Common Mental Disorders and Disability Across Cultures

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<h3>Objective.</h3> —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. <h3>Design.</h3> —A cross-sectional sample selected by two-stage sampling. <h3>Setting.</h3> —Primary health care facilities in 14 countries covering most major cultures and languages. <h3>Patients.</h3> —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). <h3>Main Outcome Measures.</h3> —Patient-reported physical disability, number of disability days, and interviewer-rated occupational role functioning. <h3>Results.</h3> —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. <h3>Conclusions.</h3> —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. (<i>JAMA</i>. 1994;272:1741-1748)