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

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.

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

Scandinavian Journal of Public Health ◽

10.1177/1403494817735755 ◽

2017 ◽

Vol 47 (2) ◽

pp. 127-136 ◽

Cited By ~ 5

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.

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

Social Psychiatry and Psychiatric Epidemiology ◽

10.1007/s00127-019-01803-w ◽

2019 ◽

Vol 55 (8) ◽

pp. 1053-1060 ◽

Cited By ~ 1

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.

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Excess mortality of mental disorder

The British Journal of Psychiatry ◽

10.1192/bjp.173.1.11 ◽

1998 ◽

Vol 173 (1) ◽

pp. 11-53 ◽

Cited By ~ 1128

Author(s):

Clare Harris ◽

Brian Barraclough

Keyword(s):

Mental Disorders ◽

Mental Disorder ◽

English Language ◽

Common Mental Disorders ◽

Premature Death ◽

Medline Search ◽

Risk Of Death ◽

Increased Risk ◽

Standardised Mortality Ratios ◽

The Common

BackgroundWe describe the increased risk of premature death from natural and from unnatural causes for the common mental disorders.MethodWith a Medline search (1966–1995) we found 152 English language reports on the mortality of mental disorder which met our inclusion criteria. From these reports, covering 27 mental disorder categories and eight treatment categories, we calculated standardised mortality ratios (SMRs) and 95% confidence intervals (CIs) for all causes of death, all natural causes and all unnatural causes; and for most, SMRs for suicide, other violent causes and specific natural causes.ResultsHighest risks of premature death, from both natural and unnatural causes, are for substance abuse and eating disorders. Risk of death from unnatural causes is especially high for the functional disorders, particularly schizophrenia and major depression. Deaths from natural causes are markedly increased for organic mental disorders, mental retardation and epilepsy.ConclusionAll mental disorders have an increased risk of premature death.

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Sex differences of resource utilisation and outcomes in patients with atrial arrhythmias and heart failure

Heart ◽

10.1136/heartjnl-2019-315566 ◽

2019 ◽

Vol 106 (7) ◽

pp. 527-533 ◽

Cited By ~ 2

Author(s):

Laura Ueberham ◽

Sebastian König ◽

Sven Hohenstein ◽

Rene Mueller-Roething ◽

Michael Wiedemann ◽

...

Keyword(s):

Heart Failure ◽

Sex Differences ◽

Hospital Mortality ◽

Linear Mixed Model ◽

Adverse Outcomes ◽

Resource Utilisation ◽

Hospital Outcomes ◽

Risk Of Death ◽

Increased Risk ◽

Generalised Linear Mixed Model

ObjectiveAtrial fibrillation or atrial flutter (AF) and heart failure (HF) often go hand in hand and, in combination, lead to an increased risk of death compared with patients with just one of both entities. Sex-specific differences in patients with AF and HF are under-reported. Therefore, the aim of this study was to investigate sex-specific catheter ablation (CA) use and acute in-hospital outcomes in patients with AF and concomitant HF in a retrospective cohort study.MethodsUsing International Statistical Classification of Diseases and Related Health Problems and Operations and Procedures codes, administrative data of 75 hospitals from 2010 to 2018 were analysed to identify cases with AF and HF. Sex differences were compared for baseline characteristics, right and left atrial CA use, procedure-related adverse outcomes and in-hospital mortality.ResultsOf 54 645 analysed cases with AF and HF, 46.2% were women. Women were significantly older (75.4±9.5 vs 68.7±11.1 years, p<0.001), had different comorbidities (more frequently: cerebrovascular disease (2.4% vs 1.8%, p<0.001), dementia (5.3% vs 2.2%, p<0.001), rheumatic disease (2.1% vs 0.8%, p<0.001), diabetes with chronic complications (9.7% vs 9.1%, p=0.033), hemiplegia or paraplegia (1.7% vs 1.2%, p<0.001) and chronic kidney disease (43.7% vs 33.5%, p<0.001); less frequently: myocardial infarction (5.4% vs 10.5%, p<0.001), peripheral vascular disease (6.9% vs 11.3%, p<0.001), mild liver disease (2.0% vs 2.3%, p=0.003) or any malignancy (1.0% vs 1.3%, p<0.001), underwent less often CA (12.0% vs 20.7%, p<0.001), had longer hospitalisations (6.6±5.8 vs 5.2±5.2 days, p<0.001) and higher in-hospital mortality (1.6% vs 0.9%, p<0.001). However, in the multivariable generalised linear mixed model for in-hospital mortality, sex did not remain an independent predictor (OR 0.96, 95% CI 0.82 to 1.12, p=0.579) when adjusted for age and comorbidities. Vascular access complications requiring interventions (4.8% vs 4.2%, p=0.001) and cardiac tamponade (0.3% vs 0.1%, p<0.001) occurred more frequently in women, whereas stroke (0.6% vs 0.5%, p=0.179) and death (0.3% vs 0.1%, p=0.101) showed no sex difference in patients undergoing CA.ConclusionsThere are sex differences in patients with AF and HF with respect to demographics, resource utilisation and in-hospital outcomes. This needs to be considered when treating women with AF and HF, especially for a sufficient patient informed decision making in clinical practice.

