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Melzner L, Kröger C. [Incapacity to work due to mental disorders-economic, individual, and treatment-specific aspects]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:751-759. [PMID: 38789543 PMCID: PMC11230963 DOI: 10.1007/s00103-024-03894-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/07/2024] [Indexed: 05/26/2024]
Abstract
The changes in the modern work environment are accompanied by specific stressors that can have a negative impact on employees' mental health. In line with this, the proportion of sick-leave days due to mental disorders has recently risen to 17.7% compared to 10.9% in 2007, which in 2021 was associated with costs of 42.9 billion euros due to losses of gross value and productivity.Based on current health economic studies, this review provides an overview of the economic impact of incapacity to work and early retirement due to various mental disorders in Germany. In absolute figures, expenditure on incapacity to work is particularly high for common mental illnesses such as affective and anxiety disorders. Rarer mental disorders such as post-traumatic stress disorder and eating disorders cause high costs in relation to their low prevalence, particularly due to sickness benefit payments.In addition to these economic implications, the consequences of incapacity to work, early retirement, and unemployment are examined at an individual level and explanatory approaches for the specific psychosocial stresses are presented. The latter highlights the need for scientifically substantiated treatment methods. Certified treatments have proven to be efficient in reducing the number of sick-leave days, particularly for common mental disorders. This applies even more to workplace-related interventions, which appear to be superior to conventional methods in this respect. Workplace-based therapies incorporate work-related models and focus on the planning of reintegration into the workplace. Further naturalistic studies are needed to test the transferability of the effectiveness of these treatments to other disorders.
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Affiliation(s)
- Lena Melzner
- Institut für Psychologie, Abteilung für Klinische Psychologie und Psychotherapie, Universität Hildesheim, Universitätsplatz 1, 31141, Hildesheim, Deutschland.
| | - Christoph Kröger
- Institut für Psychologie, Abteilung für Klinische Psychologie und Psychotherapie, Universität Hildesheim, Universitätsplatz 1, 31141, Hildesheim, Deutschland
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2
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Guimarães GO, D'Angelo F, Brouillette K, Souza LDM, da Silva RA, Mondin TC, Pedrotti Moreira F, Kapczinski F, de Azevedo Cardoso T, Jansen K. Incidence and risk factors for anxiety disorders in young adults: A population-based prospective cohort study. L'ENCEPHALE 2023; 49:572-576. [PMID: 36253174 DOI: 10.1016/j.encep.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/18/2022] [Accepted: 08/04/2022] [Indexed: 11/06/2022]
Abstract
Anxiety disorders are among the most common psychiatric disorders in the general population. Our objective was to describe the cumulative incidence and risk factors of anxiety disorders, including obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD), in a follow-up of young adults over a five-year period. This is a prospective cohort conducted in two waves. The first took place from 2007 to 2009, in which 1,560 young adults aged between 18 and 24 years were evaluated using the Mini-International Neuropsychiatric Interview (MINI). Subjects were invited to participate in the second wave, which wave took place from 2012 to 2014, where 1,244 young adults were evaluated using the MINI-Plus. Our findings showed a cumulative incidence of 10.9% for any anxiety disorder, 6.5% for generalized anxiety disorder, 6.0% for agoraphobia, 2.0% for OCD, 1.6% for panic disorder, 1.1% for social anxiety and 0.7% for PTSD. Being female and having had a depressive episode were risk factors to develop any anxiety disorder. We observed a high cumulative incidence of anxiety disorders in a population-based sample of young adults. Our data highlights the importance of the early identification of these disorders as this could lead to early illness detection, early illness management and a reduced burden of disease.
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Affiliation(s)
- G O Guimarães
- Department of Health and Behavior, Catholic University of Pelotas - Universidade Católica de Pelotas, Rua Gonçalves Chaves, 373, Sala 424C, 96015-560 Pelotas, RS, Brazil
| | - F D'Angelo
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - K Brouillette
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; School of Interdisciplinary Science, Life Sciences Program, McMaster University, Hamilton, ON, Canada
| | - L D M Souza
- Department of Health and Behavior, Catholic University of Pelotas - Universidade Católica de Pelotas, Rua Gonçalves Chaves, 373, Sala 424C, 96015-560 Pelotas, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil
| | - R A da Silva
- Department of Health and Behavior, Catholic University of Pelotas - Universidade Católica de Pelotas, Rua Gonçalves Chaves, 373, Sala 424C, 96015-560 Pelotas, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil
| | - T C Mondin
- Department of Health and Behavior, Catholic University of Pelotas - Universidade Católica de Pelotas, Rua Gonçalves Chaves, 373, Sala 424C, 96015-560 Pelotas, RS, Brazil; Pró-Reitoria de Assuntos Estudantis (PRAE), Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - F Pedrotti Moreira
- Department of Health and Behavior, Catholic University of Pelotas - Universidade Católica de Pelotas, Rua Gonçalves Chaves, 373, Sala 424C, 96015-560 Pelotas, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil
| | - F Kapczinski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil; Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Departamento de Psiquiatria, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - T de Azevedo Cardoso
- Department of Health and Behavior, Catholic University of Pelotas - Universidade Católica de Pelotas, Rua Gonçalves Chaves, 373, Sala 424C, 96015-560 Pelotas, RS, Brazil; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; School of Interdisciplinary Science, Life Sciences Program, McMaster University, Hamilton, ON, Canada; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil
| | - K Jansen
- Department of Health and Behavior, Catholic University of Pelotas - Universidade Católica de Pelotas, Rua Gonçalves Chaves, 373, Sala 424C, 96015-560 Pelotas, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil.
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3
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Øien-Ødegaard C, Hauge LJ, Stene-Larsen K, Christiansen STG, Bjertness E, Reneflot A. Widening the knowledge of non-employment as a risk factor for suicide: a Norwegian register-based population study. BMC Public Health 2023; 23:1181. [PMID: 37337178 DOI: 10.1186/s12889-023-16084-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 06/08/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND There is a known association between employment status and suicide risk. However, both reason for non-employment and the duration affects the relationship. These factors are investigated to a lesser extent. About one third of the Norwegian working age population are not currently employed. Due to the share size of this population even a small increase in suicide risk is of importance, and hence increased knowledge about this group is needed. METHODS We used discrete time event history analysis to examine the relationship between suicide risk and non-employment due to either unemployment or health-problems, and the duration of these non-employment periods. We analyze data from the Norwegian population registry from 2004 to 2014, which includes all Norwegian residents in the ages 19-58 born between 1952 and 1989. In total the data consists of 1 063 052 men and 1 024 238 women, and 2 039 suicides. RESULTS The suicide risk among the non-employed men and women is significantly higher than that of the employed. For the unemployed men, the suicide risk is significantly higher than the employed within the first 18 months. For the unemployed women we only find a significant association with suicide risk among those unemployed for six to twelve months. The suicide risk is especially increased among those with temporary health-related benefits. In the second year of health-related non-employment men have eightfold and women over twelvefold the OR for suicide, compared to the employed. CONCLUSION There is an association between non-employment and suicide risk. Compared to the employed both unemployed men and men and women with health-related non-employment have elevated suicide risk, and the duration of non-employment may be the driving force. Considering the large share of the working age population that are not employed, non-employment status should be considered in suicide risk assessment by health care professionals and welfare providers.
