scholarly journals Suicide attempt following sickness absence and disability pension due to common mental disorders: a prospective Swedish twin study

2019 ◽  
Vol 55 (8) ◽  
pp. 1053-1060 ◽  
Author(s):  
M. Wang ◽  
L. Mather ◽  
P. Svedberg ◽  
E. Mittendorfer-Rutz
Keyword(s):  
Mental Disorders ◽  
Suicide Attempt ◽  
Sickness Absence ◽  
Disability Pension ◽  
Depressive Disorders ◽  
Proportional Hazards ◽  
Common Mental Disorders ◽  
Cox Proportional Hazards ◽  
Shared Environment ◽  
Familial Factors

Abstract Purpose The aim of this study was to investigate if sickness absence and disability pension (SA/DP) in general and due to specific common mental disorders (CMDs) are associated with subsequent suicide attempt among women and men by taking familial factors (genetics and shared environment) into consideration. Methods This register-based cohort study includes 4871 twin pairs 18–65 years of age discordant for SA/DP due to CMDs 2005–2010. Twins were followed up for suicide attempt from inpatient and specialised outpatient care until December 2012. Conditional Cox proportional hazards regression models, adjusting for familial factors, were used to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results SA/DP due to CMDs was associated with a higher risk of suicide attempt (HR 3.14, CI 2.51–3.93). The risk of suicide attempt was five times higher among men and three times higher among women, compared to the SA/DP unaffected co-twins. In the diagnosis-specific analysis, SA/DP due to anxiety disorders resulted in the highest HR (4.09, CI 2.37–7.06) for suicide attempt, followed by depressive disorders (HR 3.70, CI 2.66–5.14) and stress-related disorders (HR 1.96, CI 1.35–2.84). The stratified analysis on zygosity indicates that there seems to be a genetic influence on the associations between SA/DP due to CMDs and suicide attempt, particularly among women and among those with SA/DP due to depressive disorders. Conclusions SA/DP due to CMDs was a risk factor for suicide attempt among women and men. Genetic factors might explain part of the associations for women and for those with SA/DP due to depressive disorders.

Synergistic effect between back pain and common mental disorders and the risk of future disability pension: a nationwide study from Sweden

2015 ◽  
Vol 46 (2) ◽  
pp. 425-436 ◽  
Author(s):  
T. E. Dorner ◽  
K. Alexanderson ◽  
P. Svedberg ◽  
P. Tinghög ◽  
A. Ropponen ◽  
...  
Keyword(s):  
Back Pain ◽  
Mental Disorders ◽  
Synergistic Effect ◽  
Sickness Absence ◽  
Outpatient Care ◽  
Disability Pension ◽  
Common Mental Disorders ◽  
Hazard Ratios ◽  
Co Morbidity ◽  
Individual Condition

BackgroundThe aim of this study was to analyse a possible synergistic effect between back pain and common mental disorders (CMDs) in relation to future disability pension (DP).MethodAll 4 823 069 individuals aged 16–64 years, living in Sweden in December 2004, not pensioned in 2005 and without ongoing sickness absence at the turn of 2004/2005 formed the cohort of this register-based study. Hazard ratios (HRs) and 95% confidence intervals (CIs) for DP (2006–2010) were estimated. Exposure variables were back pain (M54) (sickness absence or inpatient or specialized outpatient care in 2005) and CMD (F40-F48) [sickness absence or inpatient or specialized outpatient care or antidepressants (N06a) in 2005].ResultsHRs for DP were 4.03 (95% CI 3.87–4.21) and 3.86 (95% CI 3.68–4.04) in women and men with back pain. HRs for DP in women and men with CMD were 4.98 (95% CI 4.88–5.08) and 6.05 (95% CI 5.90–6.21). In women and men with both conditions, HRs for DP were 15.62 (95% CI 14.40–16.94) and 19.84 (95% CI 17.94–21.94). In women, synergy index, relative excess risk due to interaction, and attributable proportion were 1.24 (95% CI 1.13–1.36), 0.18 (95% CI 0.11–0.25), and 2.08 (95% CI 1.09–3.06). The corresponding figures for men were 1.45 (95% CI 1.29–1.62), 0.29 (95% CI 0.22–0.36), and 4.21 (95% CI 2.71–5.70).ConclusionsCo-morbidity of back pain and CMD is associated with a higher risk of DP than either individual condition, when added up, which has possible clinical implications to prevent further disability and exclusion from the labour market.

