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Which mental disorders are associated with the greatest impairment in functioning?

Abstract

Objective

The objective of this study is to estimate the comparative associations of mental disorders with three measures of functional impairment: the Global Assessment of Functioning (GAF); the number of days in the past 12 months of total inability to work or carry out normal activities because of emotions, nerves, or mental health (i.e., days out of role); and a modified version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0).

Methods

Secondary data analysis of the linked Mental Health Surveillance Study and the National Survey on Drug Use and Health (n = 5653), nationally representative population surveys conducted in the United States. Generalized linear models assessed the independent effects of mental disorders on each measure of functional impairment, controlling for mental disorder comorbidity, physical health disorders, and sociodemographic factors.

Results

The results varied across measures of functional impairment. However, mood disorders generally tended to be associated with the greatest functional impairment, anxiety disorders with intermediate impairment, and substance use disorders with the least impairment. All 15 disorders were significantly associated with the GAF score in multiple regression models, eight disorders were significantly associated with the WHODAS score, and three disorders were significantly associated with days out of role.

Conclusions

Our results highlight the value of complementary measures of functional impairment.

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Acknowledgements

This study was funded by the Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, Rockville, MD, USA (Contract No. HHSS283201000003C). The funding organization participated in designing the study and interpreting results.

Author information

Correspondence to Mark J. Edlund.

Ethics declarations

Informed consent

After the study was described to participants, verbal informed consent was obtained.

Ethical approval

The study was approved by the RTI International Institutional Review Board in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Conflict of interest

The authors declare that they have no conflict of interest.

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Edlund, M.J., Wang, J., Brown, K.G. et al. Which mental disorders are associated with the greatest impairment in functioning?. Soc Psychiatry Psychiatr Epidemiol 53, 1265–1276 (2018). https://doi.org/10.1007/s00127-018-1554-6

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Keywords

  • Disability
  • Functional impairment
  • Mental disorders
  • Global Assessment of Functioning