Inequity in disability pension: an intersectional analysis of the co-constitution of gender, education and age. The Hordaland Health Study

Variation in general practitioners' depression care following certification of sickness absence: a registry-based cohort study

BACKGROUND

Depression is more prevalent among women and people with low socio-economic status. Uncertainties exist about how general practitioner (GP) depression care varies with patients' social position.

OBJECTIVE

To investigate associations between patients' gender and educational status combined and GP depression care following certification of sickness absence.

METHODS

Nationwide registry-based cohort study, Norway, 2012-14. Reimbursement claims data from all consultations in general practice for depression were linked with information on socio-demographic data, social security benefits and depression medication. The study population comprised all individuals aged 25-66 years with taxable income, sick-listed with a new depression diagnosis in general practice in 2013 (n = 8857). We defined six intersectional groups by combining educational level and gender. The outcome was type of GP depression care during sick leave: follow-up consultation(s), talking therapy, medication and referral to secondary care. Associations between intersectional groups and outcome were estimated using generalized linear models.

RESULTS

Among long-term absentees (17 days or more), highly educated women were less likely to receive medication compared to all other patient groups [relative risk (RR) ranging from 1.17 (95% confidence interval 1.03-1.33) to 1.49 (1.29-1.72)] and more likely to receive talking therapy than women with medium [RR = 0.90 (0.84-0.98)] or low [RR = 0.91 (0.85-0.98)] education.

CONCLUSIONS

Our findings suggest that GPs provide equitable depression care regarding consultations and referrals for all intersectional groups but differential drug treatment and talking therapy for highly educated women. GPs need to be aware of these variations to provide personalized care and to prevent reproducing inequity.

Occupational prestige and sickness absence inequality in employed women and men in Sweden: a registry-based study

OBJECTIVES

Socioeconomic position has been linked to sickness absence (SA). However, less is known about the role of occupational prestige, a measure of social status afforded by one's occupation, in SA. We investigated the association between occupational prestige and SA and the distribution of the association in women and men. We also examined the effect of intersections of gender and occupational prestige on SA.

DESIGN

Longitudinal.

SETTING

A nationwide representative sample of Swedish working population.

PARTICIPANTS

97 397 employed individuals aged 25-59 years selected from the 2004, 2007 and 2010 waves of the Swedish Labour Force Survey and prospectively linked to the Swedish Longitudinal Integration Database for Health Insurance and Labour Market Studies.

OUTCOME MEASURES

The number of SA days in any particular year during a 3-year follow-up and long-term (>120 days) SA based on those with at least one sick leave spell during the follow-up.

RESULTS

Occupational prestige was weakly associated with SA in the total sample after adjusting for potential confounders. In the gender-stratified analysis, women in lower prestige occupations had higher absenteeism rates than women in high prestige occupations; men in lower prestige occupations had higher odds for long-term SA than men in high prestige occupations. In the intersectional analysis, women regardless of prestige level and men in lower prestige occupations had higher probability of SA compared with men in high prestige occupations. Women in high prestige occupations had the highest absenteeism rates (incidence rate ratio (IRR), 2.25, 95% CI, 2.20 to 2.31), while men in medium prestige occupations had the lowest rates (IRR, 1.17, 95% CI, 1.13 to 1.20). Compared with the rest of the groups, men in low and medium prestige occupations had higher odds for long-term absence.

CONCLUSION

There is need to pay close attention to occupational prestige as a factor that may influence health and labour market participation.

Risk and risk factors for disability pension among patients with treatment resistant depression- a matched cohort study

BACKGROUND

Treatment resistant depression (TRD) is common among patients with depression, and is associated with clinical and functional disability. However, the risk and risk factors for being granted disability pension (DP) among patients with TRD have not been investigated.

METHODS

All antidepressant initiators in Sweden with a diagnosis of depression in specialized care were identified in nationwide registers 2006-2013 and followed regarding treatment trials. TRD was defined as the start of a third sequential trial. Patients with TRD who were not on DP (N = 3204) were matched by age, sex, history of depression, calendar year, and time for treatment start with 3204 comparators with depression and ongoing antidepressant treatment. A proportional Cox Regression was performed with DP as outcome, adjusted for various sociodemographic and clinical covariates.

RESULTS

Compared to the comparison cohort, TRD was associated with a doubled risk for all-cause DP (aHR 2.07; 95%CI 1.83-2.35), DP due to depression (2.28; 1.82-2.85) and to any mental disorder (2.24; 1.95-2.57) but not due to somatic diagnoses (1.25; 0.84-1.86). Among significant risk factors for DP in TRD were female sex, being > 29 years of age, unemployment and a diagnosis of comorbid personality disorder (ICD-10 codes F60.0-9).

CONCLUSION

TRD is associated with an elevated risk for DP compared to other patients with depression, with large potential costs for the affected patients and for society. Clinical and therapeutic implications for patients with TRD who are granted DP should be further investigated.

LIMITATION

No clinical data, e.g. type of depression or reason for treatment switch, was available for this study.

Temporary Disability Pension, RTW-Intentions, and RTW-Behavior: Expectations and Experiences of Disability Pensioners over 17 Months

Purpose: Individuals receiving a temporary disability pension (TDP) should get the opportunity to return to work (RTW). The current study aims to determine the factors contributing to RTW. Methods: 453 individuals on TDP were interviewed at three measurement points (T1, T2 = T1 + approximately 7 months, T3 = T1 + approximately 17 months). Socio-demographics, psychological predictors, and current work status (maintained TDP, permanent disability pension, old-age pension, employed, or receipt of other benefits) were assessed. Results: Throughout the duration of the study, only four of the former temporary disability pensioners returned to work, and an additional seven made themselves available to the labor market. These were individuals who were younger, in TDP for a shorter period of time, and reported a higher RTW-intention. Higher RTW-intention was cross-sectionally associated with younger age, shorter TDP duration, and more positive outcome expectancies. Additionally, study participants who expected that medical rehabilitation would help them RTW were more motivated to RTW. An increase in RTW-intention over 17 months was related to younger age and better health. Conclusion: Personal factors such as self-efficacy and job-related variables appear less important for RTW than age and subjective health status. The observed RTW rates call for early support and tailored medical rehabilitation interventions that help individuals prevent functional limitations, overcome disability, and facilitate RTW.