Disability mediates the impact of common conditions on perceived health.

BACKGROUND: We examined the extent to which disability mediates the observed associations of common mental and physical conditions with perceived health. METHODS AND FINDINGS: WHO World Mental Health (WMH) Surveys carried out in 22 countries worldwide (n = 51,344 respondents, 72.0% response rate). We assessed nine common mental conditions with the WHO Composite International Diagnostic Interview (CIDI), and ten chronic physical with a checklist. A visual analog scale (VAS) score (0, worst to 100, best) measured perceived health in the previous 30 days. Disability was assessed using a modified WHO Disability Assessment Schedule (WHODAS), including: cognition, mobility, self-care, getting along, role functioning (life activities), family burden, stigma, and discrimination. Path analysis was used to estimate total effects of conditions on perceived health VAS and their separate direct and indirect (through the WHODAS dimensions) effects. Twelve-month prevalence was 14.4% for any mental and 51.4% for any physical condition. 31.7% of respondents reported difficulties in role functioning, 11.4% in mobility, 8.3% in stigma, 8.1% in family burden and 6.9% in cognition. Other difficulties were much less common. Mean VAS score was 81.0 (SD = 0.1). Decrements in VAS scores were highest for neurological conditions (9.8), depression (8.2) and bipolar disorder (8.1). Across conditions, 36.8% (IQR: 31.2-51.5%) of the total decrement in perceived health associated with the condition were mediated by WHODAS disabilities (significant for 17 of 19 conditions). Role functioning was the dominant mediator for both mental and physical conditions. Stigma and family burden were also important mediators for mental conditions, and mobility for physical conditions. CONCLUSIONS: More than a third of the decrement in perceived health associated with common conditions is mediated by disability. Although the decrement is similar for physical and mental conditions, the pattern of mediation is different. Research is needed on the benefits for perceived health of targeted interventions aimed at particular disability dimensions.

Mental disorders among persons with diabetes--results from the World Mental Health Surveys.

OBJECTIVE: To estimate 12-month prevalence rate of mood, anxiety, and alcohol-use disorders among community samples of diabetic persons. We assess whether associations of specific mental disorders with diabetes are consistent across diverse countries after controlling for age and gender. RESEARCH DESIGN AND METHODS: Eighteen surveys of household-residing adults were conducted in two phases across 17 countries in Europe, the Americas, the Middle East, Africa, Asia, and the South Pacific (Part 1, N=85,088). Mental disorders, identified by the World Mental Health-Composite International Diagnostic Interview, included anxiety disorders (generalized anxiety disorder, panic disorder/agoraphobia, posttraumatic stress disorder, and social phobia), mood disorders (dysthymia and major depressive disorder), and alcohol abuse/dependence. Diabetes was ascertained by self-report (Part 2, N=42,697). Association was assessed by age-gender adjusted odds ratios. RESULTS: Risk of mood and anxiety disorders was slightly higher among persons with diabetes relative to those without: odds ratio of 1.38 for depression (95% CI=1.15-1.66) and 1.20 for anxiety disorders, (95 % CI=1.01-1.42), after adjusting for age and gender. Odds ratio estimates across countries did not differ more than chance expectation. Alcohol-use disorders were uncommon among persons with diabetes in most countries, and not associated with diabetes in pooled survey data. CONCLUSIONS: Population sample surveys revealed mood and anxiety disorders occurred with somewhat greater frequency among persons with diabetes than those without diabetes. Prevalence of major depression among persons with diabetes was lower in the general population than suggested by prior studies of clinical samples. Strength of association did not differ significantly across disorders or countries.

Toward a global view of alcohol, tobacco, cannabis, and cocaine use: findings from the WHO World Mental Health Surveys.

BACKGROUND: Alcohol, tobacco, and illegal drug use cause considerable morbidity and mortality, but good cross-national epidemiological data are limited. This paper describes such data from the first 17 countries participating in the World Health Organization's (WHO's) World Mental Health (WMH) Survey Initiative. METHODS AND FINDINGS: Household surveys with a combined sample size of 85,052 were carried out in the Americas (Colombia, Mexico, United States), Europe (Belgium, France, Germany, Italy, Netherlands, Spain, Ukraine), Middle East and Africa (Israel, Lebanon, Nigeria, South Africa), Asia (Japan, People's Republic of China), and Oceania (New Zealand). The WHO Composite International Diagnostic Interview (CIDI) was used to assess the prevalence and correlates of a wide variety of mental and substance disorders. This paper focuses on lifetime use and age of initiation of tobacco, alcohol, cannabis, and cocaine. Alcohol had been used by most in the Americas, Europe, Japan, and New Zealand, with smaller proportions in the Middle East, Africa, and China. Cannabis use in the US and New Zealand (both 42%) was far higher than in any other country. The US was also an outlier in cocaine use (16%). Males were more likely than females to have used drugs; and a sex-cohort interaction was observed, whereby not only were younger cohorts more likely to use all drugs, but the male-female gap was closing in more recent cohorts. The period of risk for drug initiation also appears to be lengthening longer into adulthood among more recent cohorts. Associations with sociodemographic variables were consistent across countries, as were the curves of incidence of lifetime use. CONCLUSIONS: Globally, drug use is not distributed evenly and is not simply related to drug policy, since countries with stringent user-level illegal drug policies did not have lower levels of use than countries with liberal ones. Sex differences were consistently documented, but are decreasing in more recent cohorts, who also have higher levels of illegal drug use and extensions in the period of risk for initiation.