Abstract
Background:
Role impairment due to health problems is a public health issue. China Mental Health Survey (CMHS) is a national epidemiological study in China, providing plenty of information on mental disorders and physical diseases.This study focused on the association between mental disorders and physical diseases with role impairment.
Methods:
This study was based on CMHS, a cross-sectional study in a large-scale nationally representative sample across China from 2012 to 2015. Trained interviewers carried out face-to-face interviews with 28,140 respondents using the Composite International Diagnostic Interview-3.0 (CIDI-3.0). The prevalence of mental disorders and physical diseases was assessed. In addition, each respondent reported information about the number of days in the past month being totally and partially unable to work or carry out their other normal daily activities because of problems with either mental disorders or physical diseases. Associations of role impairment with physical diseases and mental disorders were analyzed by multiple regression.
Results:
Overall, the weighted rate of role impairment was 3.68% in patients with any mental disorders and 8.75% in those with any physical diseases. Chronic pain (β = 0.07, P <0.001) became the main physical disease associated with role impairment, while depressive disorder (β = 0.12, P <0.001) became the main mental disorder associated with role impairment. Patients with more mental disorders or physical diseases experienced more days with role impairment.
Conclusions:
Common mental disorders and physical diseases account for a large proportion of the number of days out of role. It should be addressed to substantially increase the level of mental health in China.
Keywords: Role impairment, Mental disorder, Physical disease, China Mental Health Survey, Chronic pain, Depressive disorder
Introduction
Days of role impairment is defined as the number of days in the preceding 30 days when individuals were totally or partially incapacitated in performing regular activities due to mental disorders or physical diseases.[1] Lost labor productivity, which was calculated by missed or reduced work, could significantly contribute to the financial burden.[2] Understanding the level of role impairment in different health conditions can help allocate more resources to diseases that cause more severe role impairment, thereby mitigating indirect costs related to human capital.
Patients with numerous common mental disorders or physical diseases were prone to role impairment.[3–12] In Europe, approximately 30% of patients with common mental disorders or physical diseases reported experiencing role impairment in daily activities, work, or social interactions. Significantly, the rate of role impairment reported by patients with mental disorders was higher than that of patients with physical diseases (29.1%), especially for partial role impairment.[12] Moreover, the association between mental disorders and physical diseases with role impairment varied in different diseases. The study on the association between health problems and days out of role (DOR) in the 24 countries that took part in the World Mental Health Surveys revealed that the most potent individual predictors of DOR were neurological disorders, mood disorders, and anxiety disorders, while chronic pain had a population-level effect.[3] Studies have shown that patients with mental disorders experience higher level of disability and role impairment compared with those with physical diseases.[13,14] Given the existence of treatment and management measures for such disorders, it is possible to relieve role impairment of patients with various diseases.
However, there is limited evidence of role impairment across nationally representative ranges in China. The China Mental Health Survey (CMHS), which was carried out from 2012 to 2015, is a comprehensive national survey on mental disorders. CMHS aimed to investigate the prevalence of mental disorders and reported the 12-month prevalence of any mental disorder as 9.3%.[15] Furthermore, for assessing the comorbidity of common physical diseases alongside mental disorders, CMHS compared the association between mental disorders and physical diseases with role impairment.
Incorporating national data from CMHS, the current study focuses on the association between mental disorders and physical diseases with role impairment. First, this study describes the distribution of role impairment across different mental disorders, physical diseases, and sociodemographic groups. Second, this study evaluates the association between mental disorders and physical diseases with role impairment. Comparing the role impairment of patients with mental disorders and physical diseases, the current study will provide a scientific basis for treatment, rehabilitation, and prevention of mental disorders and physical diseases.
Methods
Study design and survey population
In brief, 32,552 community residents aged 18 years and over were sampled from 1256 village residences in 157 disease surveillance points across 31 provinces, municipalities, or autonomous regions in China, using a multistage clustered-area probability sampling procedure from 2012 to 2015. The people in institutions, including workplaces, construction sites, schools and universities, hospitals, military areas, and elderly homes, were excluded. This survey also excluded pregnant women and people who had difficulties communicating with interviewers.
