Teasing apart the complex relationship between psychological distress, mental health conditions, social factors, and disability in the United States
Creators: name: Lauer, Eric Andrew
Publisher: name: No Publisher Supplied
Year: 2017

description: Context: In the United States, more than 50 million people experience mental illness and  disabilities. However, despite research suggesting improved mental health is associated  with disability prevention, there has been limited study of mental health indicators and  standardized disability identifiers included in national surveys for public health  surveillance efforts. Moreover, studies are complicated by the fact that functional  limitations are common to both mental disorders and disabilities and it is unclear how  well mental health symptoms, function, and disability are differentiable in populationbased  studies.    Specific Aims: The goals of this dissertation were to (1) examine the association between  non-specific psychological distress (NSPD), duration of activity limitations due to mental  health conditions (ALMH), and the function and activity difficulties used to identify  people with disabilities in U.S. national surveys (Study 1); (2) determine the risk of  experiencing disabilities among people reporting combinations of NSPD or ALMH to  test if mental health symptoms and conditions could be distinguished (Study 2); and (3)  measure the association between mental health, social determinants of health (SDH), and  cognitive disability and identify groups with distinct conceptual and empirical differences  across measures (Study 3).    Methods: 2008-2015 National Health Interview Survey data was used to (1) estimate the  risk of disabilities among people reporting NSPD or ALMH (Study 1), (2) estimate risk  of disabilities across combined NSPD-ALMH subgroups and demographic factors (Study  2); and (3) estimate the prevalence of SDH and risk of cognitive disability among people  with poor mental health (Study 3).    Results: The first study found that people reporting NSPD and ALMH were at  significantly increased risk of reporting a disability, including hearing and vision  disabilities. For example, after adjusting for gender and race/ethnicity, people ages 35-54  years reporting severe NSPD were at 8.5 times greater risk of reporting a cognitive  disability, compared to people ages 35-64 reporting no NSPD. The second study found  synergy between NSPD and ALMH when estimating disability risk. For example, people  reporting NSPD and ALMH were at 7.1 (95% CI = 6.6, 7.6) times the risk of reporting  cognitive disabilities, compared to people reporting NSPD and no ALMH. The third  study found the prevalence of cognitive disability and adverse SDH increased in a robust,  stepwise fashion across gradients of poor mental health (defined by NSPD and/or  ALMH). Within NSPD-ALMH groups, cognitive disability risk was increased among  people with adverse SDH, compared to people without adverse SDH.    Conclusion: The findings of this dissertation provide evidence that people with any  psychological distress and/or any duration of mental health conditions are at significantly  increased risk of experiencing all disability types. This should be more heavily  recognized in the mental health and disability literature and provides evidence that people  with disabilities, especially cognitive disabilities, identified by federally recognized  disability questions, represent a population experiencing psychological distress and  serious mental illness. Theoretically, the results of this dissertation were consistent with  the conceptual framework supported by the International Classification of Functioning,  Disability, and Health (ICF). I was able to show that the risk of disabilities increases on a  continuum of impairment described by the ICF, with severity of psychological distress  and duration of mental health condition. Further, I was also able to validate both the  psychiatric literature and ICF and show that the distinction between mental health  symptoms and conditions matters in a very concrete, quantitative, inferential manner in a  population study. Although federally recognized disability questions are designed to  capture conceptually distinct populations, disability as a field should recognize the  pervasiveness of poor mental health among people with disabilities. In national  surveillance, identifying people based on mental health symptoms and/or conditions  identifies subpopulations with differential distributions of social determinants of health  and disability risk targetable for public health interventions. Disability and mental health  policy can now use this information to improve and provide more specific supports,  services, and programs for both groups. The over 65 federally recognized definitions of  disability should recognize that mental health plays a substantial role in the disability  experience.