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Salinas Fredricson A, Krüger Weiner C, Adami J, Rosén A, Lund B, Hedenberg-Magnusson B, Fredriksson L, Svedberg P, Naimi-Akbar A. Sick leave and disability pension among TMD patients with musculoskeletal diseases, mental and behavioural disorders - a SWEREG-TMD population-based cohort study. BMC Public Health 2023; 23:852. [PMID: 37165335 PMCID: PMC10173494 DOI: 10.1186/s12889-023-15815-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/05/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Temporomandibular disorders (TMD) are associated with musculoskeletal diseases (MSD), mental and behavioural disorders (MBD), and patients with TMD have been shown to have 2-3 times more days of sick leave (SL) and disability pension (DP) than the general population. MSD and MBD are two of the most common causes for SL and DP, and the association between TMD and the influence of comorbidities on the need for SL and DP among TMD patients need further clarification. This study investigates the impact of MSD and MBD comorbidity on SL and DP among TMD patients diagnosed in a hospital setting and/or surgically treated. METHODS All incident TMD patients diagnosed or treated in a hospital setting between 1998 and 2016 and aged 23-59 were included. A non-exposed comparison cohort was collected from the general population. The cohorts were grouped based on the presence of comorbidity: No comorbidity (Group I); MSD comorbidity (Group II); MBD comorbidity (Group III); and combined MSD and MBD comorbidity (Group IV). Main outcomes were mean annual days of SL and DP, and statistical analysis was conducted using generalized estimated equations. RESULTS TMD subjects with no comorbidities (Group I) and with MSD/MBD comorbidity (Group II and III) were 2-3 times more often on SL and DP than the corresponding groups from the general population. However, in the group with both MSD and MBD comorbidity (Group IV), the difference between the TMD subjects and the general population was diminishing, suggesting an additive effect. CONCLUSION TMD patients are more dependent on SL and DP benefits compared to general population and the difference remains even after considering MSD and MBD comorbidity. In individuals with combined MSD and MBD comorbidity, concurrent TMD has less impact on the need for social insurance benefits. The results accentuate the impact TMD has on the patients' impaired ability to return to work and why TMD should be recognized as having a substantial impact on individual and economic suffering as well as on societal costs, with emphasis on the influence of comorbidities on patient suffering.
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Affiliation(s)
- Adrian Salinas Fredricson
- Public Dental Services, Folktandvården Stockholm, Eastmaninstitutet, Department of Oral and Maxillofacial Surgery, Eastmaninstitutet Käkkirurgi, Dalagatan 11, 102 31, Stockholm, Sweden.
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Carina Krüger Weiner
- Public Dental Services, Folktandvården Stockholm, Eastmaninstitutet, Department of Oral and Maxillofacial Surgery, Eastmaninstitutet Käkkirurgi, Dalagatan 11, 102 31, Stockholm, Sweden
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Oral and Maxillofacial Surgery, Gävle County Hospital, Gävle, Sweden
| | | | - Annika Rosén
- Public Dental Services, Folktandvården Stockholm, Eastmaninstitutet, Department of Oral and Maxillofacial Surgery, Eastmaninstitutet Käkkirurgi, Dalagatan 11, 102 31, Stockholm, Sweden
- Department of Clinical Dentistry, Division of Oral and Maxillofacial Surgery, University of Bergen, Bergen, Norway
- Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
| | - Bodil Lund
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Medical Unit for Reconstructive Plastic- and Craniofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Britt Hedenberg-Magnusson
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Orofacial Pain and Jaw Function, Public Dental Services, Folktandvården Stockholm, EastmaninstitutetStockholm, Sweden
| | - Lars Fredriksson
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Orofacial Pain and Jaw Function, Public Dental Services, Folktandvården Stockholm, EastmaninstitutetStockholm, Sweden
| | - Pia Svedberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Aron Naimi-Akbar
- Public Dental Services, Folktandvården Stockholm, Eastmaninstitutet, Department of Oral and Maxillofacial Surgery, Eastmaninstitutet Käkkirurgi, Dalagatan 11, 102 31, Stockholm, Sweden
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Health Technology Assessment-Odontology (HTA-O), Malmö University, Malmö, Sweden