In CMHS, trained interviewers used Composite International Diagnostic Interview-3.0 (CIDI-3.0) to diagnose mental disorders. CMHS obtained information on the 12-month diagnoses of mood disorders, anxiety disorders, substance use disorders, eating disorders, and impulse-control disorders. Additionally, it assessed the prevalence of physical diseases and levels of role impairment among adults in the Chinese community. The detailed sampling methodology and sample size calculation method of CMHS have been published.[16] In total, 28,140 participants were interviewed by CIDI-3.0.
CMHS was approved by the Ethical Committee of the Sixth Hospital of Peking University (No. IMHIRB2013–13–1). All procedures involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1975 Helsinki Declaration and its later amendments or similar ethical standards. Written informed consent for data use was obtained from all participants.
Measurements
Mental disorders
According to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), 12-month prevalence of mental disorders was assessed, including mood disorders (depressive disorder and bipolar disorder), anxiety disorders (panic attack, agoraphobia without history of panic disorder, specific phobia, social phobia, obsessive compulsive disorder [OCD], posttraumatic stress disorder [PTSD], and generalized anxiety disorder [GAD]), alcohol and drug use disorders, impulse-control disorders, and eating disorders. One categorical variable quantifies the number of mental disorders, with categories defined as 0, 1, 2, and 3 or more.
Physical diseases
Information on physical diseases over the past 12 months was collected based on self-reports or observations by interviewers. CMHS collected information on physical diseases, including arthritis, cardiovascular diseases (heart attack, heart disease, and hypertension), cerebrovascular disease (stroke), chronic pains (severe headache or migraine, back or neck pain, or other chronic pain), allergy (seasonal allergies and asthma), respiratory diseases (chronic obstructive pulmonary disease and emphysema), diabetes, digestive diseases (stomach and intestinal ulcer), neurological disorders (epilepsy), and cancer. A categorical variable measures the number of physical diseases, also categorized as 0, 1, 2, and 3 or more.
Role impairment
CMHS included four questions about role impairment resulting from problems with health conditions, based on the conceptual model of the International Classification of Functioning, Disability, and Health. The item how many days out of the last 30 days was assessed through the following questions:
(1) Were you totally unable to work or carry out normal activities?
(2) Were you able to work or carry out normal activities, but had to cut down on what you did, or not get as much done as usual?
(3) Did you cut back on the quality of your work or how carefully you worked?
(4) Did it take extreme effort to perform up to your usual level at work or at your other normal daily activities?
Respondents were asked about their DOR and the days of partial role impairment in the past 30 days. A day with partial role impairment was defined as a day on which respondents had to either cut down on what they did or cut back on the quality of what they did or needed extreme effort to perform as usual. An aggregate measure of role impairment was computed: (1 × DOR) + (0.5 × quantity cut down days) + (0.5 × quality cut back days) + (0.25 × extreme effort days). The measure had a range of 0 to 30 and was set to 30 if the total days of role impairment is more than 30.
Sleep problems
For the assessment of sleep problems, the CIDI-3.0 contained the following questions:
Did you have a period lasting two weeks or longer in the past 12 months when you had any of the following problems with your sleep: (1) When nearly every night it took you two hours or longer before you could fall asleep? (2) When you woke up nearly every night and took an hour or more to get back to sleep? (3) When you woke up nearly every morning at least two hours earlier than you wanted to? (4) When you felt tired or drowsy during the day?
Responses were coded as “yes” or “no”. If participants answered yes to any of the four questions, they were defined as having sleep problems.
Sociodemographic information
This study evaluated six sociodemographic factors: gender, age, residential status, marital status, education level, and income level. Age was categorized into four groups: 18–34, 35–49, 50–64, and ≥65 years. Place of residence was categorized into urban and rural settings. Marital status was categorized as married and unmarried/separated/divorced/widowed. Education level was categorized as illiterate or below, elementary school, high school, and college or above. Last, income status was categorized by segmenting the total household income from the past 12 months into high, medium, and low tiers, based on the 33% and 66% income quantiles.
Analysis procedures
The method of weighting adjustment has been published elsewhere, which included the sampling weight, nonresponse weight, poststratification weight, and extreme adjustment.[16]
Role impairment of patients with each type of mental disorder and physical disease was described. Four linear regression models were used to assess the association between mental disorders and physical diseases with role impairment, and the days of role impairment served as dependent variables in four models. In model 1, individual mental disorders and individual physical diseases were independent variables. In model 2, individual mental disorders, individual physical diseases, and six sociodemographic factors were independent variables. In model 3, all mental disorders, all physical diseases, and six sociodemographic factors were independent variables. In model 4, the number of mental disorders, the number of physical diseases, sleep problems, and six sociodemographic factors were independent variables. SAS 9.4 (SAS Institute Inc., NC, USA) was used for statistical analyses. P value less than 0.05 using two-sided tests was considered statistically significant.
