Mediators of the association between depression and role functioning

M. A. Buist-Bouwman, J. Ormel, R. De Graaf, P. De Jonge, E. Van Sonderen, J. Alonso, R. Bruffaerts, W. A M Vollebergh, Jordi Alonso, Matthias Angermeyer, Sebastian Bernert, Ronny Bruffaerts, Traolach S. Brugha, Giovanni De Girolamo, Ron De Graaf, Koen Demyttenaere, Isabelle Gasquet, Josep Maria Haro, Steven J. Katz, Ronald C. KesslerViviane Kovess, Jean Pierre Lépine, Johan Ormel, Gabriella Polidori, Gemma Vilagut

Research output: Contribution to journalArticlepeer-review


Objective: While the adverse effect of Major Depressive Episode on role functioning is well established, the exact pathways remain unclear. Method: Data from The European Study of the Epidemiology of Mental Disorders, a cross-sectional survey including 21 425 adults from six European countries, were used to assess 12-month depression (Composite International Diagnostic Interview), activity limitations and role functioning in the past 30 days (Disability Assessment Schedule). An a priori model based on the World Health Organization's International Classification of Functioning, Disability and Health was designed and a structural equation model for categorical and ordinal data was used (MPlus) to estimate the extent to which six limitations mediated the association between depression and role functioning. Results: The unadjusted association between depression and role functioning was strong (0.43; SE = 0.04). In the best-fitting model, only concentration and attention problems and embarrassment mediated a significant amount of association (direct effect dropped to 0.17; SE = 0.10, which was no longer significant). Conclusions: Targeting cognition and embarrassment in treatment could help reduce depression-associated role disfunctioning.

Original languageEnglish
Pages (from-to)451-458
Number of pages8
JournalActa Psychiatrica Scandinavica
Issue number6
Publication statusPublished - 2008


  • Depression
  • Functional limitations
  • General population
  • Role functioning

ASJC Scopus subject areas

  • Psychiatry and Mental health


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