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Andersson C, Stenfors CUD, Lilliengren P, Einhorn S, Osika W. Benevolence - Associations With Stress, Mental Health, and Self-Compassion at the Workplace. Front Psychol 2021; 12:568625. [PMID: 34140909 PMCID: PMC8204106 DOI: 10.3389/fpsyg.2021.568625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 04/30/2021] [Indexed: 01/07/2023] Open
Abstract
Objective Benevolence is an emerging concept in motivation theory and research as well as in on pro-social behavior, which has stimulated increasing interest in studying factors that impair or facilitate benevolence and effects thereof. This exploratory study examines the associations between benevolence, stress, mental health, self-compassion, and satisfaction with life in two workplace samples. Methods In the first study n = 522 (38% = female, median age = 42) participants answered questionnaires regarding self-reported stress symptoms (i.e., emotional exhaustion), depressive symptoms and benevolence. In the second study n = 49 (female = 96%) participants answered questionnaires regarding perceived stress, self-compassion, anxiety, depression symptoms, and benevolence. Results In study 1, measures of emotional exhaustion (r = −0.295) and depression (r = −0.190) were significantly negatively correlated with benevolence. In study 2, benevolence was significantly negatively correlated with stress (r = −0.392) and depression (r = −0.310), whereas self-compassion (0.401) was significantly positively correlated with benevolence. While correlations were in expected directions, benevolence was not significantly associated with Satisfaction with Life (r = 0.148) or anxiety (r = −0.199) in study 2. Conclusion Self-assessed benevolence is associated with levels of perceived stress, exhaustion, depression, and self-compassion. Future studies are warranted on how benevolence is related to stress and mental ill health such as depression and anxiety, and if benevolence can be trained in order to decrease stress and mental ill health such as depression and anxiety in workplace settings.
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Affiliation(s)
- Christina Andersson
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Cecilia U D Stenfors
- Department of Psychology, Stockholm University, Stockholm, Sweden.,Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Peter Lilliengren
- Department of Health Care Sciences, St. Lukas Educational Institute, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Stefan Einhorn
- Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Walter Osika
- Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Stockholm Health Care Services, Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Ropponen A, Wang M, Narusyte J, Kärkkäinen S, Blom V, Svedberg P. The predictive role of sickness absence spell durations in associations with inpatient- and specialized outpatient care among a population-based Swedish twin sample. BMC Health Serv Res 2021; 21:315. [PMID: 33827571 PMCID: PMC8028110 DOI: 10.1186/s12913-021-06310-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/22/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The associations between a sickness absence spell duration and patient care have been rarely studied. An assumption is that associations would differ by spell duration and by the patient care type, inpatient- or specialized outpatient, due to severity of diseases and/or conditions. We aimed to investigate sickness absence spells in various spell durations as a predictor for subsequent inpatient- and specialized outpatient care separately, and to study if familial confounding plays a role in these associations. METHODS We followed a population-based sample of Swedish twins born 1925-90 with national registers from 2001 for first incident sickness absence spell (days to calculate spell duration categorized into ≤30 days, 31-90 days, 91-180 days and ≥ 181 days), or no sickness absence, and for inpatient- and specialized outpatient care until 2013 (n = 24,975). Cox proportional hazards models were applied for hazard ratios (HR) with 95% confidence intervals (CI) while accounting for covariates and familial confounding. RESULTS First incident sickness absence spell across all duration categories was associated with an increased risk of inpatient- (age- and sex adjusted HR 1.28 to 6.05) or specialized outpatient care (HR 1.17-2.50), both in comparison to those without any sickness absence or the shortest sickness absence spell category (1-30 days). The associations remained statistically significant while controlling for covariates or familial confounding. CONCLUSIONS First incident sickness absence spell increases the risk of inpatient care or specialized outpatient care regardless of the duration of the sickness absence spell. Hence, incident sickness absence spells should be noted and targeted to actions at workplaces as well as in primary and occupational health care.
