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Low functional status as a predictor of incidence of emotional disorders in the general population



To examine the association between baseline functional status and any emotional disorder at follow-up, after controlling for potential confounders. The effect modification of previous mental disorders and physical conditions was assessed.


Data are from the Netherlands Mental Health Survey and Incidence Study-2, a representative population-based, 3-year longitudinal study completed in 2012. Individuals at risk of a new or a recurrent emotional disorder were selected at baseline (n = 4,574). The appearance of any emotional disorder between waves, assessed with the Composite International Diagnostic Interview 3.0, was the outcome. Functional status at baseline was assessed with the physical (PCS) and mental component summary (MCS) of the Short Form-36 Health Survey version 1 and with the number of disability days collected with the World Health Organization Disability Assessment Scale II. Multivariable logistic regression models adjusted by socio-demographic and lifestyle factors were fitted. Interaction terms between previous mental disorders or physical conditions with the predictors were tested.


At baseline, 12.1 % had low PCS score, 5.9 % had low MCS score and 30.3 % reported any disability days. The incidence of emotional disorders in 3 years was 9.1 % [95 % confidence interval (95 % CI) 8.1–10.3]. Having low PCS or low MCS at baseline [PCS adjusted OR (aOR) 1.51, p value = 0.02; MCS aOR 1.90, p = 0.002] or reporting more than 15 disability days (aOR 1.63, p = 0.035) was significantly associated with 3-year incidence of emotional disorders. Having a previous mental disorder modified the relationship between MCS and incidence. Among those with a low MCS score, a previous mental disorder considerably increased the risk of incident emotional disorders (aOR 2.72, p = <0.001).


Low functional status is an independent risk factor for developing emotional disorders in the general population. Appropriate identification followed by early intervention may contribute to reduce their associated burden.

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  1. 1.

    World Health Organization. (2001). International classification of functioning, disability and health: ICF.

  2. 2.

    Edwards, T. M., Stern, A., Clarke, D. D., Ivbijaro, G., & Kasney, L. M. (2010). The treatment of patients with medically unexplained symptoms in primary care: a review of the literature. Mental Health in Family Medicine, 7, 209–221.

    PubMed Central  PubMed  Google Scholar 

  3. 3.

    Schaefert, R., Hausteiner-Wiehle, C., Hauser, W., Ronel, J., Herrmann, M., & Henningsen, P. (2012). Non-specific, functional, and somatoform bodily complaints. Deutsches Ärzteblatt International, 109, 803–813.

    PubMed Central  PubMed  Google Scholar 

  4. 4.

    Rief, W., & Hiller, W. (1999). Toward empirically based criteria for the classification of somatoform disorders. Journal of Psychosomatic Research, 46, 507–518.

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Deary, V., Chalder, T., & Sharpe, M. (2007). The cognitive behavioural model of medically unexplained symptoms: A theoretical and empirical review. Clinical Psychology Review, 27, 781–797.

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Kroenke, K., Spitzer, R. L., Williams, J. B., Linzer, M., Hahn, S. R., deGruy, F. V, I. I. I., et al. (1994). Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. Archives of Family Medicine, 3, 774–779.

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Smith, G. R, Jr, Monson, R. A., & Ray, D. C. (1986). Patients with multiple unexplained symptoms. Their characteristics, functional health, and health care utilization. Archives of Internal Medicine, 146, 69–72.

    Article  PubMed  Google Scholar 

  8. 8.

    Aamland, A., Malterud, K., & Werner, E. L. (2012). Phenomena associated with sick leave among primary care patients with medically unexplained physical symptoms: A systematic review. Scandinavian Journal of Primary Health Care, 30, 147–155.

    Article  PubMed Central  PubMed  Google Scholar 

  9. 9.

    Kroenke, K., & Mangelsdorff, A. D. (1989). Common symptoms in ambulatory care: Incidence, evaluation, therapy, and outcome. American Journal of Medicine, 86, 262–266.

