Download - Measures of disability pension due to common mental disorders and subsequent suicidal behaviour
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 ([email protected])Division of Insurance Medicine,Karolinska Institutet, Stockholm, Sweden
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.3 maj 2023Syed Rahman 2
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.
3 maj 2023Syed Rahman 3
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.
3 maj 2023Syed Rahman 4
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.3 maj 2023Syed Rahman 5
Data sourceNational 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. 3 maj 2023Syed Rahman 6
Results- Suicide attempt Multivariate Hazard Ratios (HR), 95% Confidence Interval (CI)Stratified by sexCharacteristics 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 (3.3–6.4) 34 (3.3) 2.9(1.9–4.3)
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
3 maj 2023Syed Rahman 7
Results- Suicide attempt Multivariate Hazard Ratios (HR), 95% Confidence Interval (CI)Stratified by ageCharacteristics 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 (2.8–5.8) 37 (3.5) 3.6 (2.5–5.2)
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
3 maj 2023Syed Rahman 8
Results- Suicide Multivariate Hazard Ratios (HR), 95% Confidence Interval (CI)Stratified by sexCharacteristics 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
3 maj 2023Syed Rahman 9
Results- Suicide Multivariate Hazard Ratios (HR), 95% Confidence Interval (CI)Stratified by ageCharacteristics 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
3 maj 2023Syed Rahman 10
SummaryRisk 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
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SummaryRisk 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 individuals3 maj 2023Syed Rahman 12