Ormel J, VonKorff M, Ustun T B, Pini S, Korten A, Oldehinkel T
Department of Psychiatry, University of Groningen, The Netherlands.
JAMA. 1994 Dec 14;272(22):1741-8. doi: 10.1001/jama.272.22.1741.
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.
A cross-sectional sample selected by two-stage sampling.
Primary health care facilities in 14 countries covering most major cultures and languages.
A total of 25,916 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).
Patient-reported physical disability, number of disability days, and interviewer-rated occupational role functioning.
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.
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.
在控制躯体疾病的情况下，研究常见精神疾病对功能残疾的影响以及这种关系的跨文化一致性。次要目的是确定与特定精神障碍相关的残疾水平。
采用两阶段抽样选择的横断面样本。
14个国家的初级卫生保健机构，涵盖大多数主要文化和语言。
使用一般健康问卷对这些机构的25916名连续就诊者进行精神病理学筛查（应答率96%）。从一般健康问卷得分分层中抽取筛查患者，对5447名患者进行第二阶段的综合国际诊断访谈（应答率62%）。
患者报告的躯体残疾、残疾天数以及访谈者评定的职业角色功能。
在控制躯体疾病严重程度后，精神病理学始终与残疾增加相关。躯体疾病严重程度是残疾的一个独立因素，尽管作用较弱。发现精神疾病严重程度与残疾之间存在剂量反应关系。在重度抑郁症、惊恐障碍、广泛性焦虑症和神经衰弱患者中，残疾最为突出；在控制精神疾病共病后，特定疾病的差异较小。结果在残疾测量指标和各中心之间是一致的。
精神病理学与残疾之间的一致关系表明，常见精神疾病在不同文化中对个人和社会经济具有令人信服的影响。这表明高阶人类能力（如情感、动机和认知）的损害作为功能残疾的决定因素的重要性。