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Affiliation(s)
- Annina Ropponen
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
- Finnish Institute of Occupational Health, Helsinki, Finland.
| | - Mo Wang
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Jurgita Narusyte
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
- Center of Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Sanna Kärkkäinen
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Victoria Blom
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Pia Svedberg
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
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Salonen L, Blomgren J, Laaksonen M. From long-term sickness absence to disability retirement: diagnostic and occupational class differences within the working-age Finnish population. BMC Public Health 2020; 20:1078. [PMID: 32641015 PMCID: PMC7346453 DOI: 10.1186/s12889-020-09158-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background It is well documented that sickness absence is strongly associated with disability retirement. A long-term sickness absence (LTSA) in particular increases the risk of disability retirement, but little is known about the variation of this risk across diagnostic causes. Further, as occupational classes differ in their diagnostic profiles, it is likely that the role of diagnosis in the pathway from LTSA to disability retirement varies between occupational classes. We examined how LTSA of different diagnostic causes predicts all-cause disability retirement and disability retirement due to the same diagnostic group or due to some other diagnostic group than that which caused the LTSA spell in different occupational classes. Methods Cox proportional hazards models were used to analyse a 70% random sample of all employed Finns aged 25–62 Finns in 2006 (N = 1,458,288). Disability retirement was followed from 2007 to 2014. The risk of disability retirement was compared between occupational classes with at least one LTSA spell due to musculoskeletal diseases, mental disorders, respiratory diseases, or circulatory diseases and those who had no LTSA spells due to these diagnostic groups during 2005. Results Those who had LTSA due to musculoskeletal diseases or mental disorders transferred more often to disability retirement due to same diagnostic group, whereas those who had LTSA due to respiratory or circulatory diseases transferred more often to disability retirement due to some other diagnostic group. The largest occupational class differences in all-cause disability retirement were found among those with LTSA due to mental disorders. For men, the hazard ratios (HR) varied from HR 5.70 (95% confidence interval (CI) 5.00–6.52) in upper non-manual employees to 2.70 (95% CI 2.50–2.92) in manual workers. For women, the corresponding HRs were 3.74 (95% CI 3.37–4.14) in upper non-manual employees and 2.32 (95% 2.17–2.50) in manual workers. Conclusions The association between LTSA and disability retirement varies between diagnostic groups, and the strength of this association further depends on the person’s occupational class and gender.
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Affiliation(s)
- Laura Salonen
- Department of Social Research, University of Turku, Turku, Finland.
| | - Jenni Blomgren
- The Social Insurance Institution of Finland, Helsinki, Finland
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Mather L, Narusyte J, Ropponen A, Bergström G, Blom V, Helgadóttir B, Svedberg P. Sick leave due to mental disorders, morbidity and mortality: a prospective study of discordant twin pairs. Soc Psychiatry Psychiatr Epidemiol 2020; 55:25-32. [PMID: 31076801 DOI: 10.1007/s00127-019-01715-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 04/25/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate if sick leave due to mental disorders increases the risk of morbidity measured by inpatient and specialized outpatient care, and mortality among women and men, independent of familial factors. METHODS An open cohort study of 4979 twin pairs discordant for sick leave due to mental disorders was conducted in 2005-2013. Twins were followed up in the cause of death and national patient registries until the end of study, emigration, death, and inpatient and specialized outpatient care. Conditional Cox proportional hazard regression, adjusting for the familial factors shared by the twins, was used to calculate hazard ratios (HR) with 95% confidence intervals (CI). In case of non-proportional hazards, time-varying covariates were used. RESULTS Sick leave due to mental disorders increased the risk for inpatient care among men (HR: 1.90, CI 1.66-2.17) and women (HR: 1.39, CI 1.27-1.51). For men, the risk of outpatient care was higher the first 2 years (HR: 2.08, CI 1.87-2.31), after which it was attenuated (HR: 1.32, CI 1.02-1.70). For women, the HR was 1.57 (CI 1.47-1.68) for the whole study time. There was an increased risk of death among men (HR: 2.91, CI 1.70-4.99), but not among women (HR: 0.84, CI 0.53-1.35). CONCLUSIONS Sick leave due to mental disorders was a risk factor for mortality for men only, and increased the risk of inpatient and specialized outpatient care among both women and men, but the risks were higher for men when stratifying for sex.