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Affiliation(s)
- Carine Øien-Ødegaard
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Lars Johan Hauge
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kim Stene-Larsen
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Espen Bjertness
- Department of Community Medicine and Global Health (Department of Health and Society), University of Oslo, Oslo, Norway
| | - Anne Reneflot
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
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Jespersen CHB, Butt JH, Krøll J, Winkel BG, Kanters JK, Gislason G, Torp-Pedersen C, Bundgaard H, Jensen HK, Køber L, Tfelt-Hansen J, Weeke PE. Workforce attachment after a congenital long QT syndrome diagnosis: a Danish nationwide study. Open Heart 2022; 9:openhrt-2022-002056. [PMID: 35793863 PMCID: PMC9260845 DOI: 10.1136/openhrt-2022-002056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/15/2022] [Indexed: 11/12/2022] Open
Abstract
Objective To examine workforce attachment among patients with congenital long QT syndrome (cLQTS) following diagnosis and identify factors associated with workforce attachment. Methods and results In this nationwide cohort study, all patients diagnosed with cLQTS in Denmark between 1996 and 2016 aged 18–60 years at diagnosis were identified using nationwide registries. Patients attached to the workforce at diagnosis were included. Attachment to the workforce 1 year after cLQTS diagnosis was examined and compared with a background population matched 1:4 on age, sex and employment status. Multiple logistic regression was performed to identify factors associated with 1-year workforce detachment among patients with cLQTS. 298 patients fulfilled the inclusion criteria. Six months after cLQTS diagnosis, 90.9% of patients with cLQTS were attached to the workforce compared with 95.0% in the background population (p=0.006 for difference). One year after diagnosis, 93.3% of patients with cLQTS were attached to the workforce compared with 93.8% in the background population (p=0.26). Among patients with cLQTS, a severe cLQTS disease manifestation was associated with workforce detachment 1 year after diagnosis (compared with asymptomatic patients; aborted cardiac arrest OR 20.4 (95% CI, 1.7 to 249.9); ventricular tachycardia/syncope OR 10.9 (95% CI, 1.1 to 110.5)). No other associated factors were identified. Conclusions More than 90% of patients with cLQTS remained attached to the workforce 1 year after diagnosis, which was similar to a matched background population. Patients with a severe cLQTS disease manifestation were less likely to be attached to the workforce 1 year after diagnosis.
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Affiliation(s)
- Camilla H B Jespersen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jawad Haider Butt
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Johanna Krøll
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jørgen K Kanters
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Medical Sciences, Univeristy of Copenhagen, Copenhagen, Denmark
| | - Peter E Weeke
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Collie A, Gray SE. The relationship between work disability and subsequent suicide or self-harm: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000922. [PMID: 36962884 PMCID: PMC10021753 DOI: 10.1371/journal.pgph.0000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 11/12/2022] [Indexed: 12/12/2022]
Abstract
Work disability occurs when an injury or illness limits the ability of a worker to participate in employment. While evidence suggests that people with work disability are at increased risk of suicide and intentional self-harm, this relationship has not been the subject of systematic review. This scoping review aims to assess and summarise the research literature regarding the relationship between work disability and subsequent suicide or intentional self-harm. Review protocol was published on the Open Science Foundation and is reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Peer-reviewed studies published in English from 1st January 2000 were included if they reported suicide or self-harm outcomes in people aged 15 years or older with work disability. Studies were identified via systematic search of Medline, Scopus and Pubmed databases, via recommendation from topic experts, and citation searching of included articles. A narrative synthesis was undertaken. Literature search yielded 859 records of which 47 eligible studies were included, nine set in workers' compensation, 20 in sickness absence, 13 in disability pension systems, and five from mixed cohorts. Of 44 quantitative studies, 41 reported a positive relationship between work disability and suicidal behaviour. The relationship is observed consistently across nations, work disability income support systems and health conditions. Several factors elevate risk of suicidal behaviour, including presence of mental health conditions and longer work disability duration. There were few studies in some nations and no suicide prevention interventions. The risk of suicide and self-harm is elevated in people experiencing work disability. Further observational research is required to fill evidence gaps. This review suggests the need for governments, employers and those involved in the care of people with work disability to focus on identification and monitoring of those at greatest risk of suicidal behaviour, and suicide prevention.
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Affiliation(s)
- Alex Collie
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Shannon Elise Gray
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Frey BN, Vigod S, de Azevedo Cardoso T, Librenza-Garcia D, Favotto L, Perez R, Kapczinski F. The Early Burden of Disability in Individuals With Mood and Other Common Mental Disorders in Ontario, Canada. JAMA Netw Open 2020; 3:e2020213. [PMID: 33104205 PMCID: PMC7588941 DOI: 10.1001/jamanetworkopen.2020.20213] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IMPORTANCE Large population-based data on the trajectory to disability after the first diagnosis of a mood disorder are lacking. OBJECTIVE To assess the time between an incident mood disorder diagnosis and the receipt of disability services during a follow-up period of as long as 20 years. DESIGN, SETTING, AND PARTICIPANTS This cohort study used health administrative and social service data from ICES for 1 902 792 adults aged 18 to 59 years living in Ontario, Canada. A narrow cohort of individuals who had a new diagnosis of a mood disorder between October 1, 1997, and March 31, 2007, matched by sex and age to individuals with no history of mood disorder, included 278 296 participants. A broader cohort of individuals who had a new diagnosis of other common mental disorders during the same period, matched by sex and age to individuals with no history of mental disorder diagnosis, included 1 624 496 individuals. All individuals were followed up to a maximum end date of March 31, 2017. Data analysis was conducted from November 2017 to June 2018. EXPOSURE Incident diagnosis of mood or common mental disorder. MAIN OUTCOMES AND MEASURES Disability outcomes were as follows: (1) entry into the Ontario Disability Support Program (ODSP), signifying long-term inability to work because of a disability, and (2) admission into a long-term care (LTC) residence, signifying the inability to live in independent housing. Cox proportional hazards models were used. RESULTS In the full cohort of 1 902 792 individuals, 278 296 participants (14.6%) were included in the mood disorder cohort (mean [SD] age, 37.5 [11.9] years; 157 386 [56.6%] women), and 1 624 496 participants (85.4%) were included in the common mental disorder cohort (mean [SD], 36.5 [11.8] years; 932 545 [57.4%] women). The incidence of ODSP initiation was greater among individuals with mood disorders than those without (51.5 per 10 000 person-years vs 25.5 per 10 000 person-years; adjusted hazard ratio [aHR], 2.03; 95% CI, 1.95-2.11) and for those with common mental disorders (45.0 per 10 000 person-years vs 27.6 per 10 000 person-years; aHR, 1.57; 95% CI, 1.55-1.60). The aHR for admission to LTC was also higher among individuals with mood disorders compared with those without (aHR, 2.20; 95% CI, 1.80-2.69) and those with common mental disorders compared with those without (aHR, 1.21; 95% CI, 1.14-1.29). Individuals with bipolar disorders had greater ODSP rates than individuals with major depressive disorders (crude rate ratio: 4.31 [95% CI, 3.56-5.17] vs 1.82 [95% CI, 1.36-2.43]). CONCLUSIONS AND RELEVANCE This cohort study found that mood disorders were associated with elevated and early rates of disability services. Effective early intervention strategies targeting functional impairment in this population are encouraged.
