Measures of disability pension due to common mental disorders and subsequent suicidal behaviour
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This study investigated the associations between different measures of disability pension (DP), including main and side diagnoses, duration, and grade, and subsequent suicidal behavior in Sweden. The study found that for suicide attempt, risk factors included having a main diagnosis of depressive disorder compared to stress-related disorders, and having a side diagnosis of substance abuse or personality disorder. Being on full-time DP also increased risk. For suicide, risk factors included having a main diagnosis of depressive disorder compared to stress-related disorders for men and older individuals, and having a side diagnosis of substance abuse or personality disorder for women and younger individuals. Having a side diagnosis of substance abuse and being on full-time DP also increased risk of suicide for older individuals.
Measures of disability pension due to common mental disorders and subsequent suicidal behaviour
- 1. Measures of disability pension due to common mental disorders and subsequent suicidal behaviour - a population-based prospective cohort study in Sweden. In Collaboration with: Prof Kristina Alexanderson, Prof Jussi Jokinen and Associate Prof Ellenor Mittendorfer-Rutz Syed Rahman (syed.rahman@ki.se) Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- 2. Background In most OECD countries, there is a shift towards mental diagnoses for disability pension (DP) claim. OECD, Sickness, Disability and Work: Breaking the Barriers. Paris 2010 A significant association has been reported between DP and suicidal behaviour. Qin et al., 2003, Leinonen 2013, Jonsson et at., 2013 There are documented sex and age differences in both disability pension and suicidal behaviour. Hawton et al., 2009, 2000, Crump et al., 2013, Haukenes et al., 2012, Rahman et al., 2014 No information on association between different DP measures and suicidal behaviour. 27 juli 2016Syed Rahman 2
- 3. Aim To investigate the associations between different measures of DP (main and side diagnoses, duration and grade) and subsequent suicidal behaviour (suicide attempt and suicide) in individuals on DP due to CMD. 27 juli 2016Syed Rahman 3
- 4. Methods Design: nationwide register-based prospective cohort study. Inclusion criteria: individuals aged 19-64 years, on DP due to CMD during 2005, N = 48 803. Exclusion criteria: schizophrenic spectrum and bipolar disorders during 2001-05 (n = 1656), old-age pensioners in 2005 (n = 402). Final cohort: N = 46 745 individuals. 27 juli 2016Syed Rahman 4
- 5. Methods Follow-up (2006-10): Suicide attempt n=1 046, Suicide n=210. Censoring: for emigration, death (due to other causes in case of suicide). Statistical method: Hazard ratios and 95% CI were estimated by Cox regression in SPSS v.20. All analyses were stratified by age and sex. 27 juli 2016Syed Rahman 5
- 6. Data source National registers: LISA by Statistics Sweden: information on sex, age, educational, area of living, country of birth, family status. NPR by National Board of Health and Welfare including following information: (i) in- and outpatient registers (ii) cause of death register. MiDAS by Social Insurance Agency (SIA) with information on date, diagnoses, duration and grade of disability pension. 27 juli 2016Syed Rahman 6