Adverse outcomes of sick leave due to mental disorders: A prospective study of discordant twin pairs

2017 ◽  
Vol 47 (2) ◽  
pp. 127-136 ◽  
Author(s):  
Lisa Mather ◽  
Victoria Blom ◽  
Gunnar Bergström ◽  
Pia Svedberg
Keyword(s):  
Mental Disorders ◽  
Sick Leave ◽  
Disability Pension ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Shared Environment ◽  
Hazard Ratios ◽  
Time Varying Covariates ◽  
Discordant Twin

Aims: The aim of this study was to investigate whether sick leave due to different mental disorders increased the risk of reoccurring sick-leave, disability pension and unemployment, taking genetics and shared environment into account. Methods: This register-based cohort study contains 2202 discordant twin pairs 18–64 years old, where one twin had sick leave due to a mental disorder 2005–2006. The end of the sick-leave spell was the start of follow-up for both twins. The twins were followed up for reoccurring sick-leave, disability pension and unemployment (> 180 days in a year), until December 2012. Analyses were censored for disability pension, death, emigration and old-age pension. Cox proportional hazards models with time-varying covariates were used to calculate hazard ratios with 95% confidence intervals (CI). Results: Those with sick leave due to mental disorders had a 3.64 (CI: 3.24–4.08) times higher risk of reoccurring sick-leave within the first two years; after that, hazard ratios were attenuated and explained by genetic factors. The first year, they had 12.24 (CI: 8.11–18.46) times the risk of disability pension. The risk was attenuated but remained at 2.75 (CI: 2.07–3.65) after one year. The risk of unemployment was 1.99 (CI: 1.72–2.31) during the whole follow-up period. The risk of unemployment and disability pension was lower for those with stress-related than other mental disorders, this was less clear for recurrent reoccuring sick-leave. Conclusions: Sick leave due to mental disorders increased the risk of reoccurring sick-leave within two years, disability pension and unemployment, independent of genetics and shared environment.

scholarly journals Adverse outcomes of sick leave due to mental disorders: prospective studies of discordant twin pairs

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
L Mather ◽  
J Narusyte ◽  
A Ropponen ◽  
G Bergström ◽  
V Blom ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Sick Leave ◽  
Outpatient Care ◽  
Disability Pension ◽  
Adverse Outcomes ◽  
Shared Environment ◽  
Twin Design ◽  
Familial Factors ◽  
Risk Of Death ◽  
Increased Risk

Abstract Background Sick leave due to mental disorders is common. We investigated if sick leave due to mental disorders increased the risk of reoccurring sick leave, disability pension, unemployment, in- and specialized outpatient care, and mortality, using a co-twin design, taking genetics and shared environment (familial factors) into account. Methods The register-based open cohort studies contained twin pairs 18-64 years old discordant for sick leave due to a mental disorder. First, 2202 pairs were followed up to 8 years from the end of the sick leave spell for reoccurring sick leave, disability pension and unemployment. Second, 4979 twin pairs were followed up to 9 years from the beginning of the sick leave spell for death, inpatient and specialized outpatient care. Conditional Cox proportional hazard regression, adjusting for familial factors, was used to calculate Hazard Ratios (HR) with 95% Confidence Intervals (CI). Results Those with sick leave due to mental disorders had 3.64 (CI: 3.24-4.08) times higher risk of reoccurring sick leave the first two years and the first year, they had 12.24 (CI: 8.11-18.46) times the risk for disability pension. The risk of unemployment was 1.99 (CI: 1.72-2.31). The HR for inpatient care was 1.90 (CI: 1.66-2.17) among men but lower among women. For men the risk of outpatient care was higher the first 2 years (HR: 2.08, CI: 1.87-2.31), and for women the HR was 1.57 (CI: 1.47-1.68) for the whole study time. There was an increased risk of death among men (HR: 2.91, CI: 1.70-4.99), but not among women. Conclusions By adjusting for familial factors we could investigate if the same factors that predispose to sick leave due to mental disorders also predispose to morbidity, mortality and unemployment and hence explain the associations. But, sick leave due to mental disorders was associated with a higher risk of work related and health outcomes, independent of familial factors. The risks varied over time and differed among women and men.

