic burden of depression. Gen Hosp Psychiatry 8: 387Google Scholar
  63. Turner RJ, Noh S (1988) Physical disability and depression: a longitudinal analysis. J Health Soc Behav 29: 23Google Scholar
  64. Von Korff M, Cottler L, George LK, Eaton WW, Leaf PJ, Burnam A (1985) Nonresponse and nonresponse bias in the ECA surveys, In: Eaton WW, Kessler LG Epidemiologic field methods in psychiatry: the NIMH Epidemiologic Catchment Area program. Academic Press, Orlando, p 85Google Scholar
  65. Von Korff M, Ormel J, Katon W, Lin EHB (1992) Disability and depression among high utilizers of health care: A longitudinal analysis. Arch Gen Psychiatry 49: 91Google Scholar
  66. Wells KB, Golding JM, Burnam MA (1988) Psychiatric disorder and limitations in physical functioning in a sample of the Los Angeles general population. Am J Psychiatry 145: 712Google Scholar
  67. Wells KB, Stewart A, Hays RD, Burnam A, Rogers, W, Daniels M, Berry S, et al (1989) The functioning and well-being of depressed patients: Results from the Medical Outcomes Study. J Am Med Assoc 262: 914Google Scholar
  68. Wells KB, Burnam MA, Rogers W, Hays R, Camp P (1992) The course of depression in adult outpatients: Results from the medical outcomes study. Arch Gen Psychiatry 49: 788Google Scholar

Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • A. C. Kouzis
    • 1
  • W. W. Eaton
    • 1
  1. 1.School of Hygiene and Public Health, Department of Mental HygieneThe Johns Hopkins UniversityBaltimoreUSA

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