Days out-of-role due to common physical and mental health problems: Results from the São Paulo Megacity Mental Health Survey, Brazil

Abstract

OBJECTIVES:To investigate the relative importance of common physical and mental disorders with regard to the number of days out-of-role (DOR; number of days for which a person is completely unable to work or carry out normal activities because of health problems) in a population-based sample of adults in the São Paulo Metropolitan Area, Brazil.METHODS:The São Paulo Megacity Mental Health Survey was administered during face-to-face interviews with 2,942 adult household residents. The presence of 8 chronic physical disorders and 3 classes of mental disorders (mood, anxiety, and substance use disorders) was assessed for the previous year along with the number of days in the previous month for which each respondent was completely unable to work or carry out normal daily activities due to health problems. Using multiple regression analysis, we examined the associations of the disorders and their comorbidities with the number of days out-of-role while controlling for socio-demographic variables. Both individual-level and population-level associations were assessed.RESULTS:A total of 13.1% of the respondents reported 1 or more days out-of-role in the previous month, with an annual median of 41.4 days out-of-role. The disorders considered in this study accounted for 71.7% of all DOR; the disorders that caused the greatest number of DOR at the individual-level were digestive (22.6), mood (19.9), substance use (15.0), chronic pain (16.5), and anxiety (14.0) disorders. The disorders associated with the highest population-attributable DOR were chronic pain (35.2%), mood (16.5%), and anxiety (15.0%) disorders.CONCLUSIONS:Because pain, anxiety, and mood disorders have high effects at both the individual and societal levels, targeted interventions to reduce the impairments associated with these disorders have the highest potential to reduce the societal burdens of chronic illness in the São Paulo Metropolitan Area.

Mental disorders and employment status in the São Paulo Metropolitan Area, Brazil: gender differences and use of health services

“…It further assessed the association between treatment seeking and employment status among respondents with 12-month DSM-IV mental disorders. Although these associations have been largely reported worldwide 5,6,7,8,9,10,11,12,13,14,15,16,17,19.18,20,21,23 , there is little information of this sort in Brazil 18,22 .…”

“…High prevalence rates of psychiatric morbidity were reported among adult residents living in the São Paulo Metropolitan Area, Brazil 24,25 , where mood, substance use and anxiety disorders, altogether, accounted for 49% of the total days out of role in the previous month 18 .…”

“…Low treatment-seeking rates reduce adequate rehabilitation and subsequent return to the workforce 7,9,10,14,15,16,22,23 . These associations, though, are likely to be two-way, as unemployment and its adverse consequences may deleteriously impact mental health 6,7,9,12,15,16,18,19 .…”

“…Mental disorders are significantly associated with unemployment and early retirement due to permanent or temporary disability 6,7,9,10,15,16,17,18,19,20 . Low treatment-seeking rates reduce adequate rehabilitation and subsequent return to the workforce 7,9,10,14,15,16,22,23 .…”

“…Results from the Global Burden of Disease (GBD) in Brazil showed that neuropsychiatric conditions were responsible for 21.5% of all disability-adjusted life years (DALYs) (25.1% among women and 18.6% among men), generating high social and economic costs 3,4 . Around the world, several studies were launched to estimate the prevalence and determinants of mental disorders in the general population, as well as to assess the impact of mental disorders on daily-living activities and work performance 5,6,7,8,9,10,11,12,13,14,15,16,17 , including in Brazil 18 . Most mental disorders have early onset, often leading to precocious and/or permanent disability, increasing the need for health care 15,16,17,18,19,20,21 .…”