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Affiliation(s)
- Benicio N. Frey
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Simone Vigod
- Women’s College Hospital and Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry and Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Taiane de Azevedo Cardoso
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Diego Librenza-Garcia
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Flavio Kapczinski
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Suicide attempt following sickness absence and disability pension due to common mental disorders: a prospective Swedish twin study. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1053-1060. [PMID: 31748874 PMCID: PMC7395035 DOI: 10.1007/s00127-019-01803-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 11/09/2019] [Indexed: 11/26/2022]
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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Mental disorders and suicidal behavior in refugees and Swedish-born individuals: is the association affected by work disability? Soc Psychiatry Psychiatr Epidemiol 2020; 55:1061-1071. [PMID: 31897579 PMCID: PMC7395008 DOI: 10.1007/s00127-019-01824-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 12/24/2019] [Indexed: 12/03/2022]
Abstract
BACKGROUND Among potential pathways to suicidal behavior in individuals with mental disorders (MD), work disability (WD) may play an important role. We examined the role of WD in the relationship between MD and suicidal behavior in Swedish-born individuals and refugees. METHODS The study cohort consisted of 4,195,058 individuals aged 16-64, residing in Sweden in 2004-2005, whereof 163,160 refugees were followed during 2006-2013 with respect to suicidal behavior. Risk estimates were calculated as hazard ratios (HR) with 95% confidence intervals (CI). The reference groups comprised individuals with neither MD nor WD. WD factors (sickness absence (SA) and disability pension (DP)) were explored as potential modifiers and mediators. RESULTS In both Swedish-born and refugees, SA and DP were associated with an elevated risk of suicide attempt regardless of MD. In refugees, HRs for suicide attempt in long-term SA ranged from 2.96 (95% CI: 2.14-4.09) (no MD) to 6.23 (95% CI: 3.21-12.08) (MD). Similar associations were observed in Swedish-born. Elevated suicide attempt risks were also observed in DP. In Swedish-born individuals, there was a synergy effect between MD, and SA and DP regarding suicidal behavior. Both SA and DP were found to mediate the studied associations in Swedish-born, but not in refugees. CONCLUSION There is an effect modification and a mediating effect between mental disorders and WD for subsequent suicidal behavior in Swedish-born individuals. Also for refugees without MD, WD is a risk factor for subsequent suicidal behavior. Particularly for Swedish-born individuals with MD, information on WD is vital in a clinical suicide risk assessment.
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Jonsson U, Coco C, Fridell A, Brown S, Berggren S, Hirvikoski T, Bölte S. Proof of concept: The TRANSITION program for young adults with autism spectrum disorder and/or attention deficit hyperactivity disorder. Scand J Occup Ther 2019; 28:78-90. [PMID: 31790309 DOI: 10.1080/11038128.2019.1695933] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The support needs of people with neurodevelopmental disorders are not sufficiently met during the initial years of adulthood. AIM To evaluate feasibility and preliminary effects of a novel programme designed to empower young adults with autism spectrum disorder (ASD) and/or attention deficit hyperactivity disorder (ADHD) to make progress within significant life domains (i.e. work, education, finance, housing/household management, health, leisure/participation in society, and relationships/social network). MATERIAL AND METHOD TRANSITION is a 24-week programme that combines group-based workshops with personalised support based on goal attainment scaling. The study enrolled 26 young adults (50% females; age 17-24 years) in the normative intellectual range, diagnosed with ASD (n = 8), ADHD (n = 4), or both (n = 14). The intervention was delivered by the regular staff of publicly funded psychiatric services in Stockholm, Sweden. RESULTS The programme was possible to implement with minor deviations from the manual. Participants and staff generally viewed the intervention positively, but also provided feedback to guide further improvement. There was a high degree of attendance throughout, with 21 participants (81%) completing the programme. All completers exceeded their predefined goal expectations within at least one domain. CONCLUSIONS The TRANSITION-programme is a promising concept that deserves further evaluation.
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Affiliation(s)
- Ulf Jonsson
- Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet and Stockholm Health Care Services, CAP Research Centre, Stockholm, Sweden.,Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Services, Stockholm, Sweden
| | - Christina Coco
- Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet and Stockholm Health Care Services, CAP Research Centre, Stockholm, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Services, Stockholm, Sweden
| | - Anna Fridell
- Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet and Stockholm Health Care Services, CAP Research Centre, Stockholm, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Services, Stockholm, Sweden
| | - Sara Brown
- The Swedish Prison and Probation Service, Norrköping, Sweden
| | - Steve Berggren
- Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet and Stockholm Health Care Services, CAP Research Centre, Stockholm, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Services, Stockholm, Sweden
| | - Tatja Hirvikoski
- Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet and Stockholm Health Care Services, CAP Research Centre, Stockholm, Sweden.,Habilitation and Health, Stockholm County Council, Stockholm, Sweden
| | - Sven Bölte
- Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet and Stockholm Health Care Services, CAP Research Centre, Stockholm, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Services, Stockholm, Sweden.,Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia
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Abstract
BACKGROUND Previous research has documented marked occupational differences in suicide risk, but these estimates are 10 years old and based on potentially biased risk assessments.AimsTo investigate occupation-specific suicide mortality in England, 2011-2015. METHOD Estimation of indirectly standardised mortality rates for occupations/occupational groups based on national data. RESULTS Among males the highest risks were seen in low-skilled occupations, particularly construction workers (standardised mortality ratio [SMR] 369, 95% CI 333-409); low-skilled workers comprised 17% (1784/10 688) of all male suicides (SMR 144, 95% CI 137-151). High risks were also seen among skilled trade occupations (SMR 135 95% CI 130-139; 29% of male suicides). There was no evidence of increased risk among some occupations previously causing concern: male healthcare professionals and farmers. Among females the highest risks were seen in artists (SMR 399, 95% CI 244-616) and bar staff (SMR 182, 95% CI 123-260); nurses also had an increased risk (SMR 123, 95% CI 104-145). People in creative occupations and the entertainment industry - artists (both genders), musicians (males) and actors (males) - were at increased risk, although the absolute numbers of deaths in these occupations were low. In males (SMR 192, 95% CI 165-221) and females (SMR 170, 95% CI 149-194), care workers were at increased risk and had a considerable number of suicide deaths. CONCLUSIONS Specific contributors to suicide in high-risk occupations should be identified and measures - such as workplace-based interventions - put in place to mitigate this risk. The construction industry seems to be an important target for preventive interventions.Declaration of interestNone.
