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Lindberg A, Svedberg P, Ropponen A, Narusyte J, Wang M. Work incapacity and psychiatric patient care following attempted suicide - a cohort study of 65 097 Swedish twins. Psychol Med 2023; 53:3728-3734. [PMID: 35260212 PMCID: PMC10277756 DOI: 10.1017/s0033291722000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/29/2021] [Accepted: 02/04/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Research is scarce on the role of familial factors and previous psychiatric care on the association between suicide attempt and future work incapacity as well as deterioration in mental health. We aimed to investigate the associations between suicide attempt and sickness absence, disability pension and psychiatric patient care and to study the influence of previous psychiatric care and familial factors (genetics and shared environment) on the associations. METHODS The study included 65 097 twins living in Sweden on 31st of December 2006, aged 19-60 years. The twins were followed 2007-2013 regarding sickness absence, disability pension, inpatient care or specialized outpatient care for a mental diagnosis. Cox regression models were performed for the whole sample, and conditional models for discordant twin pairs. The analyses were also stratified by psychiatric care before 2007. RESULTS We found that suicide attempt predicted sickness absence, disability pension, and future mental diagnosis among the whole sample. The discordant twin pair analyses showed that the association between suicide attempt and sickness absence or disability pension was influenced by familial factors. Stratified analyses of individuals with or without psychiatric care before 2007 showed that previous psychiatric care had some impact on the associations. CONCLUSIONS A suicide attempt is a risk factor for work incapacity and psychiatric patient care. Familial factors and previous psychiatric care play a role in the associations between attempting suicide and work incapacity as well as psychiatric patient care. These factors are important when developing measures preventing work incapacity among those with a suicide attempt.
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Affiliation(s)
- Anton Lindberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Pia Svedberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Annina Ropponen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jurgita Narusyte
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center of Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Mo Wang
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Risk of labour market marginalisation among young refugees and non-refugee migrants with common mental disorders. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1025-1034. [PMID: 33471136 PMCID: PMC8192389 DOI: 10.1007/s00127-020-02022-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 12/22/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Labour market marginalisation (LMM), i.e. long-term unemployment (LTU), long-term sickness absence (LTSA) and disability pension (DP), among young individuals with common mental disorders (CMDs) are a challenge for the welfare system, and refugees and non-refugee migrants seem particularly vulnerable. The aim was to investigate the risk of LMM in young adults with CMDs among refugees and non-refugee migrants compared to Swedish-born individuals and the role of country of birth, duration of residence and age at arrival. METHODS A prospective cohort study was conducted including young adults (19-30 years) with inpatient or specialised outpatient healthcare due to CMDs and/or antidepressant prescriptions during 2009 (N = 69,515). Cox regression models were used to calculate hazard ratios (HRs) with 95% confidence intervals for the risk of LMM during 2010-2013. RESULTS Both refugees and non-refugee migrants had a higher risk of LTU compared to Swedish-born individuals (HR refugees: Africa: 2.4; Asia: 2.2; Europe outside EU25: 1.6; South America: 1.4) with highest estimates in refugees from Afghanistan and Syria. Refugees from Africa and Asia had a lower risk of LTSA compared to Swedish-born individuals (HR: 0.6 and 0.7, respectively), particularly refugees from Afghanistan and Iraq. Especially among refugees, a longer duration of residence and a younger age at arrival were associated with a lower risk of LTU. CONCLUSIONS The risk of LTU among refugees and non-refugee migrants was higher and the risk of LTSA was lower, compared to Swedish-born individuals. Duration of residence and age at arrival had an influence on the risk of LTU, particularly among refugees.