scholarly journals Transitioning from sickness absence to disability pension—the impact of poor health behaviours: a prospective Swedish twin cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e031889 ◽  
Author(s):  
Björg Helgadóttir ◽  
Lisa Mather ◽  
Jurgita Narusyte ◽  
Annina Ropponen ◽  
Victoria Blom ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cohort Study ◽  
Sickness Absence ◽  
Disability Pension ◽  
Proportional Hazards ◽  
Health Behaviours ◽  
Current Smoker ◽  
Cox Proportional Hazards ◽  
Poor Health ◽  
The Impact

ObjectivesTo investigate the association between three poor health behaviours (current smoker, high consumption of alcohol and low physical activity levels) and the transition to disability pension (DP) among individuals who have recently been sickness absent. Furthermore, we aimed to explore whether having multiple poor health behaviours increased the risk of transitioning from sickness absence (SA) to DP.DesignProspective twin cohort study.SettingSweden.ParticipantsTwins aged 20–46 who had participated in a survey and been on SA (>14 days) in the year preceding baseline (date of answering the questionnaire).Main outcome measureIncident DP during the follow-up which ended on 31 December 2012 (mean 5.2 years). A national register with full coverage provided data on DP.ResultsThe Cox proportional-hazards regression analyses showed that current smokers had a higher risk of transitioning from SA to DP compared with never smokers (HR 1.76; 95% CI 1.08 to 2.84). Alcohol use and lack of physical activity as well as poor health behaviour sum score showed no significant associations.ConclusionsBeing a current smoker influences the transition from SA to DP. Although non-significant, there were indications that more physical activity and fewer poor health behaviours could reduce the risk of exiting the labour market through DP. Improving health behaviours among people on SA could be a valuable tool for preventing the transition to DP.

scholarly journals Role of social benefits for future long-term sickness absence, disability pension and unemployment among individuals on sickness absence due to mental diagnoses: a competing risk approach

2021 ◽  
Author(s):  
Annina Ropponen ◽  
Jurgita Narusyte ◽  
Mo Wang ◽  
Sanna Kärkkäinen ◽  
Lisa Mather ◽  
...  
Keyword(s):  
Sickness Absence ◽  
Cumulative Incidence ◽  
Disability Pension ◽  
Social Insurance ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Social Benefits

Abstract Purpose To investigate associations between social benefits and disability pension (DP), long-term sickness absence (LTSA, ≥ 90 days), or unemployment among Swedish twins with sickness absence (SA) due to mental diagnoses. Methods This population-based prospective twin study included register data on first incident SA spell (< 90 days) due to mental diagnoses (ICD 10 codes F00-F99) during the follow-up 2005–2016. SA < 90 days due to other diagnoses than mental diagnoses or any other social insurance benefit was identified for the preceding year of the first incident SA spell due to mental diagnoses (coded yes/no). Comparing those with any previous social benefits vs without, cumulative incidence curve to compare time to an event, and Cox proportional hazards models for cause-specific hazard ratios (HR, 95% confidence intervals, CI) treating first incident DP, LTSA and unemployment as competing risks were modeled. Results During follow-up, 21 DP, 1619 LTSA, and 808 unemployment events took place. Compared to those without, those with at least one benefit had a higher risk for DP (HR 5.03; 95%CI 1.80, 14.01), LTSA (1.67; 1.50, 1.84) and unemployment (1.24; 1.03, 1.50). The cumulative incidence for DP was very low, < 1%, for LTSA 80% with any previous social benefits vs. 60% without, and for unemployment ≤ 5%. Conclusion Social benefits received during the preceding year of SA due to mental diagnoses (< 90 days) predict DP, LTSA, and unemployment. Hence, previous social benefits may provide means for early identification of persons at risk for exit from labor market.

