International Journal of Epidemiology, Vol 26, 1063-1070, Copyright © 1997 by International Epidemiological Association
P Manninen, M Heliovaara, H Riihimaki and P Makela
STUDY OBJECTIVE: To evaluate psychological distress as a predictor of
disability due to common chronic disorders. STUDY POPULATION AND METHODS: A
10-year follow-up study was carried out among a representative cohort (N =
8655) of 18-64 year old Finnish farmers, who had participated in a health
survey in 1979 and were able to work at baseline. A record linkage with the
nationwide register of the Social Insurance Institution was made to
identify disability pensions granted between 1980 and 1990 in the cohort.
The medical certificates of 1004 (11.6%) prematurely retired farmers were
reviewed to confirm and classify disabling conditions. A sum score based on
self-reports of 11 symptoms at the baseline was used as a measure of
psychological distress. RESULTS: After adjustment for age, sex, smoking and
body mass index, the cause-specific relative risks (RR) (95% confidence
intervals [CI]) of disability in the highest quartile of the psychological
distress score as compared with the lowest quartile were for myocardial
infarction 2.34 (95% CI: 1.17-4.69), for depression 2.50 (95% CI: 1.09-
5.72), for neck-shoulder disorders 1.98 (95% CI: 1.26-3.11), for
unspecified low-back disorders 1.76 (95% CI: 1.24-2.49), for knee
osteoarthritis 1.55 (95% CI: 0.91-2.63) and for trip osteoarthritis 0.89
(95% CI: 0.42-1.85). The corresponding RR for overall disability was 1.76
(95% CI: 1.44-2.14) in the highest quartile of psychological distress score
as compared with the lowest quartile. CONCLUSIONS: Psychological distress
is an independent risk factor for disability. Its predictive significance
varies between disorders leading to functional deterioration. The
association mechanisms are likely to vary from one disorder to another.
ARTICLES
Does psychological distress predict disability?
Department of Community Health and General Practice, University of Kuopio, Finland.
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