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Affiliation(s)
- Lisa Mather
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Berzelius väg 3, 171 77, Stockholm, Sweden.
| | - J Narusyte
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Berzelius väg 3, 171 77, Stockholm, Sweden
| | - A Ropponen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Berzelius väg 3, 171 77, Stockholm, Sweden.,Finnish Institute of Occupational Health, Helsinki, Finland
| | - G Bergström
- Unit of Intervention and Implementation Research for Worker Health, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Occupational and Public Health Sciences, Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden
| | - V Blom
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Berzelius väg 3, 171 77, Stockholm, Sweden.,The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - B Helgadóttir
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Berzelius väg 3, 171 77, Stockholm, Sweden
| | - P Svedberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Berzelius väg 3, 171 77, Stockholm, Sweden
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Ropponen A, Rahman SG, Svedberg P, Helgesson M, Dorner TE, Mittendorfer-Rutz E. Changes in prescription of antidepressants and disability pension due to back pain, compared with other musculoskeletal and other somatic diagnoses: a cohort study in Sweden. BMJ Open 2019; 9:e029836. [PMID: 31530605 PMCID: PMC6756318 DOI: 10.1136/bmjopen-2019-029836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aim was to investigate differences in the prescription of antidepressants during the transition to disability pension (DP) comparing DP due to back pain with DP due to other musculoskeletal and DP due to other somatic diagnoses. DESIGN A population-based cohort study with follow-up 3 years before and after the event. Estimated prevalence and adjusted ORs with 95% CIs for antidepressant prescription were computed for the 7-year window (ie, t-3 to t+3) around the DP by generalised estimating equations for repeated measures. SETTING AND PARTICIPANTS This Swedish population-based nationwide study with registry data included individuals aged 18-64 years, with DP due to back pain (n=2011), DP due to other musculoskeletal (n=3548) or DP due to other somatic diagnoses (n=11 809). PRIMARY OUTCOME MEASURES Prescription of antidepressants. RESULTS Before DP, the prevalence of prescription of antidepressants was stable in DP due to back pain, but increased for the other DP groups. Similarly, the likelihood of prescription increased only marginally before DP due to back pain (ORs from 0.86 at t-3 to 1.10 at t-1), but clearly in DP due to musculoskeletal (from 0.42 to 1.15) and somatic diagnoses (from 0.29 to 0.98). Both prevalence measures and risks remained at the elevated levels after DP. CONCLUSIONS Pathways to DP due to musculoskeletal and somatic diagnoses seem to be partly driven by adverse mental health, which remains at a higher level after DP. The increasing prescription of antidepressants prior to DP suggests that special attention should be paid to mental health for prevention of DP. The period after DP needs attention to avoid deterioration of mental health.
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Affiliation(s)
- Annina Ropponen
- Finnish Institute of Occupational Health, Helsinki, Finland
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Syed Ghulam Rahman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Pia Svedberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Ernst Dorner
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Public Health, Institute of Social Medicine, Medizinische Universitat Wien, Wien, Austria
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Altwicker-Hámori S, Dratva J. Disability pension receipt in young adults: an analysis of the Swiss Social protection and labour market (SESAM) data. BMC Public Health 2019; 19:831. [PMID: 31242889 PMCID: PMC6595685 DOI: 10.1186/s12889-019-7098-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 05/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been an overall decreasing trend in the inflow into disability pension in Switzerland since 2003 with the exception of young adults. Disablement in young adulthood reflects a particularly critical phenomenon given the potentially far-reaching long-term social, economic and health consequences. The aim of this study was therefore to identify factors for disability pension in young adults aged 18-39, living in Switzerland. METHODS We used the 2010-2015 cross-sections of the Social protection and labour market; a unique dataset linking microdata from the Swiss Labour Force Survey, the Swiss Central Compensation Office Register, and the Unemployment Insurance Register. Multiple logistic regression was employed to explore the association between demographic, socioeconomic, and health factors and disability pension in young adults living in Switzerland with long-term activity limitation (N = 5306). Alternative specifications of the benchmark model were estimated as robustness checks; and subsample analyses were conducted excluding (i) those aged 18-24 and (ii) those with partial disability pension. RESULTS Our regression results showed that those living without a working partner (OR 2.11; 95% CI 1.51-2.94) and without a child aged 0-14 (OR 2.15; 95% CI 1.48-3.12), born in Switzerland (OR 2.68; 95% CI 1.87-3.84), of higher age (OR 1.16; 95% CI 1.12-1.19), having completed at most lower secondary school (OR 3.26; 95% CI 2.24-4.76), lacking income throughout the four-year period prior to interview (OR 3.94; 95% CI 2.70-5.75), suffering from chronic illness (OR 4.52; 95% CI 2.83-7.19), and severe long-term activity limitation (OR 4.52; 95% CI 2.83-7.19) had higher odds of DP. Our findings were robust to alternative specifications and subsamples; and the alternative specifications revealed differences by learnt occupation, with highest odds for those without an occupational qualification (OR 5.93; 95% CI 3.72-9.46; p-value 0.000) and for those in 'Manufacturing' (OR 3.59; 95% CI 1.91-6.71) relative to 'Health, education, culture, and science'. CONCLUSIONS Most importantly, our results showed that educational and employment factors are of high relevance, as well as chronic morbidity and severe long-term activity limitation. From a policy perspective, early intervention should thus focus on the attainment of vocational and academic qualifications beyond the lower secondary level, facilitating school-to-work transition and labour market integration.