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Di Thiene D, Mittendorfer-Rutz E, Rahman S, Wang M, Alexanderson K, Tiihonen J, La Torre G, Helgesson M. Trajectories of sickness absence, disability pension and unemployment in young immigrants with common mental disorders. Eur J Public Health 2020; 29:1055-1062. [PMID: 30929006 DOI: 10.1093/eurpub/ckz046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The aims were to elucidate if trajectories of labour market marginalization (LMM), measured as sickness absence (SA)/disability pension (DP) or unemployment, differed between young immigrants and natives before and after an incident diagnosis of a common mental disorder (CMD), and to investigate if educational level, psychiatric comorbidity and duration of residence in Sweden (in immigrants) had different associations with subsequent LMM in natives compared with immigrants. METHODS A total of 28 971 young adults (19-30 years), with an incident CMD (inpatient or specialized outpatient healthcare due to CMDs or dispensed prescribed antidepressants during 2007) were included. Group-based trajectory models were utilized to identify trajectories of annual months of LMM 3 years before and 6 years after the diagnosis. The associations of risk factors with different trajectories were investigated by multinomial logistic regression, χ2-test and Nagelkerke R2 to measure the associations' strength. Immigrants were categorized into Western and non-Western immigrants. RESULTS Young natives and immigrants showed similar trajectories of SA/DP. A higher proportion of non-Western immigrants (20.5%) followed trajectories of high levels of unemployment (>2 annual months) compared with Western immigrants (15%) and natives (16.5%). Educational level and duration of residence in Sweden (in immigrants) discriminated trajectories of both SA/DP and unemployment, whereas psychiatric comorbidity only discriminated trajectories of SA/DP. CONCLUSIONS Differences in trajectories of unemployment between young natives and immigrants with an incident CMD were found. Educational level and psychiatric comorbidity provided information on differences between natives and immigrants and duration of residence gave information for subgroups of immigrants.
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Affiliation(s)
- D Di Thiene
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - E Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - S Rahman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - M Wang
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - K Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - J Tiihonen
- Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - G La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - M Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Sörberg Wallin A, Sorjonen K, Lager A, Falkstedt D. Academic performance, subsequent socioeconomic status and suicide attempt in adulthood: path analyses on Swedish cohort data. J Epidemiol Community Health 2020; 74:1002-1007. [PMID: 32796011 DOI: 10.1136/jech-2020-214402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Poor academic performance in childhood is associated with suicide attempt in adulthood, but the mechanisms are not known. We investigated educational attainment as a possible pathway. METHODS We followed two sets of cohorts, born around 1950/1970, respectively, in the Swedish population-representative 'Evaluation Through Follow-up' study for a first suicide attempt in national records up to 2013. Data on grade point average (GPA) at age 13/16 and educational attainment (years of schooling) in adulthood were used. The path models included linear and Cox proportional hazards regressions. A model with matched age range during follow-up was used to compare the cohorts. RESULTS In the 1970 cohort, the association between GPA and suicide attempt between age 26 and 46 was partly mediated by attained education (total association, β=-0.82; via education: -0.29, per SD increase in GPA), but GPA also had a direct path to suicide attempt (β=-0.53). There was no evidence of such a pathway in the 1950 cohort between age 41 and 65. In the age-matched analysis, at age 26-46, the association between GPA and suicide attempt was stronger in the 1970 cohort compared to the 1950 cohort (β=-0.72 and -0.24, respectively). CONCLUSIONS Differences in attained education seem to partly explain the associations of academic performance with suicide attempt up to middle age. Furthermore, there is some indication that academic performance may have become more important for young people's mental health than it was in previous generations.
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Affiliation(s)
- Alma Sörberg Wallin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Kimmo Sorjonen
- Department of Clinical Neurosciences, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Anton Lager
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Daniel Falkstedt
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Niederkrotenthaler T, Mittendorfer-Rutz E, Mehlum L, Qin P, Björkenstam E. Previous suicide attempt and subsequent risk of re-attempt and suicide: Are there differences in immigrant subgroups compared to Swedish-born individuals? J Affect Disord 2020; 265:263-271. [PMID: 32090750 DOI: 10.1016/j.jad.2020.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/18/2019] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Studies investigating how suicide attempting refugees and non-refugee migrants differ from Swedish-born individuals in terms of re-attempts and suicide are missing. It remains unknown how mental disorders and labour market marginalization (LMM) impact on these associations. METHODS This longitudinal cohort study included Swedish residents aged 20-64 with suicide attempt in 2004-2012. In total, 42,684 individuals including 2017 refugees, and 2544 non-refugee migrants were included and followed until December 31, 2016. Risks of re-attempt and suicide were calculated as hazard ratios (HR) with 95% confidence intervals (CI), and adjusted for important confounders. Stratified analyses were to assess if mental disorders or LMM modified these associations. RESULTS In the adjusted models, refugees had an adjusted HR (aHR) of suicide re-attempt of 0.74 (CI: 0.67-0.81), and an aHR of 0.67 (CI: 0.53-0.86) for suicide death. These estimates were very similar to those of non-refugee migrants. Refugees and non-refugee migrants with suicide attempt had a lower prevalence of specialised health care due to mental disorders compared to Swedish-born attempters (48%, 44% and 61%, respectively). Mental disorders and LMM in terms of long-term sickness absence and disability pension increased the risk of re-attempt and suicide in all three groups. LIMITATIONS Only suicide attempts and mental disorders resulting in specialized in-and outpatient care were registered. CONCLUSION Migrants show considerably lower risks of re-attempt and suicide than Swedish-born individuals, with no differences between migrant groups. Despite vast differences in the prevalence of specific mental disorders, the role of mental disorders in the pathways to re-attempt and suicide does not appear to differ considerably between these groups.
