What makes the difference in people's lives when they have a mental disorder?

OBJECTIVES: The objective of this study was to identify which environmental factors are the most responsible for the disability experienced by persons with mental disorders and whether they differ (1) from those in cardiovascular diseases, chronic respiratory conditions, diabetes, and cancer, and (2) depending on the capacity level-a proxy for the impact of health conditions on the health state of individuals. METHODS: Nationally representative data from 12,265 adults in Chile collected in 2015 with the WHO Model Disability Survey was analyzed. RESULTS: The availability of personal assistance, frequency of receiving personal assistance, and assistive devices for mobility were the most important environmental factors across mental and other non-communicable diseases. Perception of discrimination and use of health services were also prominent factors. There was a huge overlap between the factors found relevant for mental and other non-communicable diseases, but a substantial variability depending on the intensity of difficulties in capacity. CONCLUSIONS: This study challenges the appropriateness of disease-specific approaches and suggests that considering intrinsic capacity levels is more informative than focusing on diagnosis alone when comparing needs and barriers that affect the performance in daily life of specific groups of individuals.

Determinants of Work Performance in Workers with Depression and Anxiety: A Cross-Sectional Study.

Depression and anxiety are highly prevalent disorders with an impact on existential aspects of person's life, including employment i.e., work performance (WP). In order to develop appropriate strategies, it is essential to identify determinants of WP. The objective of this study was to identify the built, social, attitudinal and health system-related environmental determinants of WP in workers with anxiety or depression in total (N = 1211) and regarding the level of disability. Hierarchical binary logistic regression was performed on data obtained from implementation of the WHO Model Disability Survey (MDS) in Chile in 2015. Hindering aspects of means of transportation and workplace, and the use of personal assistance were determinants of WP for all workers with anxiety or depression. Results differed with level of disability. Hindering aspects of means of transportation and workplace, and discrimination were determinants of WP for persons with mild to moderate disability, while hindering aspects of the workplace and dwelling, and the use of personal assistance were determinants of WP for persons with severe disability. Our results emphasize the need for a broader understanding of determinants of WP and the requirement for an integrative approach in developing both universal and specific strategies that go beyond workplace settings.