scholarly journals Kjønnsforskjeller i overgang fra langtidssykmelding til uførepensjon i 1997-2002

2010 ◽  
Vol 19 (2) ◽  
Author(s):  
Sturla Gjesdal
Keyword(s):  
Gender Differences ◽  
Sick Leave ◽  
Sickness Absence ◽  
Disability Pension ◽  
Proportional Hazards ◽  
Sociodemographic Factors ◽  
Cox Proportional Hazards ◽  
Research Database ◽  
Permanent Disability

<p><strong><em>Bakgrunn: </em></strong>Denne studien undersøker overgangen fra langtidssykmelding til uførepensjonering for å se om man her kan finne noe av forklaringen på den observerte overhyppighet av uførepensjonering blant kvinner.</p><p><strong><em>Metode og materiale: </em></strong>Prospektiv nasjonal kohortstudie som inkluderer 66 083 kvinner og 47 073 menn i alderen 16-62 år som var sykmeldt lenger enn åtte uker i 1997. Data er hentet fra FD-trygd. Kvinner som var sykmeldt med en W-diagnose (svangerskapsrelatert) ble ekskludert fra analysen pga alder og lav uførefrekvens. Kohorten ble fulgt opp i fem år med overgang til uførepensjon som endepunkt. Betydning av kjønn ble estimert ved hjelp av Cox' proporsjonal hasards analyse, kontrollert for sosiodemografiske faktorer. Vi gjorde separate analyser for de sykmeldte med muskel- og skjelettdiagnoser, psykiske diagnoser, hjerte/lungediagnoser og "andre" sykmeldingsdiagnoser, også med stratifisering for bostedsfylke.</p><p><strong><em>Resultater: </em></strong>22% av de sykmeldte mennene og 24% av kvinnene var uførepensjonert etter fem års oppfølging. Etter justering for sosiodemografiske faktorer var risiko for uførepensjon fortsatt høyere for kvinner med muskel- og skjelettdiagnoser, men høyere for menn i de andre diagnosegruppene og totalt.</p><p><strong><em>Konklusjon: </em></strong>Risiko for uførepensjon blant langtidssykmeldte kvinner er ikke høyere enn hos langtidssykmeldte menn. Tvert imot, etter korreksjon for sosiodemografiske variabler, er det langtidssykmeldte menn som har størst risiko for å bli uførepensjonert, særlig innen gruppen som var sykmeldt for en psykisk lidelse. Siden langtidssykefraværet er høyere blant kvinner enn blant menn, er likevel totaleffekten en større uføretilgang blant kvinnelige langtidssykmeldte.</p><p> </p><p>Gjesdal S. <strong>Gender differences in transition from long-term sickness absence to permanent disability pension, 1997-2002. </strong><em>Nor J Epidemiol </em>2009; <strong>19 </strong>(2): 193-202.</p><p><strong> </strong></p><p><strong>E</strong><strong>NGLISH SUMMARY</strong></p><p><strong><em>Background: </em></strong>The study investigates the transition from long-term sickness absence to permanent disability pension (DP) in Norway. The aim is to assess whether gender differences in this process explain the observed female excess in disability pensioning in Norway.</p><p><strong><em>Methods and data: </em></strong>Prospective national cohort study including 66,083 women and 47,073 men aged 16-62 years, with a spell of sick leave longer than 8 weeks in 1997. The data is obtained from a national research database (FD-trygd). Women on sick leave with a pregnancy related diagnosis were excluded. The endpoint was granting of a DP. The effect of gender on the risk of obtaining a DP was estimated by means of Cox' proportional hazards analysis, adjusted for sociodemographic factors. Separate analyses were carried out for those with diagnoses indicating diseases in the musculoskeletal, mental, and cardiovascular and respiratory groups combined. Stratified analyses for county of residence were also performed.</p><p><strong><em>Results: </em></strong>22% of the male and 24% of the female sample obtained a DP during follow-up. Adjusted for sociodemographic factors the risk of DP was still higher for women with musculoskeletal diagnoses, but higher for men in the remaining diagnostic groups and overall.</p><p><strong><em>Conclusion: </em></strong>The risk of DP after sickness absence is not higher in women compared to men. On the contrary, after adjustment for relevant sociodemographic variables, men on sick-leave have the highest risk of a future DP. This is most evident among those on sick-leave with a mental diagnosis. However, since longterm sickness absence is much more frequent among women, the total effect is a higher rate of DP among Norwegian women.</p>

scholarly journals Comorbidity within mental disorders: a comprehensive analysis based on 145 990 survey respondents from 27 countries

