title: Health conditions and role limitation in three European Regions: a public-health perspective.
abstract: OBJECTIVE
  To describe the distribution of role limitation in the European population aged 18-64 years and to examine the contribution of health conditions to role limitation using a public-health approach.
  
  
  METHODS
  Representative samples of the adult general population (n=13,666) aged 18-64 years from 10 European countries of the World Mental Health (WMH) Surveys Initiative, grouped into three regions: Central-Western, Southern and Central-Eastern. The Composite International Diagnostic Interview (CIDI 3.0) was used to assess six mental disorders and standard checklists for seven physical conditions. Days with full and with partial role limitation in the month previous to the interview were reported (WMH-WHODAS). Population Attributable Fraction (PAFs) of full and partial role limitation were estimated.
  
  
  RESULTS
  Health conditions explained a large proportion of full role limitation (PAF=62.6%) and somewhat less of partial role limitation (46.6%). Chronic pain was the single condition that consistently contributed to explain both disability measures in all European Regions. Mental disorders were the most important contributors to full and partial role limitation in Central-Western and Southern Europe. In Central-Eastern Europe, where mental disorders were less prevalent, physical conditions, especially cardiovascular diseases, were the highest contributors to disability.
  
  
  CONCLUSIONS
  The contribution of health conditions to role limitation in the three European regions studied is high. Mental disorders are associated with the largest impact in most of the regions. There is a need for mainstreaming disability in the public health agenda to reduce the role limitation associated with health conditions. The cross-regional differences found require further investigation.
authors.affiliation: Agency for Health and Quality Assessment of Catalonia (AQuAS), Barcelona, Spain; Universitat Pompeu Fabra, Department of Experimental Sciences and Health, Faculty of Public Health and Education in Health Sciences, Barcelona, Spain.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Barbaglia
authors.affiliation: University of Lucerne, Faculty of Humanities and Social Sciences, Department of Health Science and Health Policy, Lucerne, Switzerland.
authors.forename: Núria D
authors.initials: ND
authors.lastname: Adroher
authors.affiliation: Universitat Pompeu Fabra, Department of Experimental Sciences and Health, Faculty of Public Health and Education in Health Sciences, Barcelona, Spain; Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Vilagut
authors.affiliation: Universitair Psychiatrisch Centrum, KU Leuven (UPC-KUL), Leuven, Belgium.
authors.forename: Ronny
authors.initials: R
authors.lastname: Bruffaerts
authors.affiliation: University of Ulster, School of Psychology, Research Institute of Psychology, Northern Ireland, United Kingdom.
authors.forename: Brentan
authors.initials: B
authors.lastname: Bunting
authors.affiliation: Universidade Nova de Lisboa, Faculty of Medical Sciences, Mental Health Department, Lisbon Portugal.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Caldas de Almeida
authors.affiliation: National School of Public Health, Management and Professional Development, Bucharest, Romania.
authors.forename: Silvia
authors.initials: S
authors.lastname: Florescu
authors.affiliation: Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Girolamo
authors.affiliation: Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
authors.forename: Ron
authors.initials: R
authors.lastname: de Graaf
authors.affiliation: Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat (Barcelona), España; CIBER en Salud Mental (CIBERSAM), Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
authors.affiliation: National Center for Public Health Protection, Department of Mental Health, Sofia, Bulgaria.
authors.forename: Hristo
authors.initials: H
authors.lastname: Hinkov
authors.affiliation: Université Paris Descartes, Department of Epidemiology, Evaluation and Health policies, Paris, France.
authors.forename: Vivianne
authors.initials: V
authors.lastname: Kovess-Masfety
authors.affiliation: University of Leizpig, Department of Social Medicine, Occupational Health and Public Health, Leipzig, Germany.
authors.forename: Herbert
authors.initials: H
authors.lastname: Matschinger
authors.affiliation: Universitat Pompeu Fabra, Department of Experimental Sciences and Health, Faculty of Public Health and Education in Health Sciences, Barcelona, Spain; Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain. Electronic address: jalonso@imim.es.
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
mesh_terms: D000293:Adolescent; D000328:Adult; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004813:Epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011634:Public Health; D055815:Young Adult
keywords: Common health conditions; Disability; Discapacidad; Population attributable risk; Proporción atribuible de riesgo; Role limitation; Trastornos físicos; Trastornos mentales