title: Days out-of-role due to common physical and mental health problems: results from the São Paulo Megacity Mental Health Survey, Brazil.
abstract: OBJECTIVE
  To investigate the relative importance of common physical and mental disorders with regard to the number of days out-of-role (DOR; number of days for which a person is completely unable to work or carry out normal activities because of health problems) in a population-based sample of adults in the São Paulo Metropolitan Area, Brazil.
  
  
  METHODS
  The São Paulo Megacity Mental Health Survey was administered during face-to-face interviews with 2,942 adult household residents. The presence of 8 chronic physical disorders and 3 classes of mental disorders (mood, anxiety, and substance use disorders) was assessed for the previous year along with the number of days in the previous month for which each respondent was completely unable to work or carry out normal daily activities due to health problems. Using multiple regression analysis, we examined the associations of the disorders and their comorbidities with the number of days out-of-role while controlling for socio-demographic variables. Both individual-level and population-level associations were assessed.
  
  
  RESULTS
  A total of 13.1% of the respondents reported 1 or more days out-of-role in the previous month, with an annual median of 41.4 days out-of-role. The disorders considered in this study accounted for 71.7% of all DOR; the disorders that caused the greatest number of DOR at the individual-level were digestive (22.6), mood (19.9), substance use (15.0), chronic pain (16.5), and anxiety (14.0) disorders. The disorders associated with the highest population-attributable DOR were chronic pain (35.2%), mood (16.5%), and anxiety (15.0%) disorders.
  
  
  CONCLUSIONS
  Because pain, anxiety, and mood disorders have high effects at both the individual and societal levels, targeted interventions to reduce the impairments associated with these disorders have the highest potential to reduce the societal burdens of chronic illness in the São Paulo Metropolitan Area.
authors.affiliation: Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São PauloSP, Brazil.
authors.forename: Laura Helena
authors.initials: LH
authors.lastname: Andrade
authors.forename: Marcos C
authors.initials: MC
authors.lastname: Baptista
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
authors.forename: Maria
authors.initials: M
authors.lastname: Petukhova
authors.forename: Ronny
authors.initials: R
authors.lastname: Bruffaerts
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
authors.forename: Camila M
authors.initials: CM
authors.lastname: Silveira
authors.forename: Erica R
authors.initials: ER
authors.lastname: Siu
authors.forename: Yuan-Pang
authors.initials: YP
authors.lastname: Wang
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Viana
mesh_terms: D000041:Absenteeism; D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D059350:Chronic Pain / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008603:Mental Health / Q000706:statistics & numerical data; D015995:Prevalence; D012959:Socioeconomic Factors; D013997:Time Factors; D014505:Urban Population / Q000706:statistics & numerical data; D014944:World Health Organization; D055815:Young Adult