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Clostridium Difficile-Associated Disease in Allogeneic Transplant Patients.

Blood ◽

10.1182/blood.v104.11.5095.5095 ◽

2004 ◽

Vol 104 (11) ◽

pp. 5095-5095

Author(s):

Justin S. Sadhu ◽

Erik R. Dubberke ◽

Robert Gatti ◽

Steven M. Devine ◽

Victoria J. Fraser

Keyword(s):

Clostridium Difficile ◽

Retrospective Chart Review ◽

Adverse Outcomes ◽

Allogeneic Transplant ◽

Risk Of Death ◽

Transplant Patients ◽

Increased Risk ◽

One Year ◽

Gastric Acid Suppression ◽

Underlying Diseases

Abstract Allogeneic transplant (allo) patients (pts) are at high risk for Clostridium difficile-associated disease (CDAD), yet there are few studies evaluating CDAD in allo pts. We carried out a retrospective chart review of all allo pts who had CDAD on a transplant (tx) unit between 8/01 and 7/03. 37 pts were identified who had CDAD during tx hospitalization (hosp) or after tx during the study period. 17 (46%) were admitted for initial tx, 13 (35%) for infection, and 7 (19%) for other reasons. 15 (40%) had acute leukemia, 6 (16%) lymphoma, 4 (11%) myelodisplastic syndrome, and 12 (32%) other underlying diseases. On admission, 17 (46%) pts were in complete remission, 4 (11%) in partial remission, 7 (19%) in relapse, and 9 (24%) presented with refractory disease. 5 pts (14%) had CDAD before day 0 (median d-2, range d-9 to d-1) and 32 pts (86%) had CDAD after tx (median d+49, d0 to d+3185). In the 60 days prior to CDAD, pts had median 1 (0–4) prior hosp and 15 days (1–50) hospitalized; 36 pts (97%) received antibiotics, 35 (95%) immunosuppressants, 33 (89%) antimotility/narcotic agents, 31 (84%) gastric acid suppression, 23 (62%) chemo, and 14 (38%) TBI. Within 48 hours of CDAD, 31 (86%) pts had diarrhea, 12 (33%) fever, 10 (28%) abdominal tenderness, 7 (19%) abdominal distention, and 7 (19%) hypothermia. 22 pts (59%) had either moderate or severe CDAD. 25 (68%) pts were treated for their primary episode of CDAD with metronizadole (met), 2 (5%) with vancomycin (vanc), 8 (22%) with met and vanc, and 2 (5%) were not treated for CDAD. 32 (86%) pts responded to therapy (median 2 days, range 0–25 days). Of the 32 pts who had CDAD post allo, 3 (9%) had gut graft-versus-host disease (GVHD) before CDAD and 8/29 (28%) developed gut GVHD after CDAD. Those 8 pts developed CDAD median d+114 (range +1 to +278) and gut GVHD d+131 (+1 to +454), with gut GVHD coming median 11 days (0 to 176) after CDAD. 7 pts (19%) died before discharge. The median survival time for all pts was 79 days after CDAD and 205 days after tx. Of the 30 (81%) pts discharged alive, 10 (33%) had recurrent CDAD episodes (median 1, range 1–3). When compared to mild CDAD, patients with severe CDAD had an increased risk of death at one year after CDAD (OR 3.3; CI 1.4–7.6). CDAD in allo pts may be associated with an increased risk of gut GVHD, death, and other adverse outcomes.

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The Covariation Between Burnout and Sick Leave Due to Mental Disorders Is Explained by a Shared Genetic Liability: A Prospective Swedish Twin Study With a Five-Year Follow-up

Twin Research and Human Genetics ◽

10.1017/thg.2014.46 ◽

2014 ◽

Vol 17 (6) ◽

pp. 535-544 ◽

Cited By ~ 7

Author(s):

Lisa Mather ◽

Gunnar Bergström ◽

Victoria Blom ◽

Pia Svedberg

Keyword(s):

