Trajectories of health care use before and after granted disability pension due to common mental disorders- a nationwide register-based study in Sweden

In Collaboration with Ellenor Mittendorfer-Rutz, Kristina Alexanderson, Jussi Jokinen, Petter Tinghög

Syed Rahman (syed.rahman@ki.se)Division of Insurance Medicine,Karolinska Institutet, Stockholm, Sweden

Background and Aim Despite common mental disorders (CMD) now being frequent underlying diagnoses

for granting disability pension (DP), knowledge is sparse regarding healthcare use

patterns around DP granting time

Studies suggest an increase in prescribed psychotropics and in self-reported

symptoms of depression and anxiety just before DP, and a decrease later

oThis study aimed to identify if transition to DP due to CMD is associated with changes in in- and specialized

outpatient healthcare use

if the trajectories of healthcare use are different before and after changes in DP

granting criteria1 maj 2023Syed Rahman 2

Methods Two cohorts, before and following inclusion of stricter DP granting criteria

Inclusion : age 19-64, DP due to CMD granted in 2005-06 (wave1) or in 2009-10

(wave2), without missing in socio-demographics n=24292 and n=4056, respectively

Analyses: trajectory analyses for 3 years before, year during and 3 years after DP by

repeated-measure logistic regression wirth Generalized Estimating Equations and

Chi-square for differences

Adjusted for sex, age, education, place of residence, country of birth and family

situation

Health care: in- or specialised outpatient care due to mental or somatic diagnoses

01/05/2023Syed Rahman 3

Trajectory differences

1 maj 2023Syed Rahman 4

t-3 t-2 t-1 t0 t+1 t+2 t+3.03

.04

.05

.06

.07

.08

.09

Inpatient care due to mental diagnoses

wave 1 wave 2(after)

Estim

ated

pre

vale

nce

t-3 t-2 t-1 t0 t+1 t+2 t+3.09.14.19.24.29.34.39.44.49.54.59

Specialized outpatient care due to mental diagnoses

wave 1 wave 2 (after)

Estim

ated

pre

vale

nce

t-3 t-2 t-1 t0 t+1 t+2 t+3.4

.6

.8

1.0

1.2

Inpatient care due to mental diagnoses

wave1 wave2 (after)t-3 t-2 t-1 t0 t+1 t+2 t+3

.2

.4

.6

.8

1.0

1.2

1.4Specialized outpatient care due to mental diagnoses

Conclusions Incidence of DP due to CMD was 6 times higher before inclusion of stricter

criteria

Trajectories, in general, were similar in both waves, increasing up until 1 year

prior to DP and declining immediately after

Prevalence of healthcare use in wave 2 was higher than wave 1

Overall, <50% of individuals receive specialized care 1 year prior to DP

granting

1 maj 2023Syed Rahman 5

Conclusions Incidence of DP due to CMD was 6 times higher before inclusion of stricter

criteria

Trajectories, in general, were similar in both waves, increasing up until 1 year

prior to DP and declining immediately after

Prevalence of healthcare use in wave 2 was higher than wave 1

Overall, <50% of individuals receive specialized care 1 year prior to DP

granting

1 maj 2023Syed Rahman 6

Thank you !

Syed Rahmansyed.rahman@ki.seDivision of Insurance MedicineDepartment of Clinical NeurosciencesKarolinska Institutet, Sweden