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    de Graaf, R., Bijl, R. V., Ten, H. M., Beekman, A. T., & Vollebergh, W. A. (2004). Rapid onset of comorbidity of common mental disorders: Findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Acta Psychiatrica Scandinavica, 109, 55–63.

    Article  PubMed  Google Scholar 

  11. 11.

    Muntaner, C., Eaton, W. W., & Diala, C. C. (2000). Social inequalities in mental health: A review of concepts and underlying assumptions. Health (London), 4, 89–113.

    Article  Google Scholar 

  12. 12.

    de Graaf, R., Ten Have, M., & van Dorsselaer, S. (2010). The Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2): Design and methods. International Journal of Methods in Psychiatric Research, 19, 125–141.

    Article  PubMed  Google Scholar 

  13. 13.

    Demidenko, E. (2008). Sample size and optimal design for logistic regression with binary interaction. Statistics in Medicine, 27, 36–46.

    Article  PubMed  Google Scholar 

  14. 14.

    Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36 health survey manual and interpretation guide. Boston, MA: The Health Institute.

    Google Scholar 

  15. 15.

    Kazis, L. E., Anderson, J. J., & Meenan, R. F. (1989). Effect sizes for interpreting changes in health status. Medical Care, 27, S178–S189.

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum.

    Google Scholar 

  17. 17.

    Von Korff, M., Crane, P. K., Alonso, J., Vilagut, G., Angermeyer, M. C., Bruffaerts, R., et al. (2008). Modified WHODAS-II provides valid measure of global disability but filter items increased skewness. Journal of Clinical Epidemiology, 61, 1132–1143.

    Article  Google Scholar 

  18. 18.

    Kessler, R. C., Greenberg, P. E., Mickelson, K. D., Meneades, L. M., & Wang, P. S. (2001). The effects of chronic medical conditions on work loss and work cutback. Journal of Occupational and Environmental Medicine, 43, 218–225.

    Article  CAS  PubMed  Google Scholar 

  19. 19.

    de Graaf, R., Tuithof, M., van Dorsselaer, S., & Ten Have, M. (2012). Comparing the effects on work performance of mental and physical disorders. Social Psychiatry and Psychiatric Epidemiology, 47(11), 1873–1883.

  20. 20.

    Alonso, J., Angermeyer, M. C., Bernert, S., Bruffaerts, R., Brugha, T. S., Bryson, H., et al. (2004). Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica, 109(s420), 38–46.

  21. 21.

    Bruffaerts, R., Vilagut, G., Demyttenaere, K., Alonso, J., Alhamzawi, A., Andrade, L. H., et al. (2012). Role of common mental and physical disorders in partial disability around the world. British Journal of Psychiatry, 200, 454–461.

    Article  PubMed Central  PubMed  Google Scholar 

  22. 22.

    Kessler, R. C., & Ustun, T. B. (2004). The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 13, 93–121.

    Article  PubMed  Google Scholar 

  23. 23.

    Haro, J. M., Palacin, C., Vilagut, G., Martinez, M., Bernal, M., Luque, I., et al. (2006). Prevalence of mental disorders and associated factors: Results from the ESEMeD-Spain study. Medicina Clínica (Barc), 126, 445–451.

    Article  Google Scholar 

  24. 24.

    Brugha, T., Bebbington, P., Tennant, C., & Hurry, J. (1985). The list of threatening experiences: A subset of 12 life event categories with considerable long-term contextual threat. Psychological Medicine, 15, 189–194.

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Craig, C. L., Marshall, A. L., Sjostrom, M., Bauman, A. E., Booth, M. L., Ainsworth, B. E., et al. (2003). International physical activity questionnaire: 12-country reliability and validity. Medicine and Science in Sports and Exercise, 35, 1381–1395.

    Article  PubMed  Google Scholar 

  26. 26.

    Leidy, N. K. (1994). Functional status and the forward progress of merry-go-rounds: Toward a coherent analytical framework. Nursing Research, 43, 196–202.

    Article  CAS  PubMed  Google Scholar 

  27. 27.

    Collings, S. (2005). Disability and the detection of mental disorder in primary care. Social Psychiatry and Psychiatric Epidemiology, 40, 994–1002.

