Chronic physical illness, psychiatric disorder and disability in the workplace

While agreement is growing that mental illness burdens the North American e conomy, how it impacts productivity - particularly compared to physical ill ness - is unclear. Hypothesizing that lost work days are only the tip of th e iceberg, we also examined the association of mental and chronic physical illness with partial work days and days requiring extra effort to function. Data from 4225 employed individuals, aged 18-54, were analyzed. These were a subset of respondents to the Ontario Health Survey's Mental Health Supple ment, a 1990/91 epidemiologic survey of households across Ontario, Canada. Psychiatric disorder was assessed using the University of Michigan' modific ation of WHO's Composite International Diagnostic Interview (UM-CIDI). Similar to US reports, professional/managerial groups had lower rates of af fective and anxiety disorders and fewer disability days compared to the res t of the workforce. However, no single occupational group was consistently at greater risk for either physical or psychiatric problems. Even after accounting for sociodemographic characteristics and work conditi ons,mental and physical status had clear, but different, impacts on product ivity. Physical conditions alone had a fairly constant effect across all ty pes of disability days and were the largest contributor to total work day l oss. They also significantly impacted partial and extra effort days but wer e far less important than conditions involving a mental disorder. Responden ts with mental health problems, either alone or in combination with physica l illnesses, appeared more likely to go to work but to require greater effo rt to function. WHO projects that mental illness will become the second most important caus e of global disease burden in the next century. Our findings suggest that a mong working individuals, it affects productivity more subtly than does phy sical illness. However, with an estimated eight percent of Ontario's workfo rce experiencing more than two months annually of decreased productivity, i t still incurs significant social and economic costs. (C) 2000 Elsevier Sci ence Ltd. All rights reserved.