Abstract
Objective: Mental illness often interferes with daily functioning and an individual's pattern of psychiatric signs and symptoms may predict risk of future disability. Understanding the linkage between psychiatric symptoms and impaired functioning is critical for accurate rehabilitation planning and legal assessment. Here, we investigated the stability of functional impairment measures over 18 months and their association with psychiatric symptoms. Moreover, we developed a clinical self-report measure that allows estimation of functional impairment levels over 18 month observation periods.Methods: Consecutively treated outpatients and daycare patients (N = 155) from several psychiatric units in Switzerland completed the Dissociative Experiences Scale, Somatoform Dissociation Questionnaire, Multidimensional Inventory for Dissociation, Beck Depression Inventory, Brief Symptom Inventory, and WHO Disability Assessment Schedule at baseline, 6, 12, and 18 month follow-up examinations. The association between symptoms functional impairment over time was investigated using longitudinal linear mixed models. Penalized regression was used to identify questionnaire items that best predicted functional impairment.Results: We found high stability in the extent of functional impairment over 18 months. Fear of negative evaluation, fatigue, concentration problems, negative alterations in mood, and dissociative symptoms showed the strongest association with functional impairment measures. The empirically derived scale for functional impairment prediction explained between 0.62 and 0.77 of the variance in disability across various life domains.Conclusion: Given the capability for somatic and mental symptoms associated with social anxiety, depression, and dissociation to predict future disability, these symptoms have strong potential for guiding rehabilitation planning and prognostic evaluation in insurance medicine. The Functional Impairment Prediction Scale may serve as a valuable, empirical-based extension in legal assessments of how work capacity is affected by psychological factors.
Highlights
Mental illness often interferes with daily functioning and work ability
A study conducted by the Organization for Economic Cooperation and Development (OECD) in West European countries, America and Australia reported an overall increase of disability payments due to mental disorders from the mid-1990s through 2009
A cohort study conducted in the Netherlands between July 2010 and June 2011 revealed that 33% of men and 35% of women who received disability payments had a main diagnosis of a mental disorder [6]
Summary
Mental illness often interferes with daily functioning and work ability. Worldwide, psychiatric disability accounts for the highest proportion of disability among all diseases [1]. Data in other West European countries, America and Australia are similar, and in most countries an increasing percentage of disability payments are granted due to mental disorders. A study conducted by the Organization for Economic Cooperation and Development (OECD) in West European countries, America and Australia reported an overall increase of disability payments due to mental disorders from the mid-1990s through 2009. In the UK, for instance, government data from 1995 to 2014 showed a decrease of overall disability payments by 6.4%, but an increase in payments due to mental disorders from 21.4 to 45.4% [5]. The major challenges mental disorders represent for the health and social security systems of both developed and developing countries call for better insights into the mechanisms causing disability
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