Explaining the disability paradox: a cross-sectional analysis of the Swiss general population

BMC Public Health. 2012 Aug 15;12:655. doi: 10.1186/1471-2458-12-655.


Background: Disability can be broken down into difficulties in different components of functioning such as impairments and limitations in activities and participation (A&P). Previous studies have produced the seemingly surprising result that persons with severe impairments tend to report high quality of life (QoL) including perceived health regardless of their condition; the so-called "disability paradox". We aim to study the role of contextual factors (i.e. the personal and environmental situation) in explaining the disability paradox.

Methods: The Swiss Health Survey provides information on the perceived health of 18,760 participants from the general population. We construct a conditional independence graph applying random forests and stability selection in order to represent the structure of impairment, A&P limitation, contextual factors, and perceived health.

Results: We find that impairment and A&P limitations are not directly related but only via a cluster of contextual factors. Similarly, impairment and perceived health are not directly related. On the other hand, perceived health is directly connected with A&P limitations. We hypothesize that contextual factors have a moderating and/or mediating effect on the relationship of impairment, A&P limitations, and perceived health.

Conclusion: The disability paradox seems to dissolve when contextual factors are put into consideration. Contextual factors may be responsible for some persons with impairments developing A&P limitations and others not. In turn, persons with impairments may only then perceive bad health when they experience A&P limitation. Political interventions at the level of the environment may reduce the number of persons who perceive bad health.

MeSH terms

  • Adult
  • Aged
  • Cross-Sectional Studies
  • Diagnostic Self Evaluation*
  • Disability Evaluation
  • Disabled Persons / psychology*
  • Disabled Persons / statistics & numerical data
  • Female
  • Health Surveys
  • Humans
  • Male
  • Middle Aged
  • Mobility Limitation
  • Quality of Life / psychology*
  • Switzerland