Results
Distribution of role impairment
In CMHS, a total of 28,140 participants completed CIDI-3.0. Table 1 shows sample characteristics of respondents in CMHS and the distribution of role impairment. Of the 28,140 participants, the weighted rate of role impairment was 12.55%. The weighted rate of partial role impairment was 11.79%, while 3.45% reported full role impairment. The weighted rate of role impairment was 3.68% in patients with any mental disorders, and 8.75% in those with any physical diseases.
Table 1.
Distribution of role impairment by demographic characteristics in CMHS.
| Demographic factor category | Weighted role impairment | Role impairment days† | |||
|---|---|---|---|---|---|
| Number | Role impairment (%) | Full role impairment (%) | Partial role impairment (%) | ||
| Gender | |||||
| Male | 1585 | 6.55 | 1.49 | 6.08 | 0.00 (0.00, 0.00) |
| Female | 1812 | 5.99 | 1.95 | 5.71 | 0.00 (0.00, 0.00) |
| Age* (years) | |||||
| 18–34 | 530 | 4.14 | 0.94 | 3.83 | 0.00 (0.00, 0.00) |
| 35–49 | 1070 | 3.93 | 0.89 | 3.78 | 0.00 (0.00, 0.00) |
| 50–64 | 1221 | 2.92 | 0.94 | 2.76 | 0.00 (0.00, 0.00) |
| ≥65 | 568 | 1.55 | 0.67 | 1.41 | 0.00 (0.00, 0.00) |
| Residence | |||||
| Urban | 1319 | 6.34 | 1.56 | 6.02 | 0.00 (0.00, 0.00) |
| Rural | 2078 | 6.21 | 1.89 | 5.77 | 0.00 (0.00, 0.00) |
| Marital status | |||||
| Married | 2901 | 10.61 | 2.80 | 10.00 | 0.00 (0.00, 0.00) |
| Unmarried/separated/divorced/widowed | 496 | 1.94 | 0.65 | 1.79 | 0.00 (0.00, 0.00) |
| Education level | |||||
| Illiterate or below elementary school | 1051 | 3.03 | 1.21 | 2.80 | 0.00 (0.00, 0.00) |
| Elementary school | 728 | 2.54 | 0.84 | 2.37 | 0.00 (0.00, 0.00) |
| High school graduate | 1370 | 5.67 | 1.27 | 5.38 | 0.00 (0.00, 0.00) |
| College or above | 244 | 1.28 | 0.13 | 1.23 | 0.00 (0.00, 0.00) |
| Economic status | |||||
| Low | 1213 | 4.29 | 1.58 | 3.93 | 0.00 (0.00, 0.00) |
| Middle | 1095 | 3.85 | 0.98 | 3.61 | 0.00 (0.00, 0.00) |
| High | 1089 | 4.40 | 0.89 | 4.25 | 0.00 (0.00, 0.00) |
| Mental disorders | |||||
| Depressive disorder* | 488 | 1.76 | 0.46 | 1.72 | 0.50 (0.00, 4.00) |
| Bipolar disorder* | 90 | 0.27 | 0.12 | 0.27 | 1.75 (0.00, 7.00) |
| Any mood disorders* | 569 | 2.00 | 0.57 | 1.95 | 0.16 (0.00, 0.50) |
| Panic attack* | 52 | 0.14 | 0.05 | 0.13 | 2.00 (0.00, 8.00) |
| Agoraphobia* | 45 | 0.15 | 0.05 | 0.15 | 3.50 (0.00, 10.00) |
| Specific phobia* | 253 | 0.88 | 0.32 | 0.85 | 0.00 (0.00, 4.25) |
| Social phobia* | 72 | 0.23 | 0.08 | 0.23 | 1.50 (0.00, 12.50) |
| GAD* | 22 | 0.07 | 0.03 | 0.07 | 0.00 (0.00, 4.25) |
| OCD* | 184 | 0.78 | 0.14 | 0.78 | 0.00 (0.00, 2.25) |
| PTSD* | 19 | 0.07 | 0.04 | 0.07 | 3.25 (0.00, 7.00) |
| Any anxiety disorders* | 349 | 1.12 | 0.42 | 1.08 | 0.00 (0.00, 4.25) |
| Alcohol use disorder* | 141 | 0.77 | 0.24 | 0.72 | 0.00 (0.00, 1.25) |