    Article  PubMed  Google Scholar 

  28. 28.

    Henningsen, P., Zimmermann, T., & Sattel, H. (2003). Medically unexplained physical symptoms, anxiety, and depression: A meta-analytic review. Psychosomatic Medicine, 65, 528–533.

    Article  PubMed  Google Scholar 

  29. 29.

    Kroenke, K., Jackson, J. L., & Chamberlin, J. (1997). Depressive and anxiety disorders in patients presenting with physical complaints: Clinical predictors and outcome. American Journal of Medicine, 103, 339–347.

    Article  CAS  PubMed  Google Scholar 

  30. 30.

    Ormel, J., Oldehinkel, A. J., Nolen, W. A., & Vollebergh, W. (2004). Psychosocial disability before, during, and after a major depressive episode: A 3-wave population-based study of state, scar, and trait effects. Archives of General Psychiatry, 61, 387–392; Clin.Pharmacol.Ther.

  31. 31.

    Iancu, S. C., Batelaan, N. M., Zweekhorst, M. B., Bunders, J. F., Veltman, D. J., Penninx, B. W., et al. (2014). Trajectories of functioning after remission from anxiety disorders: 2-year course and outcome predictors. Psychological Medicine, 44, 593–605.

    Article  CAS  PubMed  Google Scholar 

  32. 32.

    Buist-Bouwman, M. A., Ormel, J., de, G. R., & Vollebergh, W. A. (2004). Functioning after a major depressive episode: Complete or incomplete recovery? Journal of Affective Disorders, 82, 363–371.

    PubMed  Google Scholar 

  33. 33.

    Mathieson, F., Collings, S., & Dowell, A. (2009). Sub-threshold mental health syndromes: Finding an alternative to the medication of unhappiness. Journal of Primary Health Care, 1, 74–77.

    PubMed  Google Scholar 

  34. 34.

    Solomon, D. A., Leon, A. C., Endicott, J., Mueller, T. I., Coryell, W., Shea, M. T., et al. (2004). Psychosocial impairment and recurrence of major depression. Comprehensive Psychiatry, 45, 423–430.

    Article  PubMed  Google Scholar 

  35. 35.

    Gonzales, L. R., Lewinsohn, P. M., & Clarke, G. N. (1985). Longitudinal follow-up of unipolar depressives: An investigation of predictors of relapse. Journal of Consulting and Clinical Psychology, 53, 461–469.

    Article  CAS  PubMed  Google Scholar 

  36. 36.

    Faravelli, C., Ambonetti, A., Pallanti, S., & Pazzagli, A. (1986). Depressive relapses and incomplete recovery from index episode. American Journal of Psychiatry, 143, 888–891.

    Article  CAS  PubMed  Google Scholar 

  37. 37.

    Hemingway, H., Stafford, M., Stansfeld, S., Shipley, M., & Marmot, M. (1997). Is the SF-36 a valid measure of change in population health? Results from the Whitehall II Study. BMJ, 315, 1273–1279.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

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The authors would like to thank Carlos García Forero for his support in statistical matters and Dave Mc Farlane for his help in improving the understanding of the manuscript. The Netherlands Mental health Survey and Incidence Study-2 (NEMESIS-2) is conducted by the Netherlands Institute of Mental Health and Addiction in Utrecht. Financial support has been received from the Ministry of Health, Welfare and Sport, with supplemental support from the Netherlands Organization for Health Research and Development (ZonMw) and the Genetic Risk and Outcome of Psychosis (GROUP) investigators. Gabriela Barbaglia received support from the Spanish Ministry of Science and Innovation “Rio Hortega grant” (CM 10-00099), Spain.

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Correspondence to Gabriela Barbaglia.

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Barbaglia, G., ten Have, M., van Dorsselaer, S. et al. Low functional status as a predictor of incidence of emotional disorders in the general population. Qual Life Res 24, 651–659 (2015).

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  • Functional status
  • Emotional disorders
  • SF-36
  • Disability
  • Incidence