Disability acquisition and mental health: effect modification by demographic and socioeconomic characteristics using data from an Australian longitudinal study

OBJECTIVES: There is evidence of a causal relationship between disability acquisition and poor mental health, but the substantial heterogeneity in the magnitude of the effect is poorly understood and may be aetiologically informative. This study aimed to identify demographic and socioeconomic factors that modify the effect of disability acquisition on mental health. DESIGN AND SETTING: The Household, Income and Labour Dynamics in Australia Survey is a nationally representative longitudinal survey of Australian households that has been conducted annually since 2001. Four waves of data were included in this analysis, from 2011 to 2014. PARTICIPANTS: Individuals who acquired a disability (n=387) were compared with those who remained disability-free in all four waves (n=7936). PRIMARY OUTCOME MEASURE: Mental health was measured using the mental health subscale of the Short Form 36 (SF-36) general health questionnaire, which measures symptoms of depression, anxiety and psychological well-being. METHODS: Linear regression models were fitted to estimate the effect of disability acquisition on mental health, testing for effect modification by key demographic and socioeconomic characteristics. To maximise causal inference, we used a propensity score approach with inverse probability of treatment weighting to control for confounding and multiple imputation using chained equations to assess the impact of missing data. RESULTS: On average, disability acquisition was associated with a 5-point decline in mental health score (estimated mean difference: −5.1, 95% CI −7.2 to –3.0). There was strong evidence that income and relationship status modified the effect, with more detrimental effects in the lowest (−12.5, 95% CI −18.5 to –6.5) compared with highest income quintile (−1.1, 95% CI –4.9 to 2.7) and for people not in a relationship (−8.8, 95% CI −12.9 to –4.8) compared with those who were (−3.7, 95% CI −6.1 to –1.4). CONCLUSIONS: Our results suggest that the detrimental effect of disability acquisition on mental health is substantially greater for socioeconomic disadvantaged individuals.