| Drug use disorder* | 23 | 0.08 | 0.02 | 0.07 | 1.00 (0.00, 5.00) |
| Alcohol/Drug use disorders* | 162 | 0.83 | 0.25 | 0.78 | 0.00 (0.00, 1.50) |
| Eating disorder* | 2 | 0.02 | 0.01 | 0.02 | 0.00 (7.00, 20.00) |
| Impulse-control disorders* | 131 | 0.53 | 0.14 | 0.47 | 0.00 (0.00, 2.00) |
| Any mental disorders* | 966 | 3.68 | 0.99 | 3.55 | 0.00 (0.00, 2.00) |
| Physical diseases | |||||
| Arthritis* | 1215 | 3.72 | 1.17 | 3.57 | 0.00 (0.00, 0.00) |
| Cardiovascular diseases* | 1058 | 2.75 | 1.06 | 2.55 | 0.00 (0.00, 0.00) |
| Cerebrovascular disease* | 96 | 0.28 | 0.19 | 0.28 | 0.00 (0.00, 1.00) |
| Chronic pains* | 1932 | 6.42 | 1.77 | 6.19 | 0.00 (0.00, 0.00) |
| Respiratory diseases* | 175 | 0.54 | 0.26 | 0.51 | 0.00 (0.00, 1.00) |
| Allergy* | 473 | 1.72 | 0.49 | 1.66 | 0.00 (0.00, 0.00) |
| Diabetes* | 247 | 0.67 | 0.32 | 0.64 | 0.00 (0.00, 0.00) |
| Digestive diseases* | 414 | 1.18 | 0.28 | 1.14 | 0.00 (0.00, 0.50) |
| Neurological disorders* | 31 | 0.15 | 0.07 | 0.14 | 0.50 (0.00, 3.50) |
| Cancer* | 36 | 0.11 | 0.09 | 0.11 | 0.00 (0.00, 1.50) |
| Any physical diseases* | 2635 | 8.75 | 2.49 | 8.36 | 0.00 (0.00, 0.00) |
| Number of mental disorders* | |||||
| 0 | 2419 | 8.84 | 2.45 | 8.24 | 0.00 (0.00, 0.00) |
| 1 | 627 | 2.38 | 0.53 | 2.29 | 0.00 (0.00, 1.25) |
| 2 | 255 | 0.96 | 0.35 | 0.82 | 1.00 (0.00, 5.50) |
| 3 or more | 96 | 0.34 | 0.11 | 0.45 | 3.00 (0.00, 7.50) |
| Number of physical diseases* | |||||
| 0 | 762 | 3.80 | 0.95 | 3.43 | 0.00 (0.00, 0.00) |
| 1 | 898 | 3.49 | 0.74 | 3.34 | 0.00 (0.00, 0.00) |
| 2 | 876 | 2.88 | 0.86 | 2.75 | 0.00 (0.00, 0.00) |
| 3 or more | 338 | 2.38 | 0.90 | 2.27 | 0.00 (0.00, 1.50) |
| Sleep problem* | 1847 | 6.12 | 1.92 | 5.81 | 0.00 (0.00, 0.75) |
| Total | 3397 | 12.55 | 3.45 | 11.79 | 0.00 (0.00, 0.00) |
*Statistically significant differences in the reported rate of role impairment across groups (P <0.05); †Data are shown as median (Q1, Q3). CMHS: China Mental Health Survey; GAD: Generalized anxiety disorder; OCD: Obsessive compulsive disorder; PTSD: Posttraumatic stress disorder.
By weighting, chronic pains (6.42%), arthritis (3.72%), and cardiovascular diseases (2.75%) were the conditions with the highest rate among patients with physical diseases who reported role impairment, while depressive disorder (1.76%), OCD (0.78%), and alcohol use disorder (0.77%) were the conditions with the highest rate among patients with mental disorders reporting role impairment. The weighted rates of role impairment reported by patients with 0, 1, 2, and 3 or more mental disorders were 8.84%, 2.38%, 0.96%, and 0.34%, respectively. The weighted rates of role impairment reported by patients with 0, 1, 2, and 3 or more physical diseases were 3.80%, 3.49%, 2.88%, and 2.38%, respectively. Participants with sleep problems reported a weighted rate of role impairment of 6.12%.
