Psychological distress and risk of long-term disability: population-based longitudinal study

J Epidemiol Community Health. 2012 Jul;66(7):586-92. doi: 10.1136/jech.2010.119644. Epub 2011 Mar 21.


Background: Common mental disorders are known to cause long-term disability, although not much is known about long-term consequences of milder forms of psychological distress.

Objective: To investigate the association between increasing levels of psychological distress and 5-year risk of long-term disability pensions awarded for somatic or psychiatric conditions.

Methods: In this longitudinal population-based study, a cohort of 17,205 individuals, aged 18-64 years, recruited in 2002 in Stockholm County was prospectively followed up for new disability pension awards. The 12-item General Health Questionnaire (GHQ-12) was used to measure baseline psychological distress, and participants were categorised as having no, mild, moderate or severe psychological distress (GHQ-12 scores of 0; 1-2; 3-7 and 8-12, respectively). Details of new disability pension awards were obtained through record linkage with the Swedish National Insurance register. Comprehensive information on a range of sociodemographic, lifestyle and health characteristics was available.

Results: Increasing levels of psychological distress at baseline were associated with an increased likelihood of obtaining a disability pension later in life. Even mild psychological distress was independently associated with the award of a disability pension for both somatic (HR=1.7; 95% CI 1.3 to 2.2) and psychiatric diagnoses (2.2; 1.4 to 3.6). Over a quarter of disability pensions awarded for a somatic diagnosis, and almost two-thirds awarded for a psychiatric diagnosis, could be attributed to psychological distress.

Conclusions: Mild psychological distress may be associated with more long-term disability than previously acknowledged and its public health importance may be underestimated.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Disabled Persons*
  • Humans
  • Life Style
  • Longitudinal Studies
  • Mental Disorders / diagnosis
  • Middle Aged
  • Prospective Studies
  • Risk Assessment / methods
  • Social Class
  • Stress, Psychological / complications*
  • Surveys and Questionnaires
  • Sweden
  • Young Adult