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Affiliation(s)
- Szilvia Altwicker-Hámori
- Research Unit for Health Sciences, ZHAW School of Health Professions, Technikumstrasse 81, 8400, Winterthur, Switzerland.
| | - Julia Dratva
- Research Unit for Health Sciences, ZHAW School of Health Professions, Technikumstrasse 81, 8400, Winterthur, Switzerland.,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
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Halonen JI, Merikukka M, Gissler M, Kerkelä M, Virtanen M, Ristikari T, Hiilamo H, Lallukka T. Pathways from parental mental disorders to offspring's work disability due to depressive or anxiety disorders in early adulthood-The 1987 Finnish Birth Cohort. Depress Anxiety 2019; 36:305-312. [PMID: 30329200 DOI: 10.1002/da.22847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/14/2018] [Accepted: 09/22/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Parental mental disorders have been shown to predict offspring's mental health problems. We examined whether pathways from parental mental disorders to offspring's psychiatric work disability in early adulthood are mediated through offspring's mental disorders and social disadvantage in adolescence. METHODS Study population consisted of the 1987 Finnish Birth Cohort. Data on parents' psychiatric care or work disability due to mental diagnosis between 1987 and 2000 and the cohort participants' health and social factors between 2001 and 2005 were derived from administrative national registers. From 2006 through 2015, 52,182 cohort participants were followed for admittance of psychiatric work disability due to depressive or anxiety disorders. First, we applied a pathway analysis to examine the occurrence of each path. We then used mediation analysis to assess the proportion of association between parental mental disorders and work disability mediated by offspring's health and social disadvantage. RESULTS The pathway model indicated that the association from parental mental disorders to offspring's work disability due to depressive or anxiety disorder is through mental disorders and social disadvantage in adolescence. Odds Ratio for the total effect of parental mental disorders on offspring's psychiatric work disability was 1.85 (95% confidence interval [CI] 1.46-2.34) in the model including offspring's mental disorders that mediated this association by 35%. Corresponding results were 1.86 (95% CI 1.47-2.35) and 28% for social disadvantage in adolescence. CONCLUSIONS These findings suggest that intergenerational determination of work disability due to mental disorders could be addressed by actions supporting mental health and social circumstances in adolescence.
