Days out-of-role due to common physical and mental health problems: Results from the Sa ˜o Paulo Megacity Mental Health Survey, Brazil Laura Helena Andrade, I Marcos C. Baptista, I Jordi Alonso, II,III,IV Maria Petukhova, V Ronny Bruffaerts, VI Ronald C. Kessler, V Camila M. Silveira, I Erica R. Siu, I Yuan-Pang Wang, I Maria Carmen Viana I,VII I Faculdade de Medicina da Universidade de Sa ˜ o Paulo, Department and Institute of Psychiatry, Section of Psychiatric Epidemiology - LIM 23, Sa ˜ o Paulo/SP, Brazil. II IMIM-Institut Hospital del Mar d’Investigacions Me ` diques, Health Services Research Unit, Barcelona, Spain. III CIBER Epidemiologı´a y Salud Pu ´ blica (CIBERESP), Barcelona, Spain. IV Universitat Pompeu Fabra (UPF) de Barcelona, Department of Experimental and Life Sciences, Barcelona, Spain. V Harvard Medical School, Department of Health Care Policy, Boston, MA, USA. VI Universitair Psychiatrisch Centrum, Katholieke Universiteit Leuven (UPC-KUL), University Hospitals Gasthuisberg, Leuven, Belgium. VII Universidade Federal do Espı´rito Santo, Department of Social Medicine and Post-Graduate Program in Public Health, Health Sicences Center, Vitoria/ES, Brazil. OBJECTIVES: To investigate the relative importance of common physical and mental disorders with regard to the number of days out-of-role (DOR; number of days for which a person is completely unable to work or carry out normal activities because of health problems) in a population-based sample of adults in the Sa ˜ o Paulo Metropolitan Area, Brazil. METHODS: The Sa ˜ o Paulo Megacity Mental Health Survey was administered during face-to-face interviews with 2,942 adult household residents. The presence of 8 chronic physical disorders and 3 classes of mental disorders (mood, anxiety, and substance use disorders) was assessed for the previous year along with the number of days in the previous month for which each respondent was completely unable to work or carry out normal daily activities due to health problems. Using multiple regression analysis, we examined the associations of the disorders and their comorbidities with the number of days out-of-role while controlling for socio-demographic variables. Both individual-level and population-level associations were assessed. RESULTS: A total of 13.1% of the respondents reported 1 or more days out-of-role in the previous month, with an annual median of 41.4 days out-of-role. The disorders considered in this study accounted for 71.7% of all DOR; the disorders that caused the greatest number of DOR at the individual-level were digestive (22.6), mood (19.9), substance use (15.0), chronic pain (16.5), and anxiety (14.0) disorders. The disorders associated with the highest population-attributable DOR were chronic pain (35.2%), mood (16.5%), and anxiety (15.0%) disorders. CONCLUSIONS: Because pain, anxiety, and mood disorders have high effects at both the individual and societal levels, targeted interventions to reduce the impairments associated with these disorders have the highest potential to reduce the societal burdens of chronic illness in the Sa ˜ o Paulo Metropolitan Area. KEYWORDS: Mental Disorders; Chronic Disease; Disability; Prevalence; Burden of Illness. Andrade LH, Baptista MC, Alonso J, Petukhova M, Bruffaerts R, Kessler RC, et al. Days out-of-role due to common physical and mental health problems: Results from the Sa ˜ o Paulo Megacity Mental Health Survey, Brazil. Clinics. 2013;68(11):1392-1399. Received for publication on February 5, 2013; First review completed on March 10, 2013; Accepted for publication on May 22, 2013 E-mail: lhsgandr@usp.br Dr. Wang and Dr. Viana share the senior authorship for this article. Tel.: 55 11 2661-6976 & INTRODUCTION Similar to many low- and middle- income countries (1), Brazil is facing an epidemiologic transition (2) characterized by an increasing burden of chronic, non-communicable diseases surpassing infectious diseases (3). According to the most recent Global Burden of Diseases (GBD) report (4,5), 8 of the 10 leading causes of years living with disability (YLD) in the Tropical Latin America region are either chronic pain or mental disorders. The results from the first GBD report in Brazil (2) showed that neuropsychiatric disorders ranked first as the major cause of YLD (34%), followed by chronic respiratory diseases (11.2%). The World Health Organization (WHO) International Classification of Functioning, Disability and Health (6) defines disability as a broad term for impairments, activity limitations, and participation restrictions, taking into Copyright ß 2013 CLINICS – This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: 10.6061/clinics/2013(11)02 CLINICAL SCIENCE 1392