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Affiliation(s)
- Ben Windsor-Shellard
- Head of Lifestyle and Risk Factors Analysis,Health Analysis and Life Events,Office for National Statistics,UK
| | - David Gunnell
- Professor of Epidemiology,Population Health Sciences,Bristol Medical School,University of Bristol; andNational Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol National Health Service Foundation Trust and the University of Bristol,UK
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11
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Erlangsen A, Qin P, Mittendorfer-Rutz E. Studies of Suicidal Behavior Using National Registers. CRISIS 2018; 39:153-158. [PMID: 29792362 DOI: 10.1027/0227-5910/a000552] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Annette Erlangsen
- 1 Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Hellerup, Denmark.,2 Department of Mental Health, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,3 Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Ping Qin
- 4 National Center for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway
| | - Ellenor Mittendorfer-Rutz
- 5 Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
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12
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Henriksson M, Nyberg J, Schiöler L, Hensing G, Kuhn GH, Söderberg M, Torén K, Löve J, Waern M, Åberg M. Cause-specific mortality in Swedish males diagnosed with non-psychotic mental disorders in late adolescence: a prospective population-based study. J Epidemiol Community Health 2018; 72:582-588. [PMID: 29581226 DOI: 10.1136/jech-2018-210461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/06/2018] [Accepted: 03/10/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND While risk of premature death is most pronounced among persons with severe mental illness, also milder conditions are associated with increased all-cause mortality. We examined non-psychotic mental (NPM) disorders and specific causes of natural death in a cohort of late adolescent men followed for up to 46 years. METHODS Prospective cohort study of Swedish males (n=1 784 626) who took part in structured conscription interviews 1968-2005. 74 525 men were diagnosed with NPM disorders at or prior to conscription. Median follow-up time was 26 years. HRs for cause-specific mortality were calculated using Cox proportional hazards models. RESULTS Risks in fully adjusted models were particularly elevated for death by infectious diseases (depressive and neurotic/adjustment disorders (HR 2.07; 95% CI 1.60 to 2.67), personality disorders (HR 2.90; 95% CI 1.96 to 4.28) and alcohol-related and other substance use disorders (HR 9.02; 95% CI 6.63 to 12.27)) as well as by gastrointestinal causes (depressive and neurotic/adjustment disorders (HR 1.64; 95% CI 1.42 to 1.89), personality disorders (HR 2.77; 95% CI 2.27 to 3.38) and alcohol-related/substance use disorders (HR 4.41; 95% CI 3.59 to 5.42)). CONCLUSION Young men diagnosed with NPM disorders had a long-term increased mortality risk, in particular due to infectious and gastrointestinal conditions. These findings highlight the importance of early preventive actions for adolescents with mental illness.
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Affiliation(s)
- Malin Henriksson
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jenny Nyberg
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Goteborg, Sweden
| | - Linus Schiöler
- Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Gunnel Hensing
- Section for Social Medicine and Epidemiology, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Georg H Kuhn
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Goteborg, Sweden
| | - Mia Söderberg
- Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Kjell Torén
- Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jesper Löve
- Section for Social Medicine and Epidemiology, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Maria Åberg
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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13
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Rørth R, Fosbøl EL, Mogensen UM, Kragholm K, Jhund PS, Petrie MC, Schou M, Gislason GH, McMurray JJV, Torp-Pedersen C, Køber L, Kristensen SL. Evidence-Based Therapy and Its Association With Workforce Detachment After First Hospitalization for Heart Failure. JACC-HEART FAILURE 2017; 6:41-48. [PMID: 29226811 DOI: 10.1016/j.jchf.2017.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/14/2017] [Accepted: 09/19/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This study investigated the association between the use of evidence-based medicine (EBM) for heart failure (HF) and risk of workforce detachment. BACKGROUND The ability to work can be a marker of functional capacity and quality of life. METHODS We examined a nationwide cohort of patients in the workforce 1 year after first hospitalization for HF. EBM was defined as treatment with β-blockers and renin angiotensin system inhibitors. The fraction of target dose (0 TO 1) for each drug was calculated. The sum of the fractions gave each patient a score between 0 and 2. Patients were stratified into 4 groups according to this score: group 4 score = 2 (target dose of both drugs); group 3 score <2 to >1; group 2 score ≤1 to >0.5; and group 1 score ≤0.5. The risk of subsequent workforce detachment was estimated in cause specific Cox regression models. RESULTS One year after first HF hospitalization, 10,185 patients were part of the workforce, and 7,561 (74%) were in treatment with at least 1 of the components of EBM. During a median follow-up of 727 days, 2,698 individuals (36%) became detached from the workforce. Patients receiving more EBM had a significantly lower risk of workforce detachment compared with those receiving less EBM (group 4 hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.77 to 0.98; group 3 HR: 0.85; 95% CI: 0.77 to 0.94; and group 2 HR 0.92; 95% CI: 0.83 to 1.02), all compared to group 1. CONCLUSIONS Patients in the workforce 1 year after first HF hospitalization and treated with target or near-target doses of EBM were associated with a significantly lower risk of subsequent workforce detachment.
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Affiliation(s)
- Rasmus Rørth
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik M Mogensen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Kristian Kragholm
- Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Mark C Petrie
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev/Hellerup, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev/Hellerup, Denmark; The Danish Heart Foundation, Copenhagen, Denmark; The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Christian Torp-Pedersen
- Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Aalborg, Denmark; Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Søren L Kristensen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
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14
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Rørth R, Fosbøl EL, Mogensen UM, Kragholm K, Numé AK, Gislason GH, Jhund PS, Petrie MC, McMurray JJ, Torp-Pedersen C, Køber L, Kristensen SL. Employment status at time of first hospitalization for heart failure is associated with a higher risk of death and rehospitalization for heart failure. Eur J Heart Fail 2017; 20:240-247. [DOI: 10.1002/ejhf.1046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/27/2017] [Accepted: 09/25/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Rasmus Rørth
- Department of Cardiology, Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Emil L. Fosbøl
- Department of Cardiology, Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Ulrik M. Mogensen
- Department of Cardiology, Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Kristian Kragholm
- Departments of Cardiology and Epidemiology/Biostatistics; Aalborg University Hospital; Aalborg Denmark
| | - Anna-karin Numé
- Department of Cardiology; Herlev and Gentofte University Hospital; Herlev, /Hellerup Denmark
| | - Gunnar H. Gislason
- Department of Cardiology; Herlev and Gentofte University Hospital; Herlev, /Hellerup Denmark
- The Danish Heart Foundation; Copenhagen Denmark
| | - Pardeep S. Jhund
- BHF Cardiovascular Research Centre; University of Glasgow; Glasgow UK
| | - Mark C. Petrie
- BHF Cardiovascular Research Centre; University of Glasgow; Glasgow UK
| | | | - Christian Torp-Pedersen
- Departments of Cardiology and Epidemiology/Biostatistics; Aalborg University Hospital; Aalborg Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Søren L. Kristensen
- Department of Cardiology, Rigshospitalet; University of Copenhagen; Copenhagen Denmark
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15
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Rod NH, Kjeldgård L, Åkerstedt T, Ferrie JE, Salo P, Vahtera J, Alexanderson K. Sleep Apnea, Disability Pensions, and Cause-Specific Mortality: A Swedish Nationwide Register Linkage Study. Am J Epidemiol 2017; 186:709-718. [PMID: 28520881 DOI: 10.1093/aje/kwx138] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 10/31/2016] [Indexed: 01/03/2023] Open
Abstract
Sleep apnea is a common problem affecting daily functioning and health. We evaluated associations between sleep apnea and receipt of a disability pension and mortality in a prospective study of 74,543 cases of sleep apnea (60,125 outpatient, 14,418 inpatient) from the Swedish Patient Register (2000-2009 inclusive). Cases were matched to 5 noncases (n = 371,592) and followed from diagnosis/inclusion to December 31, 2010, via nationwide registers. During a mean follow-up period of 5.1 (standard deviation, 2.7) years, 13% of men and 21% of women with inpatient sleep apnea received a disability pension. Inpatient sleep apnea was associated with higher total mortality (for men, hazard ratio (HR) = 1.71, 95% confidence interval (CI): 1.59, 1.84; for women, HR = 2.33, 95% CI: 2.04, 2.67), with associations being strongest for deaths due to ischemic heart disease (for men, HR = 2.27, 95% CI: 1.94, 2.65; for women, HR = 5.27, 95% CI: 3.78, 7.34), respiratory disorders (for men, HR = 3.29, 95% CI: 2.45, 4.42; for women, HR= 5.24, 95% CI: 3.52, 7.81), and suicide (for men, HR = 1.76, 95% CI: 1.19, 2.60; for women, HR = 4.33, 95% CI: 1.96, 9.56). There were no associations of inpatient sleep apnea with cancer mortality. Outpatient sleep apnea was associated with a higher risk of receiving a disability pension but not higher total mortality. In conclusion, inpatient sleep apnea is related to a higher risk of disability pension receipt and mortality a decade after diagnosis.