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Affiliation(s)
- Thomas Niederkrotenthaler
- Unit Suicide Research & Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria.
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, University of Oslo, Sognsvannsveien 21, NO-0374 Oslo, Norway
| | - Ping Qin
- National Centre for Suicide Research and Prevention, University of Oslo, Sognsvannsveien 21, NO-0374 Oslo, Norway
| | - Emma Björkenstam
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden; Department of Community Health Sciences, Fielding School of Public Health and California Center for Population Research, University of California Los Angeles, Los Angeles, California, United States
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Helgesson M, Tinghög P, Wang M, Rahman S, Saboonchi F, Mittendorfer-Rutz E. Trajectories of work disability and unemployment among young adults with common mental disorders. BMC Public Health 2018; 18:1228. [PMID: 30400785 PMCID: PMC6219052 DOI: 10.1186/s12889-018-6141-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 10/22/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Labour-market marginalisation (LMM) and common mental disorders (CMDs) are serious societal problems. The aims were to describe trajectories of LMM (both work disability and unemployment) among young adults with and without CMDs, and to elucidate the characteristics associated with these trajectories. METHODS The study was based on Swedish registers and consisted of all individuals 19-30 years with an incident diagnosis of a CMD in year 2007 (n = 7245), and a matched comparison group of individuals without mental disorders during the years 2004-07 (n = 7245). Group-based trajectory models were used to describe patterns of LMM both before, and after the incident diagnosis of a CMD. Multinomial logistic regressions investigated the associations between sociodemographic and medical covariates and the identified trajectories. RESULTS Twenty-six percent (n = 1859) of young adults with CMDs followed trajectories of increasing or constant high levels of work disability, and 32 % (n = 2302) followed trajectories of increasing or constant high unemployment. In the comparison group, just 9 % (n = 665) followed increasing or constant high levels of work disability and 21 % (n = 1528) followed trajectories of increasing or constant high levels of unemployment. A lower share of young adults with CMDs followed trajectories of constant low levels of work disability (n = 4546, 63%) or unemployment (n = 2745, 38%), compared to the level of constant low work disability (n = 6158, 85%) and unemployment (n = 3385, 50%) in the comparison group. Remaining trajectories were fluctuating or decreasing. Around 50% of young adults with CMDs had persistent levels of LMM at the end of follow-up. The multinomial logistic regression revealed that educational level and comorbid mental disorders discriminated trajectories of work disability, while educational level, living area and age determined differences in trajectories of unemployment (R2difference = 0.02-0.05, p < 0.001). CONCLUSIONS A large share, nearly 50%, of young adults with CMDs, substantially higher than in the comparison group of individuals without mental disorders, display increasing or high persistent levels of either work disability or unemployment throughout the follow-up period. Low educational level, comorbidity with other mental disorders and living in rural areas were factors that increased the probability for LMM.
