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Objective: The study examined functional impairment associated with psychological distress and severity of medical illness in a rural primary care population and explored how functional impairment varied with psychological distress and chronic medical illness. Methods: Fiftyeight patients recruited from three rural primary care clinics completed the 36-item Short Form Health Survey (SF-36) and the Typology of Psychic Distress (PsyDis). The chronic disease score, a measure of the severity of chronic medical illness, was calculated from data on use of prescription medications over a six-month period. T tests were used to determine the level of functional impairment associated with various levels of psychological distress and medical illness. Regression analyses were used to determine the proportion of variance in impairment that was explained by level of psychological distress and severity of medical illness. Results: High levels of psychological distress explained the variance in impairment in several domains measured by the SF-36, including general health, social functioning, emotional role, and mental health, whereas a high level of severity of chronic medical illness explained the variance in impairment in physical functioning. Both high psychological distress and high severity of chronic medical illness explained the variance in impairment in vitality, and neither variable explained variance in impairment in physical role or bodily pain. Conclusions: In this rural outpatient primary care population, functional impairment was explained more by psychological distress than by severity of medical illness. Decreasing the burden of psychological distress among primary care patients may improve functioning. [ABSTRACT FROM AUTHOR]