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Psychological distress and risk of long-term disability: population-based longitudinal study
  1. Dheeraj Rai1,
  2. Kyriaki Kosidou2,
  3. Michael Lundberg2,
  4. Ricardo Araya1,
  5. Glyn Lewis1,
  6. Cecilia Magnusson2
  1. 1Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Clifton, Bristol, UK
  2. 2Division of Public Health Epidemiology, Karolinska Institute, Norrbacka, Stockholm, Sweden
  1. Correspondence to Dr Dheeraj Rai, Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol BS8 2BN, UK; dheeraj.rai{at}


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.

  • Depression
  • disability
  • disabling disease
  • psychological distress
  • psychosocial epidemiology

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  • Funding Supported by a grant from Stockholm County Council, Swedish Council for Working Life and Social Research (DNR 2007-2064).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Stockholm Regional Ethical Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.