Risk factors of role impairment
Supplementary Table 1, http://links.lww.com/CM9/C835 shows the association between mental disorders and physical diseases with role impairment days. The regression analysis did not include eating disorders due to the small sample size of only five identified patients. In model 1, the results showed that all mental disorders and physical diseases were significantly associated with role impairment. In model 2, after controlling for six sociodemographic variables, all mental disorders and physical diseases were still significantly associated with role impairment days. In model 3, the results of multivariate analysis showed depressive disorder (β = 0.12, P <0.001), bipolar disorder (β = 0.07, P = 0.001), specific phobia (β = 0.07, P <0.001), alcohol use disorder (β = 0.03, P = 0.013), impulse-control disorder (β = 0.03, P = 0.004), arthritis (β = 0.04, P = 0.007), cardiovascular diseases (β = 0.05, P <0.001), cerebrovascular disease (β = 0.03, P = 0.048), chronic pains (β = 0.07, P <0.001), respiratory diseases (β = 0.05, P = 0.001), diabetes (β = 0.05, P = 0.022), digestive diseases (β = 0.02, P = 0.007), and cancer (β = 0.06, P = 0.048) had positive associations with role impairment days.
Supplementary Table 2, http://links.lww.com/CM9/C835 shows the association of the number of mental disorders, the number of physical diseases, sleep problems, and sociodemographic variables with role impairment days. Patients with one mental disorder experienced an additional 0.09 days of role impairment in the past 30 days compared to individuals without mental disorders. Those with two mental disorders had an additional 0.12 days, while patients with three or more mental disorders had an additional 0.14 days of role impairment compared to that among individuals without mental disorders. In comparison to individuals without physical diseases, patients with a single physical disease experienced an additional 0.03 days of role impairment in the last 30 days. The patients with two physical diseases were estimated to have an additional 0.06 days, while patients with three or more physical diseases experienced an additional 0.12 days of role impairment. Sleep problems (β = 0.09, P <0.001) were positively associated with role impairment days. Compared with the low-income group, participants with medium income (β = –0.15, P <0.001) and high income (β = –0.25, P <0.001) had significantly fewer days of role impairment. Gender, age, education level, marital status, and place of residence showed no statistical significance in the association with role impairment days.
Discussion
Using the national representative data from CMHS, this study assessed the association between mental disorders and physical diseases with role impairment in China. The findings reported the prevalence of role impairment among patients with mental disorders (3.68%) and physical diseases (8.75%), underscoring the substantial burden imposed by these conditions on individuals. The results showed that mood disorders (2.00%), followed by anxiety disorders (1.12%), exhibited the most role impairment among the five categories of mental disorders. This aligned with the 2013 and 2021 Global Burden of Disease Study, which showed that the disability adjusted life year due to depressive disorder was ranked first among all mental disorders, followed by anxiety disorders.[17,18] This indicated that mood disorders contribute to a significant disease burden due to their association with role impairment.
Notably, the results that chronic pain emerged as the leading physical disease associated with role impairment were consistent with previous studies, demonstrating the debilitating effect of chronic pain on role impairment.[11,12] Chronic pain, due to its high prevalence and incapacitating nature, was the primary contributor to days of work incapacity.[3] On the contrary, studies showed an association between chronic pain and mood and anxiety disorders.[19] Patients with chronic pain were more likely to concurrently experience mental disorders at the same time, resulting in more severe role impairment. Although this study did not distinguish whether these patients had co-existing mental disorders, it implied that improvement in the physical problem of pain could lead to a significant reduction in role impairment.
Among the mental disorders, depressive disorder was predominant. It is possible that depression can lead to difficulties in concentration, motivation, and decision making, all of which contribute to poorer job performance,[20] thereby increasing the occurrence of days with partial role impairment. Findings from CMHS on depressive disorders revealed a positive correlation between DOR and the severity of depressive symptoms across various subtypes of depressive disorders.[21] Within the spectrum of psychological symptoms in major depressive disorder, psychomotor agitation or retardation was identified as a factor contributing to impaired mobility function.[22] In addition, individuals with psychomotor retardation might experience compromised self-care function due to challenges in personal hygiene.[23] Feelings of worthlessness or guilt were found to be associated with impairments in work, family life, or getting along with others.[24] The diminished ability to think or concentrate was associated with impaired cognitive function.[25] It is noteworthy that effective treatment of depression has the potential to mitigate the functional damage caused by depressive symptoms, thereby reducing the incidence of role impairment.
