Yale Researchers Explore the Impact of Mental and Physical Disability on Economic and Social Well-Being

Ten years after passage of the Americans With Disabilities Act (ADA), Yale researchers have used the largest disability survey ever conducted to examine the prevalence and impact of mental and physical disability in the United States.

The team found that one-fourth of all working disabled persons reported job discrimination based on their disability in the past five years. Individuals with all forms of disabilities reported substantial social and economic barriers to work over and above the clinical symptoms of their illness.

“The Americans with Disabilities Act should outlaw this kind of discrimination,” said Benjamin Druss, M.D., assistant professor of psychiatry and in the Department of Epidemiology and Public Health at Yale School of Medicine. “The results indicate the importance of such legislation, and the need to monitor its implementation.”

Druss, lead author on the study, also found that one-third of Americans reporting disabilities stated that a mental disorder contributed to their disability. In contrast to physical disability, mental disability most commonly affected “higher order” mental processes, such as cognitive and social function.

“The findings illustrate the important differences between mental and physical disabilities,” Druss said. “While disability may represent a common final pathway, the pattern of deficits in the two types of disabilities are quite different. It is probably easier for an employer to build a ramp than to address the gaps in social and cognitive function seen in patients with mental disorders.”

The study, published in the current issue of American Journal of Psychiatry, examined data from the Department of Health and Human Services’ 1994-1995 National Health Interview Survey of Disability, which interviewed a random sample of 106,573 Americans about limitations in participating in major life activities.

“We wanted to step back and ask some basic questions about the nature of disability,” said Druss. “How commonly do mental or physical conditions lead to disability? To what degree do social factors such as job discrimination contribute to disabled individuals’ inability to work? And what are the similarities and differences between mental and physical disabilities?”

Because the regulations clarifying the ADA’s applicability to individuals with mental disorders were not released until 1997, Druss said, it is not clear what the impact of this legislation will be on job-based discrimination.

Druss’ team included Robert A. Rosenheck, M.D. at Yale; Steven C. Marcus and Terri Tanielian at the American Psychiatric Association Office of Research; Mark Olfson, M.D., of the New York State Psychiatric Institute/Department of Psychiatry, Columbia University; and Harold A. Pincus, M.D. of the RAND Corporation.