FUNCTIONAL IMPAIRMENT ASSOCIATED WITH PSYCHOLOGICAL DISTRESS AND MEDICAL SEVERITY IN RURAL PRIMARY-CARE PATIENTS

Objective: The study examined functional impairment associated with ps ychological distress and severity of medical illness in a rural primar y care population and explored ho rv functional impairment varied with psychological distress and chronic medical illness. methods: Fifty-ei ght patients recruited from three rural primary care clinics completed the 36-item Short Form Health Survey (SF-36) and the Typology of Psyc hic Distress (PsyDis), The chronic disease score, a measure of the sev erity of chronic medical illness, was calculated from data on use of p rescription medications over a six-month period. T tests were used to determine the level of functional impairment associated with various l evels of psychological distress and medical illness. Regression analys es were used to determine the proportion of variance in impairment tha t was explained by level of psychological distress and severity of med ical 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 ment al health, whereas a high level of severity of chronic medical illness explained the variance in impairment in physical functioning. Both hi gh psychological distress and high severity of chronic medical illness explained the variance in impairment in vitality, and neither variabl e explained variance in impairment in physical role or bodily pain. Co nclusions: In this rural outpatient primary care population, functiona l impairment was explained more by psychological distress than by seve rity of medical illness. Decreasing the burden of psychological distre ss among primary care patients may improve functioning.