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16
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Rørth R, Wong C, Kragholm K, Fosbøl EL, Mogensen UM, Lamberts M, Petrie MC, Jhund PS, Gerds TA, Torp-Pedersen C, Gislason GH, McMurray JJ, Køber L, Kristensen SL. Return to the Workforce After First Hospitalization for Heart Failure. Circulation 2016; 134:999-1009. [DOI: 10.1161/circulationaha.116.021859] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/18/2016] [Indexed: 11/16/2022]
Abstract
Background:
Return to work is important financially, as a marker of functional status and for self-esteem in patients developing chronic illness. We examined return to work after first heart failure (HF) hospitalization.
Methods:
By individual-level linkage of nationwide Danish registries, we identified 21 455 patients of working age (18–60 years) with a first HF hospitalization in the period from 1997 to 2012. Of these patients, 11 880 (55%) were in the workforce before HF hospitalization and comprised the study population. We applied logistic regression to estimate odds ratios for associations between age, sex, length of hospital stay, level of education, income, comorbidity, and return to work.
Results:
One year after first HF hospitalization, 8040 (67.7%) returned to the workforce, 2981 (25.1%) did not, 805 (6.7%) died, and 54 (0.5%) emigrated. Predictors of return to work included younger age (18–30 versus 51–60 years; odds ratio [OR], 3.12; 95% confidence interval [CI], 2.42–4.03), male sex (OR, 1.22; 95% CI, 1.12–1.34), and level of education (long-higher versus basic school; OR, 2.06; 95% CI, 1.63–2.60). Conversely, hospital stay >7 days (OR, 0.56; 95% CI, 0.51–0.62) and comorbidity including history of stroke (OR, 0.55; 95% CI, 0.45–0.69), chronic kidney disease (OR, 0.46; 95% CI, 0.36–0.59), chronic obstructive pulmonary disease (OR, 0.62; 95% CI, 0.52–0.75), diabetes mellitus (OR 0.76; 95% CI, 0.68–0.85), and cancer (OR, 0.49; 95% CI, 0.40–0.61) were all significantly associated with lower chance of return to work.
Conclusions:
Patients in the workforce before HF hospitalization had low mortality but high risk of detachment from the workforce 1 year later. Young age, male sex, and a higher level of education were predictors of return to work.
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Affiliation(s)
- Rasmus Rørth
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Chih Wong
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Kristian Kragholm
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Emil L. Fosbøl
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Ulrik M. Mogensen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Morten Lamberts
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Mark C. Petrie
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Pardeep S. Jhund
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Thomas A. Gerds
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Christian Torp-Pedersen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Gunnar H. Gislason
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - John J.V. McMurray
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Lars Køber
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
| | - Søren L. Kristensen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (R.R., E.L.F., U.M.M., L.K., S.L.K.); BHF Cardiovascular Research Centre, University of Glasgow, UK (C.W., U.M.M., M.C.P., P.S.J., J.J.V.M., S.L.K.); Department of Anesthesiology and Intensive Care Medicine, Cardiovascular Research Centre, Aalborg University Hospital, Denmark (K.K.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M.L., G.H.G.); Department of Public health, Section of
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Rahman SG, Alexanderson K, Jokinen J, Mittendorfer-Rutz E. Disability pension due to common mental disorders and subsequent suicidal behaviour: a population-based prospective cohort study. BMJ Open 2016; 6:e010152. [PMID: 27044577 PMCID: PMC4823453 DOI: 10.1136/bmjopen-2015-010152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 03/11/2016] [Accepted: 03/17/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Adverse health outcomes, including suicide, in individuals on disability pension (DP) due to mental diagnoses have been reported. However, scientific knowledge on possible risk factors for suicidal behaviour (suicide attempt and suicide) in this group, such as age, gender, underlying DP diagnoses, comorbidity and DP duration and grade, is surprisingly sparse. This study aimed to investigate associations of different measures (main and secondary diagnoses, duration and grade) of DP due to common mental disorders (CMD) with subsequent suicidal behaviour, considering gender and age differences. DESIGN Population-based prospective cohort study based on Swedish nationwide registers. METHODS A cohort of 46,515 individuals aged 19-64 years on DP due to CMD throughout 2005 was followed-up for 5 years. In relation to different measures of DP, univariate and multivariate HRs and 95% CIs for suicidal behaviour were estimated by Cox regression. All analyses were stratified by gender and age. RESULTS During 2006-2010, 1036 (2.2%) individuals attempted and 207 (0.5%) completed suicide. Multivariate analyses showed that a main DP diagnosis of 'stress-related mental disorders' was associated with a lower risk of subsequent suicidal behaviour than 'depressive disorders' (HR range 0.4-0.7). Substance abuse or personality disorders as a secondary DP diagnosis predicted suicide attempt in all subgroups (HR range 1.4-2.3) and suicide in women and younger individuals (HR range 2.6-3.3). Full-time DP was associated with a higher risk of suicide attempt compared with part-time DP in women and both age groups (HR range 1.4-1.7). CONCLUSIONS Depressive disorders as the main DP diagnosis and substance abuse or personality disorders as the secondary DP diagnosis were risk markers for subsequent suicidal behaviour in individuals on DP due to CMD. Particular attention should be paid to younger individuals on DP due to anxiety disorders because of the higher suicide risk.