Logistic Regression ◽

Mental Disorders ◽

Environmental Factors ◽

Sick Leave ◽

Social Insurance ◽

Conditional Logistic Regression ◽

Phenotypic Correlation ◽

Genetic Liability ◽

Familial Factors ◽

Shared Genetic

Background: This study aims to assess whether the associations between burnout and sick leave due to stress-related mental disorders, other mental disorders, and somatic conditions are influenced by familial (genetic and shared environmental) factors.Methods: In this prospective cohort study, 23,611 Swedish twins born between 1959 and 1985, who answered a web-based questionnaire, including the Pines Burnout Measure 2004–2006, were included. Registry data on sick leave spells from the response date until December 31, 2010 were obtained from the Swedish Social Insurance Agency. Logistic regression analysis was performed to assess odds ratios with 95% confidence intervals for the association between burnout and sick leave for the whole sample, while conditional logistic regression of the same-sex discordant twin pairs was used to estimate the association between burnout and sick leave, adjusting for familial confounding. The Bivariate Cholesky models were used to assess whether the covariation between burnout and sick leave was explained by common genetic and/or shared environmental factors.Results: Burnout was a risk factor for sick leave due to stress-related and other mental disorders, and these associations were explained by familial factors. The phenotypic correlation between burnout and sick leave due to somatic conditions was 0.07 and the association was not influenced by familial factors. The phenotypic correlations between burnout and sick leave due to stress-related (0.26) and other mental disorders (0.30) were completely explained by common genetic factors.Conclusions: The association between burnout and sick leave due to stress-related and other mental disorders seems to be a reflection of a shared genetic liability.

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P662Association of baseline disability and major adverse outcomes in patients with atrial fibrillation: an analysis from the SPORTIF trials

European Heart Journal ◽

10.1093/eurheartj/ehz747.0268 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Proietti ◽

G Y H Lip

Keyword(s):

Atrial Fibrillation ◽

Regression Analysis ◽

Controlled Trial ◽

Linear Regression Analysis ◽

Cumulative Risk ◽

Adverse Outcomes ◽

Rank Test ◽

Composite Outcome ◽

Risk Of Death ◽

Increased Risk

Abstract Introduction The modified Rankin Scale (mRS) is usually used to evaluate the degree of disability in patients who have suffered a stroke. Some data suggest that pre-stroke mRS may be associated with clinical outcomes. No data exist about atrial fibrillation (AF) patients. Purpose To evaluate if baseline level of disability, evaluated as mRS, is associated with major adverse outcomes in patients with AF Methods Data from the SPORTIF III and V trials were used to evaluate study aims. mRS was categorized as follows: i) mRS 0 = No Disability; ii) mRS 1 = Operational Limitation; iii) mRS ≥2 = Disability. Stroke/systemic embolism (SE), death and composite of stroke/SE/acute myocardial infarction (AMI)/death were considered as major adverse outcomes. Results Among 7329 patients enrolled in SPORTIF trials, 7325 (99.9%) had data about baseline mRS, with 5587 (76.3%) with mRS 0, 1156 (15.8%) with mRS 1 and 582 (7.9%) with mRS ≥2. Mean (SD) and median [IQR] CHA2DS2-VASc was progressively higher across the three mRS categories (both p<0.001). An adjusted linear regression analysis confirmed that mRS was associated with an increasing CHA2DS2-VASc (unstandardized B: 0.354, 95% confidence interval [CI]: 0.317–0.390, p<0.001]. After a mean (SD) 1.55 (0.40) years of follow-up 184 (2.5%) stroke/SE, 392 (5.4%) death and 597 (8.2%) composite events were recorded. Log-rank test showed that cumulative risk of stroke/SE (p=0.005), death (p<0.001) and composite outcome (p<0.001) was progressively higher across the mRS categories [Figure]. Cox adjusted regression analysis found no independent association between mRS categories and stroke/SE occurrence, but baseline disability (mRS ≥2) was independently associated with death (hazard ratio [HR]: 2.17, 95% CI: 1.65–2.86 compared with no disability). Both operational limitation (mRS 1) and disability (mRS ≥2) were associated with the composite outcome (HR: 1.28, 95% CI: 1.04–1.59 and HR: 1.91, 95% CI: 1.51–2.42, respectively) compared to no disability. Kaplan-Meier curves Conclusions In a large cohort of AF patients derived from a randomized controlled trial, baseline disability was associated with an increased risk of death and composite outcome of stroke/SEAMI/death. Acknowledgement/Funding None

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Abstract 17216: Upright T Wave in Lead AVR and Risk of Mortality: A Systematic Review and Meta-Analysis

