BACKGROUND There is evidence of a causal relationship between disability acquisition and poor mental health; however, the mechanism by which disability affects mental health is poorly understood. This gap in understanding limits the development of effective interventions to improve the mental health of people with disabilities. METHODS We used four waves of data from the Household, Income and Labour Dynamics in Australia Survey (2011-14) to compare self-reported mental health between individuals who acquired any disability (n=387) and those who remained disability-free (n=7936). We tested three possible pathways from disability acquisition to mental health, examining the effect of material, psychosocial and behavioural mediators. The effect was partitioned into natural direct and indirect effects through the mediators using a sequential causal mediation analysis approach. Multiple imputation using chained equations was used to assess the impact of missing data. RESULTS Disability acquisition was estimated to cause a five-point decline in mental health [estimated mean difference: -5.3, 95% confidence interval (CI) -6.8, -3.7]. The indirect effect through material factors was estimated to be a 1.7-point difference (-1.7, 95% CI -2.8, -0.6), explaining 32% of the total effect, with a negligible proportion of the effect explained by the addition of psychosocial characteristics (material and psychosocial: -1.7, 95% CI -3.0, -0.5) and a further 5% by behavioural factors (material-psychosocial-behavioural: -2.0, 95% CI -3.4, -0.6). CONCLUSIONS The finding that the effect of disability acquisition on mental health operates predominantly through material rather than psychosocial and behavioural factors has important implications. The results highlight the need for better social protection, including income support, employment and education opportunities, and affordable housing for people who acquire a disability.

中文翻译：

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物质，社会心理和行为因素是否介导残疾获得与心理健康之间的关系？顺序因果中介分析。

背景技术有证据表明，残疾获得与不良心理健康之间存在因果关系。但是，人们对残疾影响心理健康的机制了解甚少。这种理解上的差距限制了有效干预措施的发展，以改善残疾人的心理健康。方法我们使用了来自澳大利亚家庭，收入和劳动力动态调查（2011-14）的四波数据，比较了有残疾（n = 387）和无残疾（n）的个体之间的自我报告的心理健康状况。 = 7936）。我们测试了从残疾获得到心理健康的三种可能途径，并研究了物质，心理社会和行为调节者的作用。通过使用顺序因果调解分析方法，通过调解员将影响分为自然的直接和间接影响。使用链式方程的多重插补用于评估缺失数据的影响。结果估计残疾获得会导致心理健康下降五点[估计平均差异：-5.3，95％置信区间（CI）-6.8，-3.7]。通过物质因素造成的间接影响估计为1.7点差异（-1.7、95％CI -2.8，-0.6），占总影响的32％，而通过心理社会因素的影响所占比例可忽略不计特征（物质和社会心理：-1.7，95％CI -3.0，-0.5），再加上5％的行为因素（物质-心理社会-行为：-2.0，95％CI -3.4，-0.6）。结论残疾获得对心理健康的影响主要是通过物质而非心理社会和行为因素起作用的发现具有重要意义。结果表明，需要更好的社会保护，包括收入支持，就业和教育机会，以及为残障人士提供负担得起的住房。