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Affiliation(s)
- Syed Ghulam Rahman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jussi Jokinen
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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18
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Björkenstam C, Tinghög P, Brenner P, Mittendorfer-Rutz E, Hillert J, Jokinen J, Alexanderson K. Is disability pension a risk indicator for future need of psychiatric healthcare or suicidal behavior among MS patients- a nationwide register study in Sweden? BMC Psychiatry 2015; 15:286. [PMID: 26573305 PMCID: PMC4647565 DOI: 10.1186/s12888-015-0668-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 11/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental disorders and suicidal behavior are common in patients with multiple sclerosis (MS), they also carry a higher risk of disability pension (DP). Our aim was to investigate if DP and other factors are associated with psychiatric disorders and suicidal behavior among MS patients, and whether DP is a stronger risk indicator among certain groups. METHOD A prospective population-based cohort study with six-year follow-up (2005-2010), including 11 346 MS patients who in 2004 were aged 16-64 and lived in Sweden. Incidence rate ratios (IRR) with 95 % confidence intervals (CI) were calculated. RESULTS MS patients on DP had a modestly higher risk of requiring psychiatric healthcare, IRR: 1.36 (95 % CI: 1.18-1.58). MS patients with previous psychiatric healthcare had a higher IRR for both psychiatric healthcare and suicidal behavior; 2.32 (2.18-2.47) and 1.91 (1.59-2.30), respectively. DP moderated the association between sex and psychiatric healthcare, where women on DP displayed higher risk than men, X(2) 4.74 (p = 0.03). CONCLUSION The findings suggest that losing one's role in work life aggravates rather than alleviates the burden of MS, as MS patients on DP seem to have a higher need for psychiatric healthcare, especially among women; which calls for extra awareness among clinicians.
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Affiliation(s)
- Charlotte Björkenstam
- 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.
| | - Philip Brenner
- Division of Neuroscience, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
| | - Jan Hillert
- Division of Neuroscience, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Jussi Jokinen
- Division of Neuroscience, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Kristina Alexanderson
- Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
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Wang M, Björkenstam C, Alexanderson K, Runeson B, Tinghög P, Mittendorfer-Rutz E. Trajectories of Work-Related Functional Impairment prior to Suicide. PLoS One 2015; 10:e0139937. [PMID: 26444997 PMCID: PMC4596705 DOI: 10.1371/journal.pone.0139937] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/18/2015] [Indexed: 11/24/2022] Open
Abstract
Background Work-related functional impairment in terms of sickness absence and disability pension (SA/DP) has been reported to be associated with subsequent suicide. However, there is only limited knowledge on SA/DP patterns prior to suicide. The aim was to identify trajectories of work-related functional impairment prior to suicide and to describe associations of socio-demographic and medical factors with such trajectories. Methods This is a population-based retrospective cohort study of the 4 209 individuals aged 22–65 years who committed suicide during 2007–2010 in Sweden. Work-related functional impairment was measured as mean annual number of months of SA/DP. We analyzed trajectories of SA/DP during five years prior to suicide (i.e., 2002–2009) by a group-based trajectory method. Associations between socio-demographic and medical factors with different groups of trajectories were estimated by chi2-test and multinomial logistic regression. Results Five different functional impairment trajectory groups were identified prior to suicide. One group had constant low levels of SA/DP (46%), while 30% had constant high levels of SA/DP. Two groups (16%) showed increasing number of SA/DP months. The remaining 7% showed decreasing number of SA/DP months before the suicide. Sex, age, educational level, family situation, and diagnosis-specific healthcare were significantly associated with different trajectory groups (Likelihood ratio X2 tests <0.05). A larger proportion of higher educated and younger men with a lower proportion of previous suicide attempts were found in the group with constant low levels. Opposite characteristics were displayed in the group with constant high levels. Conclusions This study identified five different groups of work-related functional impairment trajectories before suicide. These differences might be partly explained by the variations in socio-demographic profiles and health care consumptions five years before suicide.
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Affiliation(s)
- Mo Wang
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Charlotte Björkenstam
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Alexanderson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bo Runeson
- Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
| | - Petter Tinghög
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
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Zetterström K, Voss M, Alexanderson K, Ivert T, Pehrsson K, Hammar N, Vaez M. Disability Pension at the Time of Coronary Revascularisation Is Associated with Higher Five-Year Mortality; A Swedish Nationwide, Register-Based Prospective Cohort Study. PLoS One 2015; 10:e0135277. [PMID: 26261990 PMCID: PMC4532455 DOI: 10.1371/journal.pone.0135277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/21/2015] [Indexed: 01/11/2023] Open
Abstract
Background Although coronary revascularisation by coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are common procedures, little is known regarding disability pension (DP) at the time of coronary revascularisation and its association with mortality. The aim was to investigate the five-year mortality following a first coronary revascularisation among women and men on DP, compared with those not on DP at the time of intervention, accounting for socio-demographic and medical factors. Material and Methods A nationwide prospective population-based cohort study was conducted, using national registers including 70,040 patients (80% men), aged 30–64 years, with a first CABG (n = 24,987; 36%) or PCI (n = 45,053; 64%) during 1994–2006 in Sweden, who were alive 30 days after the intervention. The main outcome was all-cause and cause-specific mortality within five years or through 31 December 2006, following CABG and PCI, and the exposure was DP at the time of a first coronary revascularisation. Information on DP, patient characteristics, date and cause of death was obtained from nationwide registers. Hazard ratios (HR) with 95% confidence intervals (CI) for the outcome were estimated, using Cox proportional hazard regression analyses. All analyses were stratified by type of intervention and gender. Findings Four percent died following coronary revascularisation. Cardiovascular disease was the most common cause of death (54%), followed by neoplasms (25%). Regardless of type of intervention, gender and after multivariable adjustments, patients on DP had a higher HR for five-year mortality compared with those not on DP at time of revascularisation (CABG: women HR 2.14; 95% CI 1.59–2.89, men HR 2.09; 1.84–2.38, PCI: women HR 2.25; 1.78–2.83, men HR 1.95; 1.72–2.21). Young women on DP at the time of PCI had a substantially higher HR (HR 4.10; 95% CI: 2.25–7.48). Conclusion Patients on DP at the time of first coronary revascularisation had a higher five-year risk of mortality compared with those not on DP.
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Affiliation(s)
- Katharina Zetterström
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Margaretha Voss
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Analysis and Forecasts, Swedish Social Insurance Agency, Stockholm, Sweden
| | - Kristina Alexanderson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Ivert
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Kenneth Pehrsson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Hammar
- AstraZeneca R&D, Mölndal, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marjan Vaez
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
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Benedetti F, Riccaboni R, Dallaspezia S, Locatelli C, Smeraldi E, Colombo C. Effects of CLOCK gene variants and early stress on hopelessness and suicide in bipolar depression. Chronobiol Int 2015. [PMID: 26204460 DOI: 10.3109/07420528.2015.1060603] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with mood disorders show a high dependence of behavior on the molecular characteristics of the biological clock. CLOCK rs1801260 gene polymorphism influences circadian behavior in bipolar disorder (BD), with *C carriers showing a delayed sleep onset and worse insomnia. Sleep phase delay and insomnia associate with suicide in the general population. METHODS We investigated the effects of rs1801260, and of exposure to stressful life events, on current suicidal ideation and history of suicide attempts in 87 depressed patients with BD. RESULTS rs1801260*C carriers currently showed worse Hamilton Depression Rating Scale scores for suicide and worse ratings for depressive cognitive distortions. Previous history of attempted suicide associated with exposure to higher stressful events in the early life, with rs1801260*C carriers showing a higher dependency of the modeled probability of attempting suicide on the severity of exposure to early stress. DISCUSSION CLOCK rs1801260 modulated the relationship between early stress, adult history of attempted suicide and current suicide ideation. Factors affecting the biological clock can influence "non-clock" core psychopathological features of mood disorders.