2020 ◽  
Vol 29 ◽  
Author(s):  
J. J. McGrath ◽  
C. C. W. Lim ◽  
O. Plana-Ripoll ◽  
Y. Holtz ◽  
E. Agerbo ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Mental Disorder ◽  
Proportional Hazards ◽  
Age Of Onset ◽  
Common Mental Disorders ◽  
Epidemiological Studies ◽  
Cox Proportional Hazards ◽  
Comprehensive Analysis ◽  
Diverse Range ◽  
Increased Risk

Abstract Aims Epidemiological studies indicate that individuals with one type of mental disorder have an increased risk of subsequently developing other types of mental disorders. This study aimed to undertake a comprehensive analysis of pair-wise lifetime comorbidity across a range of common mental disorders based on a diverse range of population-based surveys. Methods The WHO World Mental Health (WMH) surveys assessed 145 990 adult respondents from 27 countries. Based on retrospectively-reported age-of-onset for 24 DSM-IV mental disorders, associations were examined between all 548 logically possible temporally-ordered disorder pairs. Overall and time-dependent hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Absolute risks were estimated using the product-limit method. Estimates were generated separately for men and women. Results Each prior lifetime mental disorder was associated with an increased risk of subsequent first onset of each other disorder. The median HR was 12.1 (mean = 14.4; range 5.2–110.8, interquartile range = 6.0–19.4). The HRs were most prominent between closely-related mental disorder types and in the first 1–2 years after the onset of the prior disorder. Although HRs declined with time since prior disorder, significantly elevated risk of subsequent comorbidity persisted for at least 15 years. Appreciable absolute risks of secondary disorders were found over time for many pairs. Conclusions Survey data from a range of sites confirms that comorbidity between mental disorders is common. Understanding the risks of temporally secondary disorders may help design practical programs for primary prevention of secondary disorders.

Suicide risk within one year of cognitive impairment diagnosis in older adults: a nationwide retrospective cohort study

2019 ◽  
Author(s):  
Jae Woo Choi ◽  
Kang Soo Lee ◽  
Euna Han
Keyword(s):  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mental Disorders ◽  
Suicide Risk ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Models ◽  
One Year

Abstract Background This study aims to investigate suicide risk within one year of receiving a diagnosis of cognitive impairment in older adults without mental disorders. Methods This study used National Health Insurance Service-Senior Cohort data on older adults with newly diagnosed cognitive impairment including Alzheimer’s disease, vascular dementia, other/unspecified dementia, and mild cognitive impairment from 2004 to 2012. We selected 41,195 older adults without cognitive impairment through 1:1 propensity score matching using age, gender, Charlson Comorbidity Index, and index year, with follow-up throughout 2013. We eliminated subjects with mental disorders and estimated adjusted hazard ratios (AHR) of suicide deaths within one year after diagnosis using the Cox proportional hazards models. Results We identified 49 suicide deaths during the first year after cognitive impairment diagnosis. The proportion of observed suicide deaths was the highest within one year after cognitive impairment diagnosis (48.5% of total); older adults with cognitive impairment were at a higher suicide risk than those without cognitive impairment (AHR, 1.89; 95% confidence interval [CI], 1.18–3.04). Subjects with Alzheimer’s disease and other/unspecified dementia were at greater suicide risk than those without cognitive impairment (AHR, 1.94, 1.94; 95% CI, 1.12–3.38, 1.05–3.58). Suicide risk in female and young-old adults (60–74 years) with cognitive impairment was higher than in the comparison group (AHR, 2.61, 5.13; 95% CI, 1.29–5.28, 1.48–17.82). Conclusions Older patients with cognitive impairment were at increased suicide risk within one year of diagnosis. Early intervention for suicide prevention should be provided to older adults with cognitive impairment.

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