title: Functional impairment associated with psychological distress and medical severity in rural primary care patients.
abstract: OBJECTIVE
  The study examined functional impairment associated with psychological distress and severity of medical illness in a rural primary care population and explored how functional impairment varied with psychological distress and chronic medical illness.
  
  
  METHODS
  Fifty-eight patients recruited from three rural primary care clinics completed the 36-item Short Form Health Survey (SF-36) and the Typology of Psychic Distress (PsyDis). The chronic disease score, a measure of the severity of chronic medical illness, was calculated from data on use of prescription medications over a six-month period. T tests were used to determine the level of functional impairment associated with various levels of psychological distress and medical illness. Regression analyses were used to determine the proportion of variance in impairment that was explained by level of psychological distress and severity of medical illness.
  
  
  RESULTS
  High levels of psychological distress explained the variance in impairment in several domains measured by the SF-36, including general health, social functioning, emotional role, and mental health, whereas a high level of severity of chronic medical illness explained the variance in impairment in physical functioning. Both high psychological distress and high severity of chronic medical illness explained the variance in impairment in vitality, and neither variable explained variance in impairment in physical role or bodily pain.
  
  
  CONCLUSIONS
  In this rural outpatient primary care population, functional impairment was explained more by psychological distress than by severity of medical illness. Decreasing the burden of psychological distress among primary care patients may improve functioning.
authors.affiliation: Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque 87131, USA.
authors.forename: A
authors.initials: A
authors.lastname: Thurston-Hicks
authors.forename: S
authors.initials: S
authors.lastname: Paine
authors.forename: M
authors.initials: M
authors.lastname: Hollifield
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D002908:Chronic Disease / Q000523:psychology*; D017281:Cost of Illness; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009516:New Mexico; D011320:Primary Health Care / Q000706:statistics & numerical data; D012044:Regression Analysis; D012423:Rural Health / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D012917:Social Adjustment; D013315:Stress, Psychological / Q000150:complications*