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Affiliation(s)
- Francesco Benedetti
- a Department of Clinical Neurosciences , Scientific Institute Ospedale San Raffaele and University Vita-Salute , Milano, Italy
| | - Roberta Riccaboni
- a Department of Clinical Neurosciences , Scientific Institute Ospedale San Raffaele and University Vita-Salute , Milano, Italy
| | - Sara Dallaspezia
- a Department of Clinical Neurosciences , Scientific Institute Ospedale San Raffaele and University Vita-Salute , Milano, Italy
| | - Clara Locatelli
- a Department of Clinical Neurosciences , Scientific Institute Ospedale San Raffaele and University Vita-Salute , Milano, Italy
| | - Enrico Smeraldi
- a Department of Clinical Neurosciences , Scientific Institute Ospedale San Raffaele and University Vita-Salute , Milano, Italy
| | - Cristina Colombo
- a Department of Clinical Neurosciences , Scientific Institute Ospedale San Raffaele and University Vita-Salute , Milano, Italy
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Zetterström K, Voss M, Alexanderson K, Ivert T, Pehrsson K, Hammar N, Vaez M. Prevalence of all-cause and diagnosis-specific disability pension at the time of first coronary revascularisation: a population-based Swedish cross-sectional study. PLoS One 2015; 10:e0115540. [PMID: 25629517 PMCID: PMC4309573 DOI: 10.1371/journal.pone.0115540] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 11/25/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although coronary revascularisation by coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) is well documented, scientific knowledge on disability pension (DP) at the time of revascularisation is lacking. The aim was to investigate the prevalence of all-cause and diagnosis-specific DP at the time of a first coronary revascularisation, accounting for socio-demographic and medical factors. MATERIALS AND METHODS A population-based cross-sectional study using Swedish registers was conducted including all 65,676 patients (80% men) who when aged 30-63 years, within 1994-2006, had a first CABG (n = 22,959) or PCI (n = 42,717) and did not have old-age pension. Associations between socio-demographic and medical factors and the probability of DP were estimated by odds ratios (OR) with 95% confidence intervals (CI) using logistic regression analyses. FINDINGS The prevalence of DP at time of revascularisation was 24%, mainly due to musculoskeletal diagnoses. Sixty-two percent had had DP for at least four years before the revascularisation. In the multivariable analyses, DP was more common in women (OR: 2.40; 95% CI: 2.29-2.50), older patients (50-63 years); especially men aged 60-63 years with CABG (OR: 4.91; 95% CI: 4.27-5.66), lower educational level; especially men with PCI (OR: 2.96; 95% CI: 2.69-3.26), patients born outside Sweden; especially men with PCI (OR: 2.11; 95% CI: 1.96-2.27), and in women with an indication of other diagnoses than acute coronary syndrome (ACS) or stable angina pectoris for PCI (OR: 1.72; 95% CI: 1.31-2.24). CONCLUSION About a quarter had DP at the time of revascularisation, often due to musculoskeletal diagnoses. More than half had had DP for at least four years before the intervention. DP was associated with female gender, older age, lower educational level, and being born outside Sweden.
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Affiliation(s)
- Katharina Zetterström
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Margaretha Voss
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Analysis and Forecasts, Swedish Social Insurance Agency, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Ivert
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Kenneth Pehrsson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Hammar
- AstraZeneca R&D, Mölndal, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
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Björkenstam C, Alexanderson K, Björkenstam E, Lindholm C, Mittendorfer-Rutz E. Diagnosis-specific disability pension and risk of all-cause and cause-specific mortality--a cohort study of 4.9 million inhabitants in Sweden. BMC Public Health 2014; 14:1247. [PMID: 25476556 PMCID: PMC4289270 DOI: 10.1186/1471-2458-14-1247] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 11/24/2014] [Indexed: 11/13/2022] Open
Abstract
Background The incidence of disability pension (DP) is high in several European countries. However, knowledge on associations of cause-specific DP and premature death is limited. The aims were to: 1) investigate the association between cause-specific DP and all-cause and cause-specific mortality among women and men and 2) examine period effects of this association. Methods Three prospective population-based cohort studies were conducted, the first including all individuals aged 16–64 years who lived in Sweden all of 1995 and who were not on DP before 1995 (N = 5 006 523, 48.8% women). Those granted DP in 1995 were compared to those not granted DP regarding mortality during 1996–2009. Two other cohorts were created in a similar fashion, for 2000 and 2005, respectively, and in comparisons each of the three cohorts were followed up for four years with regard to all-cause mortality as well as death due to cancer, circulatory disorders, or suicide. All analyses were stratified by sex and we controlled for a number of socio-demographic factors and inpatient care. Results Individuals with granted DP had a higher mortality risk, women (HR 1.75; 95% CI 1.68-1.82) and men (HR 1.66; 95% CI 1.61-1.71) and highest for cancer. People on DP with some diagnoses had higher risk of premature death in other causes of death than their DP diagnoses. All-cause mortality risk varied with DP-diagnosis and was lowest for musculoskeletal diagnoses. The mortality HR decreased among women with DP between the cohort 1995, HR 2.07 (1.92–2.24) and the cohort 2005, 1.84 (1.71–1.99). Here, temporal decreases in mortality risk occurred particularly in DP due to mental diagnoses and cancer. Conclusions All DP diagnoses were associated with a higher mortality risk. Even individuals granted DP due to diagnoses with low mortality risk displayed a higher risk for premature death. This warrants close monitoring of disability pensioners and further studies on consequences of being on disability pension.
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Affiliation(s)
- Charlotte Björkenstam
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
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Benedetti F, Riccaboni R, Poletti S, Radaelli D, Locatelli C, Lorenzi C, Pirovano A, Smeraldi E, Colombo C. The serotonin transporter genotype modulates the relationship between early stress and adult suicidality in bipolar disorder. Bipolar Disord 2014; 16:857-66. [PMID: 25219494 DOI: 10.1111/bdi.12250] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 05/09/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Bipolar disorder (BD) is associated with a higher risk of suicide and with worse early life stress. A serotonin (5-hydroxytryptamine; 5-HT) transporter-linked polymorphic region (5-HTTLPR) has been shown to influence the relationship between stress and the risk of attempting suicide in the general population, but has not been investigated in BD. METHODS We studied 136 inpatients (93 females, 43 males) with a major depressive episode in the course of BD. Early and recent stressful life events were scored on the Social Readjustment Rating Scale (SRRS). Regional gray matter (GM) volumes were analyzed, acquiring T1-weighted images on a 3.0 Tesla scanner. RESULTS Homozygote l/l patients attempted suicide in a higher proportion than *s carriers. A separate-slopes logistic regression showed a significant effect of 5-HTTLPR on the relationship between stress, depression, and suicide among *s carriers, but not among l/l homozygotes, early stress associated with worse probability of attempting suicide and with earlier age at onset of BD. Exposure to early stress correlated with GM volumes in the right prefrontal cortex (Brodmann area 46) - again, in *s carriers only. CONCLUSIONS 5-HTTLPR modulated the relationship between early life stress and the core features of bipolar illness. 5-HTTLPR*s carriers showed a higher sensitivity to the effects of stress; when exposed to low levels of early stress, they were protected against suicide in respect to l/l, but higher levels of stress progressively increased their risk of suicide and reduced the age at onset of illness.
