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Clinical Articles, Lead Article

Low-Level Stress Linked To Chronic Disability

Even relatively mild psychological stress can lead to long term disability and an inability to work, according to a large population based study published online1 in the Journal of Epidemiology and Community Health.

The authors, led by Dr Dheeraj Rai, University of Bristol, conducted a longitudinal population-based study on a cohort of 17,205 individuals (aged 18-64 years). Recruited from the Stockholm area in 2002, participants completed the 12-item General Health Questionnaire (GHQ-12) to measure baseline psychological distress, categorised as having no, mild, moderate or severe
psychological distress (GHQ-12 scores of 0; 1-2; 3-7 and 8-12, respectively).

Person with stress

The cohort’s health was tracked up to 2007, details of new disability pension awards obtained through record linkage with the Swedish National Insurance register. Increasing levels of psychological distress at baseline were associated with an increased likelihood of obtaining a disability pension later in life.

Even mild psychological distress was independently associated with the award of a disability pension for both somatic (HR=1.7; 95% CI 1.3 to 2.2) and psychiatric diagnoses (2.2; 1.4 to 3.6) after taking account of other factors such as lifestyle and alcohol intake. Over a quarter of disability pensions awarded for a somatic diagnosis (such as hypertension, angina, or stroke), and almost two-thirds awarded for a psychiatric diagnosis, could be attributed to psychological distress.

The authors say that it is important to consider their findings in the context of modern working life, which places greater demands on employees, and social factors, such as a lack of close personal relationships and supportive networks. 

These factors lead them to ask: “Are the strains and demands of modern society commonly exceeding human ability?” They conclude that while mild stress should not be over-medicalised, their findings suggest that it should be taken more seriously than it is.


  1. Rai D, Kosidou K, Lundberg M, Araya R, Lewis G, Magnusson C. Psychological distress and risk of long-term disability: population-based longitudinal study. J Epidemiol Community Health 2011;doi:10.1136/jech.2010.119644

Published on: April 6, 2011

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