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.


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


Results- Suicide attempt Multivariate Hazard Ratios (HR), 95% Confidence Interval (CI)Stratified by ageCharacteristics 19-44 years 45-64 years


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


Results- Suicide Multivariate Hazard Ratios (HR), 95% Confidence Interval (CI)Stratified by sexCharacteristics Female Male


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


Results- Suicide Multivariate Hazard Ratios (HR), 95% Confidence Interval (CI)Stratified by ageCharacteristics 19-44 years 45-64 years


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


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


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

Thank you

Syed [email protected]

measures of disability pension due to common mental disorders and subsequent suicidal behaviour

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