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Affiliation(s)
- Francesco Benedetti
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele and University Vita-Salute, Milano, Italy
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Jonsson U, Alexanderson K, Kjeldgård L, Mittendorfer-Rutz E. Psychiatric diagnoses and risk of suicidal behaviour in young disability pensioners: prospective cohort studies of all 19-23 year olds in Sweden in 1995, 2000, and 2005, respectively. PLoS One 2014; 9:e111618. [PMID: 25365217 PMCID: PMC4218787 DOI: 10.1371/journal.pone.0111618] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 10/04/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Increasing rates of disability pension (DP) have been observed among young adults. We studied specific psychiatric DP diagnoses and subsequent risk of suicidal behaviour in a series of three cohorts of young adult in Sweden. METHOD In a nationwide register study, we included all young adults who in 1995, 2000, and 2005, respectively, were 19-23 years old and lived in Sweden (n≈500,000 per cohort). Rates of DP and specific psychiatric DP diagnoses were recorded in each cohort. Hazard ratios (HRs) and 95% confidence intervals (CIs) for suicidal behaviour during the following five years, with the corresponding age group as reference, were calculated by Cox proportional hazard regression, adjusted for demographic variables and previous own and parental suicidal behaviour. RESULTS The overall proportion with DP in this age group increased from 0.92% in 1995 to 2.29% in 2005, with particularly large increases in psychiatric diagnoses such as hyperkinetic disorders, pervasive developmental disorders, and depression/anxiety. The overall proportion of young disability pensioners attempting suicide during the five-year follow-up increased from 2.21% in the 1995 cohort to 3.81% in the 2005 cohort. Within most psychiatric DP diagnoses, the risk of attempted suicide did not change significantly over time, whereas suicide attempts increased in the reference group. Accordingly, the HRs for suicide attempt decreased in some psychiatric DP diagnoses. The highest adjusted HRs were observed for depression/anxiety (16.41; CI: 9.06 to 29.74) and schizophrenia (9.37; 6.13 to 14.31) in the 1995 cohort. The rate of suicide among young disability pensioners during follow-up ranged from 0.19% in 1995 to 0.37% in 2005, mainly occurring in individuals with psychiatric diagnoses. CONCLUSION Suicidal behaviour has become more prevalent among young disability pensioners, which co-occurred with an increased tendency to grant DP in psychiatric diagnoses with a known high risk of suicidal behaviour. Preventive measures are warranted.
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Affiliation(s)
- Ulf Jonsson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Linnea Kjeldgård
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Mittendorfer-Rutz E, Alexanderson K, Westerlund H, Lange T. Is transition to disability pension in young people associated with changes in risk of attempted suicide? Psychol Med 2014; 44:2331-2338. [PMID: 24433877 DOI: 10.1017/s0033291713003097] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim of the present study was to investigate trajectories of suicide attempt risks before and after granting of disability pension in young people. METHOD The analytic sample consisted of all persons 16-30 years old and living in Sweden who were granted a disability pension in the years 1995-1997; 2000-2002 as well as 2005-2006 (n = 26,624). Crude risks and adjusted odds ratios for suicide attempt were computed for the 9-year window around the year of disability pension receipt by repeated-measures logistic regressions. RESULTS The risk of suicide attempt was found to increase continuously up to the year preceding the granting of disability pension in young people, after which the risk declined. These trajectories were similar for women and men and for disability pension due to mental and somatic diagnoses. Still, the multivariate odds ratios for suicide attempts for women and for disability pension due to mental disorders were 2.5- and 3.8-fold increased compared with the odds ratios for men and disability pension due to somatic disorders, respectively. Trajectories of suicide attempts differed for young individuals granted a disability pension during 2005-2006 compared with those granted during 1995-1997 and 2000-2002. CONCLUSIONS We found an increasing risk of suicide attempt up until the granting of a disability pension in young individuals, after which the risk decreased. It is of clinical importance to monitor suicide attempt risk among young people waiting for the granting of a disability pension.
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Affiliation(s)
- E Mittendorfer-Rutz
- Department of Clinical Neuroscience,Division of Insurance Medicine, Karolinska Institutet,Stockholm,Sweden
| | - K Alexanderson
- Department of Clinical Neuroscience,Division of Insurance Medicine, Karolinska Institutet,Stockholm,Sweden
| | - H Westerlund
- Stress Research Institute, Stockholm University,Stockholm,Sweden
| | - T Lange
- University of Copenhagen,Department of Biostatistics, Copenhagen,Denmark
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Rahman S, Alexanderson K, Jokinen J, Mittendorfer-Rutz E. Risk factors for suicidal behaviour in individuals on disability pension due to common mental disorders - a nationwide register-based prospective cohort study in Sweden. PLoS One 2014; 9:e98497. [PMID: 24869674 PMCID: PMC4037205 DOI: 10.1371/journal.pone.0098497] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 05/03/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Common mental disorders (CMD) have become one of the leading causes for disability pension (DP). Studies on predictors of adverse health outcome following DP are sparse. This study aimed to examine the association of different socio-demographic factors and health care consumption with subsequent suicidal behaviour among individuals on DP due to CMD. METHOD This is a population-based prospective cohort study based on register data. All individuals aged 18-64 years, living in Sweden on 31-Dec-2004 who in 2005 were on DP due to CMD (N = 46 745) were followed regarding suicide attempt and suicide (2006-10). Univariate and multivariate hazard ratios (HR) and 95% confidence intervals (CI) for suicidal behaviour were estimated by Cox regression. RESULTS During the five-year follow-up, 1 046 (2.2%) and 210 (0.4%) individuals attempted and committed suicide, respectively. Multivariate analyses showed that young age (18-24 years) and low education predicted suicide attempt, while living alone was associated with both higher suicide attempt and suicide (range of HRs 1.23 to 1.68). Combined prescription of antidepressants with anxiolytics during 2005 and inpatient care due to mental diagnoses or suicide attempt (2001-05) were strongly associated with suicide attempt and suicide (range of HRs 1.3 to 4.9), while inpatient care due to somatic diagnoses and specialized outpatient care due to mental diagnoses during 2001-05 only predicted suicide attempt (HR 1.45; 95% CI: 1.3-1.7; HR 1.30; 95% CI: 1.1-1.7). CONCLUSIONS Along with socio-demographic factors, it is very important to consider type of previous healthcare use and medication history when designing further research or intervention aiming at individuals on DP due to CMD. Further research is warranted to investigate both characteristics of disability pension due to CMD, like duration, diagnoses and grade as well as mechanisms to subsequent suicidal behavior, taking potential gender differences into consideration.
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Affiliation(s)
- Syed Rahman
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Alexanderson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jussi Jokinen
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
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