Article Text

Download PDFPDF

Disability acquisition and mental health: effect modification by demographic and socioeconomic characteristics using data from an Australian longitudinal study
  1. Zoe Aitken1,
  2. Julie Anne Simpson2,
  3. Rebecca Bentley1,
  4. Anne Marie Kavanagh1
  1. 1 Gender and Women’s Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
  2. 2 Biostatistics Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
  1. Correspondence to Dr Zoe Aitken; zoe.aitken{at}


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.

  • disability
  • mental health
  • social epidemiology
  • epidemiological methods
  • health inequalties

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors ZA conceived the research question, conducted the analysis, interpreted the results and prepared the manuscript. JAS, RB and AMK made substantial contributions to the study conception, the data analysis methods, the interpretation of results and critically reviewed the manuscript. All authors read and approved the final manuscript.

  • Funding This work was supported by an Australian Government Research Training Program Scholarship and a National Health and Medical Research Council Postgraduate Scholarship (1093740) to ZA.

  • Competing interests None declared.

  • Patient consent We have only used de-identified data.

  • Ethics approval Ethics approval for this study was provided by the Human Ethics Advisory Groups at the Melbourne School of Population and Global Health at the University of Melbourne.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The HILDA Survey data can be obtained under strict licensing arrangements, subject to approval by the Australian Government Department of Social Services. Further details are available at:

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.