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Affiliation(s)
- Magnus Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Petter Tinghög
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- The Swedish Red Cross University, College, SE-102 15 Stockholm, Sweden
| | - Mo Wang
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Syed Rahman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Fredrik Saboonchi
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- The Swedish Red Cross University, College, SE-102 15 Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
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Wang M, Mittendorfer-Rutz E, Dorner TE, Pazarlis KA, Ropponen A, Svedberg P, Helgesson M. Determinants of work disability following lumbar spine decompression surgery. Scand J Public Health 2018; 47:281-292. [PMID: 29974820 DOI: 10.1177/1403494818785055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS Scientific knowledge about risk factors for work disability in terms of long-term sickness absence and disability pension following lumbar spine decompression surgery remains insufficient. This study aimed to investigate the associations between socio-demographic, work-related, and medical characteristics with subsequent long-term sickness absence (>90 days) and disability pension for individuals who underwent lumbar spine decompression surgery. METHODS A prospective cohort study of all individuals aged 19-60 years with diagnosed dorsopathies, who underwent lumbar spine decompression surgery 2008-10 in Sweden ( n=7373) was performed. Univariate and multivariate hazard ratios with 95% confidence intervals regarding long-term sickness absence and disability pension with a 3-year follow-up period were estimated by Cox proportional regression. RESULTS Low educational level, being a non-European immigrant and preoperative sickness absence were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2-3.8). Female sex was a risk factor for long-term sickness absence (hazard ratios: 1.3) whereas age >44 years and being a Nordic immigrant were risk factors for disability pension (hazard ratios: 1.9-2.6). Medical factors as common mental disorders, other mental disorders, prescribed psychiatric medication and somatic comorbidity were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2-3.4). A simultaneous lumbar fusion surgery and high preoperative pain severity were risk factors for long-term sickness absence (hazard ratios 1.2-1.8). CONCLUSIONS To prevent long-term work disability after lumbar spine decompression surgery, specific focus is required on older and female patients, those with mental or somatic comorbidities, high levels of preoperative pain or sickness absence, with a simultaneous lumbar fusion surgery, a low educational level or a non-European immigrant background.
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Affiliation(s)
- Mo Wang
- 1 Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | | | - Thomas E Dorner
- 2 Department of Social and Preventive Medicine, Medical University of Vienna, Austria
| | | | - Annina Ropponen
- 1 Department of Clinical Neuroscience, Karolinska Institutet, Sweden.,4 Finnish Institute of Occupational Health, Finland
| | - Pia Svedberg
- 1 Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Magnus Helgesson
- 1 Department of Clinical Neuroscience, Karolinska Institutet, Sweden
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Niederkrotenthaler T, Helgesson M, Rahman S, Wang M, Mittendorfer-Rutz E. Period effects in the risk of subsequent labour market marginalisation in young suicide attempters. Eur J Public Health 2018; 28:253-258. [PMID: 29036335 DOI: 10.1093/eurpub/ckx140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Suicide attempt in young age is associated with subsequent labour market marginalisation, but little is known about how marginalisation is affected by changes in suicide attempt rates and social insurance legislation and by age differences. Methods Prospective cohort study based on register linkage of > 2.4 million Swedish residents per birth cohort, aged 19-40 years in 1999; 2004 and 2009, respectively, and followed up for 4 years. Suicide attempters treated in inpatient care in the three years preceding study entry (n > 7000 per cohort) were compared with the general population of the same age without attempt (1987 to end of follow-up). Hazard ratios (HR) and 95% confidence intervals for long-term unemployment (>180 days), sickness absence (>90 days) and disability pension were calculated with Cox regression, adjusted for several risk markers. Additional analyses were stratified by age (below/above 30 years). Results Across all cohorts, suicide attempt was associated with subsequent labour market marginalisation. Estimates were generally highest for disability pension [e.g. 2009 cohort: adjusted (a) HR = 2.7], followed by sickness absence (2009 cohort: aHR = 2.3) and unemployment (2009 cohort: aHR = 1.5). aHRs were higher in the 2004 and 2009 cohorts compared with the 1999 cohort. For disability pension, for example, aHRs were 2.39, 3.90 and 2.68 for the 1999, 2004 and 2009 cohorts, respectively. Stratification revealed marginal age differences. Conclusion It seems to have become more difficult for suicide attempters to establish themselves on the labour market in later cohorts, which might result from changes in social insurance regulations. There were no considerable age differences.
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Affiliation(s)
- T Niederkrotenthaler
- Suicide Research Unit, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Wien, Austria
| | - M Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - S Rahman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - M Wang
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - E Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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