Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care

JAMA. 1994 Dec 14;272(22):1741-8. doi: 10.1001/jama.272.22.1741.


Objective: To examine the impact of common mental illness on functional disability and the cross-cultural consistency of this relationship while controlling for physical illness. A secondary objective was to determine the level of disability associated with specific psychiatric disorders.

Design: A cross-sectional sample selected by two-stage sampling.

Setting: Primary health care facilities in 14 countries covering most major cultures and languages.

Patients: A total of 25,916 consecutive attenders of these facilities were screened for psychopathology using the General Health Questionnaire (96% response). Screened patients were sampled from the General Health Questionnaire score strata for the second-stage Composite International Diagnostic Interview administered to 5447 patients (62% response).

Main outcome measures: Patient-reported physical disability, number of disability days, and interviewer-rated occupational role functioning.

Results: After controlling for physical disease severity, psychopathology was consistently associated with increased disability. Physical disease severity was an independent, although weaker, contributor to disability. A dose-response relationship was found between severity of mental illness and disability. Disability was most prominent among patients with major depression, panic disorder, generalized anxiety, and neurasthenia; disorder-specific differences were modest after controlling for psychiatric comorbidity. Results were consistent across disability measures and across centers.

Conclusions: The consistent relationship of psychopathology and disability indicates the compelling personal and socioeconomic impact of common mental illnesses across cultures. This suggests the importance of impairments of higher-order human capacities (eg, emotion, motivation, and cognition) as determinants of functional disability.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Comorbidity
  • Cross-Cultural Comparison*
  • Cross-Sectional Studies
  • Diagnosis-Related Groups
  • Disabled Persons / statistics & numerical data*
  • Health Status
  • Humans
  • Logistic Models
  • Mental Disorders / epidemiology*
  • Middle Aged
  • Psychiatric Status Rating Scales
  • World Health Organization