Background. This study describes the differences in
psychological distress, disability and
psychosocial resources between types of major medical conditions and
sensory impairments (collectively denoted as CMCs); and tests whether disability
psychosocial resources mediate CMC-specific mental health effects.
Methods. Data were obtained from a population-based,
cross-sectional survey of 5078 non-institutionalized, late middle-aged
older Dutch persons. The predictors were 16 types of CMCs,
including all major chronic medical diseases as well as impairment of
hearing, vision, and cognition.
The outcomes were assessed in terms of psychological distress as measured
the Hospital Anxiety
and Depression Scale. Two aspects of disability were measured (namely,
physical and role functioning) and also three psychosocial resources (namely,
mastery, self-efficacy and social support).
Results. Level of psychological distress varied across type
CMC. Hearing impairment,
neurological disease, vision impairment, and lung and heart disease had
associations with distress. The level of distress in patients with hearing
impairment was 0·45
standard deviation higher than in those without hearing impairment (adjusted
and all other CMCs). Roughly similar patterns of association were found
between type of CMC and
disability, and also, but to a lesser extent, mastery and self-efficacy.
Stepwise multiple regression
revealed that type of CMC accounted for 9%of the variance in distress
initially, but this fell to 1%
after the variance due to disability, mastery and self-efficacy was taken
out. Social support was not
a mediator. Disability and psychosocial resources accounted for 13% and
of the variance in distress, respectively.
Conclusion. These results support the conventional wisdom that
it is not the nature of the condition
that determines psychological distress, but instead the severity of the
disability and loss of
psychological resources associated with the condition on the one hand
and the psychological characteristics of the patient on the other.