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Affiliation(s)
| | - Marko Merikukka
- Department of Welfare, National Institute for Health and Welfare (THL), Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare (THL), Helsinki, Finland.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - Martta Kerkelä
- Department of Welfare, National Institute for Health and Welfare (THL), Oulu, Finland
| | - Marianna Virtanen
- Department of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden
| | - Tiina Ristikari
- Department of Welfare, National Institute for Health and Welfare (THL), Oulu, Finland
| | - Heikki Hiilamo
- Social and Public Policy, Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Tea Lallukka
- Finnish Institute of Occupational Health, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
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Risk of disability pension in first and second generation immigrants: the role of age and region of birth in a prospective population-based study from Sweden. BMC Public Health 2017; 17:931. [PMID: 29202827 PMCID: PMC5716008 DOI: 10.1186/s12889-017-4944-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In several countries, immigrants have higher disability pension (DP) rates than natives. Reasons for this are poorly understood. The aim of this study was to investigate if the risk of diagnosis-specific DP differed in first, second, and second/intermediate generation immigrants compared to natives, in general and across regions of birth, and stratified by age. METHODS A population-based prospective cohort study of all 3,507,055 individuals aged 19-50 years and living in Sweden in 2004 with a 6-year follow-up period. Hazard ratios (HR) and 95% confidence intervals (CI) for mental and somatic DP were estimated by Cox regression for first, second, and second/intermediate generation immigrants compared to natives, across regions of birth and stratified by age. RESULTS After multivariate adjustment, HRs for both mental and somatic DP were higher at follow-up in the first generation compared to natives: mental HR 1.17 (CI 1.12-1.22) and somatic 1.15 (1.09-1.22) for individuals <35 years; 1.74 (1.69-1.79) and 1.70 (1.66-1.74) ≥35 years (median), respectively. Immigrants born in Europe outside EU25, and countries outside Europe had particularly elevated HRs. Also in the second generation, HRs were higher in mental 1.29 (1.21-1.37) and somatic DP: 1.30 (1.19-1.42) in those <35 years; and 1.18 (1.10-1.27); and 1.10 (1.03-1.17) for those ≥35 years, respectively. Among second generation immigrants there were no strong differences in HRs between regions of birth. CONCLUSIONS Compared to natives, the risk of DP was higher in first and second generation immigrants. Higher estimates were seen for immigrants from Europe outside EU25 and from the rest of the world in the first generation. No considerable differences in estimates regarding mental or somatic DP diagnoses were found.
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Spanier K, Michel E, Peters E, Radoschewski FM, Bethge M. Injustice at work affects work ability and role functioning: findings of a cohort study. Int J Public Health 2017; 63:447-456. [DOI: 10.1007/s00038-017-1056-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022] Open
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Airaksinen J, Jokela M, Virtanen M, Oksanen T, Pentti J, Vahtera J, Koskenvuo M, Kawachi I, Batty GD, Kivimäki M. Development and validation of a risk prediction model for work disability: multicohort study. Sci Rep 2017; 7:13578. [PMID: 29051618 PMCID: PMC5648892 DOI: 10.1038/s41598-017-13892-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/02/2017] [Indexed: 12/23/2022] Open
Abstract
Work disability affects quality of life, earnings, and opportunities to contribute to society. Work characteristics, lifestyle and sociodemographic factors have been associated with the risk of work disability, but few multifactorial algorithms exist to identify individuals at risk of future work disability. We developed and validated a parsimonious multifactorial score for the prediction of work disability using individual-level data from 65,775 public-sector employees (development cohort) and 13,527 employed adults from a general population sample (validation cohort), both linked to records of work disability. Candidate predictors for work disability included sociodemographic (3 items), health status and lifestyle (38 items), and work-related (43 items) variables. A parsimonious model, explaining > 99% of the variance of the full model, comprised 8 predictors: age, self-rated health, number of sickness absences in previous year, socioeconomic position, chronic illnesses, sleep problems, body mass index, and smoking. Discriminative ability of a score including these predictors was high: C-index 0.84 in the development and 0.83 in the validation cohort. The corresponding C-indices for a score constructed from work-related predictors (age, sex, socioeconomic position, job strain) were 0.79 and 0.78, respectively. It is possible to identify reliably individuals at high risk of work disability by using a rapidly-administered prediction score.