Circulation ◽

10.1161/circ.142.suppl_3.17216 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

laith A derbas ◽

Raed Qarajeh ◽

Anas Noman ◽

Mohammed Al Amoodi ◽

Ala Mohsen ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Meta Analysis ◽

Adverse Outcomes ◽

Risk Scores ◽

Risk Of Death ◽

T Wave ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Lead Avr

Background: Multiple observational studies have shown that positive T wave in lead AVR (PTAVR) on 12-lead electrocardiogram is associated with an increased risk of adverse outcomes including death. We sought to review the literature and conduct a meta-analysis to estimate the risk of mortality in patients with PTAVR. Methods: We searched multiple databases to investigate the association between PTAVR and risk of death. Studies that reported adjusted odds ratio (OR) or hazards ratio (HR) of the association between PTAVR and risk of death (all cause or cardiovascular mortality) were included. We used inverse variance approach to pool adjusted OR /HR and it’s 95 % confidence interval using a random effects model meta-analysis. Results: Out of 140 relevant studies, 17 studies were eligible. Twelve studies reported all-cause mortality and enrolled 4,122 patients, 1976 (47.9%) were males. PTAVR was associated with a significant increase in all-cause mortality, with a pooled adjusted OR 2.44, 95% CI [1.76-3.39], heterogeneity I 2 = 86%. Five studies reported cardiovascular mortality and enrolled 31,713 patients, 27,628 (87.1%) were males. PTAVR was associated with a significant increase in cardiovascular mortality, with a pooled adjusted OR 2.34, 95% CI [1.82-3.0], heterogeneity I 2 = 68%. Conclusion: Our findings suggest that PTAVR is significantly associated with a higher risk of death from any cause as well cardiovascular mortality. Lead AVR, an often neglected lead, should be carefully interpreted as it may provide important prognostic information. Further studies are warranted to examined the prognostic value of PTAVR in risk stratification when added to existing cardiovascular risk scores.

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Adverse outcomes of being on sick leave due to mental disorders: a prospective co-twin study

European Journal of Public Health ◽

10.1093/eurpub/ckx186.334 ◽

2017 ◽

Vol 27 (suppl_3) ◽

Author(s):

L Mather ◽

V Blom ◽

G Bergström ◽

P Svedberg

Keyword(s):

Mental Disorders ◽

Sick Leave ◽

Twin Study ◽

Adverse Outcomes

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Workshop: Twins: a powerful study design to examine the role of genetics and environment for work incapacity

European Journal of Public Health ◽

10.1093/eurpub/ckz185.695 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

Keyword(s):

Risk Factors ◽

Environmental Factors ◽

Sick Leave ◽

Disability Pension ◽

Twin Studies ◽

Public Health Research ◽

Twin Design ◽

Genetic And Environmental Factors

Abstract Twin design is an important tool to analyze the role of genetic and environmental factors, and to better understand causal mechanisms in public health research. Twin studies have reliably shown that genetic factors are important not only for physiological traits but also for psychological and health behavioral traits as well as for health-related work incapacity in terms of sick leave and disability pension. As many countries face an aging workforce, it is becoming ever more important to understand the underlying causes of work incapacity across the entire working life. In the past decade, twin data in combination with national register data have been used to deepen our understanding of the role of genetic and environmental influences on the complex processes of sick leave and disability pension. The aim of this workshop is to present and discuss methods and results of studies based on the large Swedish, Finnish and Norwegian twin cohorts. Linear structural equations are intensively utilized in modern methods of twin studies. A variety of models are available to answer different research questions, such as the dynamics behind associations between traits and developmental processes in longitudinal designs - models also applicable in health at work and social security. Further, analyzing twin pairs discordant for an outcome or risk factor (co-twin control) provides a unique possibility to control for familial (genetic and shared environmental) factors, since cases and controls are matched optimally being twins. Findings based on twin cohorts suggest that familial factors are relevant to many risk factors as well as for work incapacity. By controlling for these unobserved confounding factors, the co-twin control design may provide more accurate estimates of risk factors for work incapacity and complement the epidemiological findings of unrelated subjects. Based on population-based twin cohort studies with long follow-up, indications also exist that familial confounding may have different roles in the associations between risk factors and work incapacity. For example, in regard to various disability pension diagnosis groups and depending on study designs (one vs. two time points, longer vs. shorter follow-up etc.). Results from prospective studies on various risk factors, including adolescents’ mental health problems, for future sick leave and disability pension will be presented. Another presentation focuses on the stability and change in genetic and environmental factors influencing work incapacity from age 18 until retirement and the likelihood of causality between educational attainment, lifestyle and work incapacity. Finally, results on adverse outcomes of sick leave due to mental disorders using an open cohort design adjusting for familial factors will be presented. During the time of rapid development in molecular genetics, the twin study design has maintained its importance and will continue to cast light on different aspects of work incapacity. Key messages Twin design offers a unique tool in public health research to examine and control for familial (genetic and shared environmental) factors. Genetic factors seem to play an important role in understanding the complex causes of work incapacity in terms of sick leave and disability pension.

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