- 7. Results- Suicide attempt Multivariate Hazard Ratios (HR), 95% Confidence Interval (CI) Stratified by sex Characteristics Female Male Total n(%) HR (95% CI) Total n(%) HR (95% CI) Main Diag Depress. dis. 355 (33.8) 1 141 (13.5) 1 SRDs* 102 (9.8) 0.7 (0.5-0.8) 25 (2.4) 0.5 (0.3-0.7) Side Diag None 232 (22.1) 1 100 (9.6) 1 Substance 43 (4.1) 4.6 (3.36.4) 34 (3.3) 2.9(1.94.3) Personality 83 (7.8) 2.3 (1.8-2.9) 39 (3.7) 1.8 (1.2-2.6) Other mental 257 (24.6) 1.4 (1.2-1.7) 101 (9.7) 1.4 (1.0-1.8) DP Grade Part-time 50 (4.8) 1 25 (2.4) 1 Full-time 686 (65.6) 2.3 (1.8-2.9) 285 (27.2) 1.2 (0.8-1.7) *adjusted for: Age, Education, Family situation, Country of birth, Area of living. *Stress-related disorders 27 juli 2016Syed Rahman 7
- 8. Results- Suicide attempt Multivariate Hazard Ratios (HR), 95% Confidence Interval (CI) Stratified by age Characteristics 19-44 years 45-64 years Total n(%) HR (95% CI) Total n(%) HR (95% CI) Main Diag Depress. dis. 218 (20.8) 1 278 (26.6) 1 SRDs* 64 (6.1) 0.7 (0.5-0.9) 63 (6.0) 0.5 (0.4-0.7) Side Diag None 140 (13.4) 1 192 (18.4) 1 Substance 40 (3.8) 4.0 (2.85.8) 37 (3.5) 3.6 (2.55.2) Personality 85 (8.1) 2.2 (1.7-2.9) 37 (3.5) 2.1 (1.4-3.0) Other mental 240 (22.9) 1.7 (1.4-2.1) 118 (11.3) 1.1 (0.9-1.4) DP Grade Part-time 28 (2.7) 1 47 (4.5) 1 Full-time 536 (51.2) 2.0 (1.5-2.8) 435 (41.6) 1.8 (1.4-2.4) *adjusted for: Sex, Education, Family situation, Country of birth, Area of living. *Stress-related disorders 27 juli 2016Syed Rahman 8
- 9. Results- Suicide Multivariate Hazard Ratios (HR), 95% Confidence Interval (CI) Stratified by sex Characteristics Female Male Total n(%) HR (95% CI) Total n(%) HR (95% CI) Main Diag Depress. dis. 53 (25.2) 1 50 (23.8) 1 SRDs* 17 (8.1) 0.7 (0.4-1.2) 10 (4.8) 0.4 (0.2-0.9) Side Diag None 34 (16.2) 1 45 (21.4) 1 Substance 9 (4.3) 7.7(3.6-16.4) 7 (3.3) 1.3 (0.6-2.9) Personality 12 (5.7) 2.9 (1.5-5.7) 9 (4.3) 1.1 (0.5-2.3) Other mental 27 (12.9) 1.2 (0.7-2.0) 32 (15.2) 1.0 (0.7-1.7) DP Grade Part-time 10 (4.8) 1 <7 (2.8) 1 Full-time 92 (43.8) 1.8 (1.0-3.2) 102 (48.6) 1.9 (0.9-3.7) *adjusted for: Age, Education, Family situation, Country of birth, Area of living. *Stress-related disorders 27 juli 2016Syed Rahman 9
- 10. Results- Suicide Multivariate Hazard Ratios (HR), 95% Confidence Interval (CI) Stratified by age Characteristics 19-44 years 45-64 years Total n(%) HR (95% CI) Total n(%) HR (95% CI) Main Diag Depress. dis. 20 (9.5) 1 83 (39.5) 1 SRDs* 12 (5.7) 1.4 (0.7-3.0) 15 (7.1) 0.4 (0.2-0.7) Side Diag None 20 (9.5) 1 59 (28.1) 1 Substance 8 (3.8) 4.1 (1.8-9.6) 8 (3.8) 2.1 (1.0-4.6) Personality 13 (6.2) 2.2 (1.1-4.4) 8 (3.8) 1.4 (0.7-3.0) Other mental 30 (14.3) 1.4 (0.8-2.5) 29 (13.8) 0.9 (0.6-1.5) DP Grade Part-time <7 (1.0) 1 14 (6.6) 1 Full-time 75 (35.7) 1.7 (0.7-4.1) 119 (56.7) 1.9 (1.1-3.1) *adjusted for: Sex, Education, Family situation, Country of birth, Area of living. *Stress-related disorders 27 juli 2016Syed Rahman 10
- 11. Summary Risk factors for suicide attempt: Depressive disorders as main diagnosis compared to stress-related disorders Substance abuse disorder as side diagnosis Personality disorder as a side diagnosis Full-time DP 27 juli 2016Syed Rahman 11
- 12. Summary Risk factors for suicide: Depressive disorders as main diagnosis compared to stress-related disorders in men and older individuals Substance abuse and personality disorders as side diagnosis in women and younger individuals Substance abuse disorder as side diagnosis in older individuals Full-time DP in older individuals 27 juli 2016Syed Rahman 12