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Affiliation(s)
| | - Markus Jokela
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Tuula Oksanen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jaana Pentti
- Department of Public Health, University of Turku, Turku, Finland
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku, Finland
| | - Markku Koskenvuo
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ichiro Kawachi
- Harvard T H Chan School of Public Health, Boston MA, USA
| | - G David Batty
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Epidemiology and Public Health, University College London, London, UK
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Werlen L, Helgesson M, Mittendorfer-Rutz E. Differences in predictors of permanent work disability between immigrants and natives: a cohort study of adults with sick leave due to common mental disorders. BMJ Open 2017; 7:e014431. [PMID: 28314745 PMCID: PMC5372068 DOI: 10.1136/bmjopen-2016-014431] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Immigrants with common mental disorders (CMDs) are reported to have a higher risk of disability pension (DP) compared with native residents; however, the reasons for this are not fully understood. This study aimed to investigate (1) differences in morbidity (3 measures) and socioeconomic status in native Swedes, 'Western' and 'non-Western' immigrants with CMDs and (2) interactions between morbidity and socioeconomic status and immigrant status regarding subsequent DP. DESIGN The study was a prospective population-based cohort study using national register data. Crude and multivariate HRs with 95% CIs were calculated using the Cox regression (2007-2010). PARTICIPANTS All individuals aged 18-59 with an incident sick-leave spell due to CMDs during 2006 were included in the study (N=66 097). The study population was divided into 3 groups based on country of birth: (1) Sweden, (2) immigrants from 'Western' countries (EU25, Norway, Iceland, North America and Oceania) and (3) immigrants from 'non-Western' countries (east Europe, Africa, Asia and South America). RESULTS Particularly, immigrants born in non-Western countries had higher levels of morbidity and lower socioeconomic status than natives (p>0.001). No significant differences in the associations between specialised psychiatric and somatic care with regard to subsequent DP were found between immigrants and native Swedes. Being prescribed more than 1 type of psychiatric medication was associated with higher HRs for DP in immigrants from Western (HR 3.34; CI 2.3 to 4.9) and non-Western countries (3.6; 1.9 to 6.4) than in native Swedes (2.55; 2.3 to 2.8) (pinteraction=0.003). Low education was a marginally stronger predictor for DP in non-Western immigrants than in native Swedes and Western immigrants (pinteraction=0.03). CONCLUSIONS Morbidity measured by medication, but not by specialised healthcare, was a stronger predictor for DP in immigrants than in native Swedes, warranting scrutiny of differences in care and treatment in immigrants and native Swedes with CMDs.
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Affiliation(s)
- Laura Werlen
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Magnus Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
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Niederkrotenthaler T, Tinghög P, Goldman-Mellor S, Wilcox HC, Gould M, Mittendorfer-Rutz E. Medical and Social Determinants of Subsequent Labour Market Marginalization in Young Hospitalized Suicide Attempters. PLoS One 2016; 11:e0146130. [PMID: 26784886 PMCID: PMC4718648 DOI: 10.1371/journal.pone.0146130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/14/2015] [Indexed: 11/18/2022] Open
Abstract
Background Individuals with a history of suicide attempt have a high risk for subsequent labour market marginalization. This study aimed at assessing the effect of individual and parental factors on different measures of marginalization. Methods Prospective cohort study based on register linkage of 5 649 individuals who in 1994 were 16–30 years old, lived in Sweden and were treated in inpatient care for suicide attempt during 1992–1994. Hazard ratios (HRs) for labour market marginalization defined as long-term unemployment (>180 days), sickness absence (>90 days), or disability pension in 1995–2010 were calculated with Cox regression. Results Medical risk factors, particularly any earlier diagnosed specific mental disorders (e.g., schizophrenia: HR 5.4 (95% CI: 4.2, 7.0), personality disorders: HR 3.9, 95% CI: 3.1, 4.9), repetitive suicide attempts (HR 1.6, 95% CI: 1.4, 1.9) were associated with a higher relative risk of disability pension. Individual medical factors were of smaller importance for long-term sickness absence, and of only marginal relevance to long-term unemployment. Country of birth outside Europe had an opposite effect on disability pension (HR 0.6, 95% CI: 0.4, 0.8) and long-term unemployment (HR 1.5, 95% CI: 1.3, 1.8). Female sex was positively correlated with long-term sickness absence (HR 1.6, 95% CI: 1.4, 1.7), and negatively associated with long-term unemployment (HR: 0.8, 95% CI: 0.7, 0.9). Conclusions As compared to disability pension, long-term sickness absence and unemployment was more strongly related to socio-economic variables. Marginalization pathways seemed to vary with migration status and sex. These findings may contribute to the development of intervention strategies which take the individual risk for marginalization into account.
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Affiliation(s)
- Thomas Niederkrotenthaler
- Medical University Vienna, Center for Public Health, Institute of Social Medicine, Suicide Research Unit, Vienna, A-1090 Vienna, Austria
- * E-mail:
| | - Petter Tinghög
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, 17 177 Stockholm, Sweden
- The Swedish Red Cross University College, Stockholm, Sweden
| | | | - Holly C. Wilcox
- Johns Hopkins School of Medicine, Baltimore, MD 21205, United States of America
| | - Madelyn Gould
- Columbia University, NYS Psychiatric Institute, New York, NY 10032, United States of America
| | - Ellenor Mittendorfer-Rutz
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, 17 177 Stockholm, Sweden
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