Not surprisingly, individuals with more mental disorders or physical diseases experienced more days with role impairment. This underscored a cumulative burden where multiple comorbidities compound role impairment, and was consistent with the report by Alonso et al,[10] which emphasized the compounded impact of comorbid conditions on role impairment. Meanwhile, the number of mental disorders exhibited a larger magnitude of association with days of role impairment compared to physical diseases.
In contrast, mental disorders exhibited more days of role impairment compared to physical diseases. This was attributed to their widespread prevalence, frequent comorbidity of physical diseases, early onset in individuals, and considerable influence on role impairment.[6] If the goal of treatment is to reduce functional impairment, greater attention should be directed toward addressing psychological symptoms during the treatment process, in addition to somatic symptoms alone. This perspective recognizes the significant impact of mental health on individuals’ functional capacity and underscores the necessity of a holistic approach that addresses both mental and physical aspects for effective intervention and management in healthcare.
Sleep problems have raised concerns due to their heightened prevalence and significant associations with role impairment, as supported by findings from the National Comorbidity Survey Replication.[26] Data from other studies suggested that effective treatment of insomnia held the potential for substantial improvements in both quality of life and productivity.[27] Additionally, this study revealed an inverse relationship between income status and the number of days of role impairment. This was consistent with the report by Habtamu et al[28] in Ethiopia, which also demonstrated that lower economic status was significantly associated with severe role impairment. Individuals with lower income status might encounter various obstacles to accessing treatment, thereby increasing the risk of role impairment if health conditions are not systematically addressed. This underscores the importance of targeted interventions that consider socioeconomic factors to mitigate barriers to treatment access and improve overall functional outcomes.
This study showed that health disfunctions were closely related to productivity loss. To mitigate the loss of productivity caused by diseases, we should carry out various measures to reduce the patient’s role impairment. First, early interventions in integrated health services are necessary to address common mental health problems. It should be advocated to expand community mental health services, enhance mental health education in health promotion strategies, and develop comprehensive management programs for chronic pain. Second, to prevent individuals from disability caused by physical diseases and mental disorders, social welfare should be provided to persons with physical diseases and mental disorders.
Those findings underscored the necessity of adopting a comprehensive healthcare approach that considered the complex interplay of multiple health conditions. Future research should prioritize longitudinal studies to gain a deeper understanding of the causal relationships and explore the mechanisms through which mental disorders and physical diseases interact to influence role impairment. Such investigations are crucial for informing targeted interventions and comprehensive healthcare strategies that effectively address the interconnected challenges posed by mental disorders and physical diseases on individuals’ role impairment over time.
This study had several limitations. First, recall bias is likely to influence the result because the respondents reported their previous situation. Second, the cross-sectional study restricts the ability to infer causality.
In conclusion, the findings of the present study reveal a significant association between physical diseases, such as chronic pain, and mental disorders, such as depressive disorder, with role impairment. Furthermore, the cumulative impact of multiple disorders markedly intensifies the degree of role impairment, underscoring the urgent need for integrated care approaches. These results emphasize the importance of coordinated healthcare strategies that address both physical and mental health conditions to effectively alleviate the burden of role impairment on individuals.
Funding
This study was supported by grants from the National Key R&D Program of China (Nos. 2017YFC0907800 and 2017YFC0907801), the National Twelfth Five-year Plan for Science and Technology Support of the Ministry of Science and Technology (Nos. 2015BAI13B01, and 2012BAI01B00), and the Special Research Project for Non-profit Public Service of Ministry of Health (Nos. 201202022).
Conflicts of interest
None.
Supplementary Material
Footnotes
How to cite this article: Muhai JN, Liu ZR, Zhang TT, Ding RX, Li T, Xu GM, Xu XD, Wang LM, Yan YP, Xiao SY, Li LJ, Yan J, Yu YQ, Xu XF, Wang ZZ, Xu YF, Huang YQ. Role impairment of patients with mental disorders and physical diseases in China: Results from the China Mental Health Survey. Chin Med J 2026;139:1658–1664. doi: 10.1097/CM9.0000000000004060
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