Work disability before and after incident myocardial infarction and subsequent common mental disorder

Abstract Background This study investigated the extent to which work-disability patterns including sickness absence and disability pension (SA/DP) before and after acute myocardial infarction (AMI) were associated with subsequent common mental disorders (CMDs) such as depression and anxiety in AMI patients without previous CMD. Methods A cohort of 11,493 patients aged 26-64 years without previous CMD with incident AMI during 2008-2010 were followed up for CMD measured as antidepressant prescription through 2013. Four SA/DP trajectory groups during the 3 years pre-AMI and 1 year post-AMI were identified. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated in Cox models. Results Higher pre-AMI SA/DP levels (>1-12 months/year), compared to the majority of patients (78%) following low increasing annual levels (increasing up to 1 month/year) of pre-AMI SA/DP, were associated with a 40-60% increased CMD rate. Regarding post-AMI findings, constant high (∼25-30 days/month) and steeply decreasing SA/DP levels within the first 3 months were associated with a 76% and 35% higher CMD rate, respectively, compared to constant low (<1 days/month) levels. Conversely, a gradually decreasing pattern of post-AMI SA/DP over a 12-month period suggested protective influences for CMD (HR = 0.80), even after adjusting for sociodemographic and medical factors. Conclusions This is the first study to demonstrate that pre- and post-AMI work disability patterns are associated with subsequent CMD risk in AMI patients. Work disability patterns should be considered in clinical practice as an indicator of AMI prognosis in terms of CMD risk. Key messages Increasing and high persistent levels of pre-AMI work disability are associated with higher risk of subsequent CMD, while gradually decreasing post-AMI work disability has a favourable CMD prognosis. Pre- and post-AMI patterns of work disability (sickness absence and disability pension) can be a useful marker in terms of CMD prognosis.

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Work disability patterns before and after incident acute myocardial infarction and subsequent risk of common mental disorders: A Swedish cohort study

Scientific Reports ◽

10.1038/s41598-019-52487-w ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

K. Bokenberger ◽

S. Rahman ◽

M. Wang ◽

M. Vaez ◽

T. E. Dorner ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Mental Disorders ◽

Work Disability ◽

Common Mental Disorders ◽

Depression And Anxiety ◽

Cox Models ◽

Hazard Ratios ◽

Antidepressant Prescription ◽

Before And After

Abstract This study investigated the extent to which work disability patterns including sickness absence and disability pension (SA/DP) before and after acute myocardial infarction (AMI) were associated with subsequent common mental disorders (CMDs) such as depression and anxiety in AMI patients without previous CMD. Total 11,493 patients 26–64 years with incident AMI during 2008–10 were followed up for CMD (measured as antidepressant prescription) through 2013. Four SA/DP trajectory groups during the 3-years pre-AMI and 1-year post-AMI were identified. Hazard ratios (HRs) with 95% confidence intervals for subsequent CMD were estimated in Cox models. Higher pre-AMI SA/DP annual levels (>1–12 months/year) were associated with 40–60% increased CMD rate than the majority (78%) with low increasing levels (increasing up to 1 month/year). Regarding post-AMI findings, constant high (~25–30 days/month) SA/DP levels within the first 3 months was associated with a 76% higher CMD rate, compared to constant low (0 days/month). A gradually decreasing post-AMI SA/DP pattern over a 12-month period suggested protective influences for CMD (HR = 0.80). This is the first study to demonstrate that pre- and post-AMI work disability patterns are associated with subsequent CMD risk in AMI patients. Work disability patterns should be considered as an indicator of AMI prognosis in terms of CMD risk.

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Trajectories of sickness absence, disability pension and unemployment in young immigrants with common mental disorders

European Journal of Public Health ◽

10.1093/eurpub/ckz046 ◽

2019 ◽

Vol 29 (6) ◽

pp. 1055-1062 ◽

Cited By ~ 1

Author(s):

D Di Thiene ◽

E Mittendorfer-Rutz ◽

S Rahman ◽

M Wang ◽

K Alexanderson ◽

...

Keyword(s):

Sickness Absence ◽

Educational Level ◽

Disability Pension ◽

Psychiatric Comorbidity ◽

Common Mental Disorders ◽

Multinomial Logistic Regression ◽

Common Mental Disorder ◽

Duration Of Residence ◽

Before And After ◽

Young Immigrants

Abstract Background The aims were to elucidate if trajectories of labour market marginalization (LMM), measured as sickness absence (SA)/disability pension (DP) or unemployment, differed between young immigrants and natives before and after an incident diagnosis of a common mental disorder (CMD), and to investigate if educational level, psychiatric comorbidity and duration of residence in Sweden (in immigrants) had different associations with subsequent LMM in natives compared with immigrants. Methods A total of 28 971 young adults (19–30 years), with an incident CMD (inpatient or specialized outpatient healthcare due to CMDs or dispensed prescribed antidepressants during 2007) were included. Group-based trajectory models were utilized to identify trajectories of annual months of LMM 3 years before and 6 years after the diagnosis. The associations of risk factors with different trajectories were investigated by multinomial logistic regression, χ2-test and Nagelkerke R2 to measure the associations’ strength. Immigrants were categorized into Western and non-Western immigrants. Results Young natives and immigrants showed similar trajectories of SA/DP. A higher proportion of non-Western immigrants (20.5%) followed trajectories of high levels of unemployment (>2 annual months) compared with Western immigrants (15%) and natives (16.5%). Educational level and duration of residence in Sweden (in immigrants) discriminated trajectories of both SA/DP and unemployment, whereas psychiatric comorbidity only discriminated trajectories of SA/DP. Conclusions Differences in trajectories of unemployment between young natives and immigrants with an incident CMD were found. Educational level and psychiatric comorbidity provided information on differences between natives and immigrants and duration of residence gave information for subgroups of immigrants.

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Synergistic effect between back pain and common mental disorders and the risk of future disability pension: a nationwide study from Sweden

Psychological Medicine ◽

10.1017/s003329171500197x ◽

2015 ◽

Vol 46 (2) ◽

pp. 425-436 ◽

Cited By ~ 18

Author(s):

T. E. Dorner ◽

K. Alexanderson ◽

P. Svedberg ◽

P. Tinghög ◽

A. Ropponen ◽

...

Keyword(s):

Back Pain ◽

Mental Disorders ◽

Synergistic Effect ◽

Sickness Absence ◽

Outpatient Care ◽

Disability Pension ◽

Common Mental Disorders ◽

Hazard Ratios ◽

Co Morbidity ◽

Individual Condition

BackgroundThe aim of this study was to analyse a possible synergistic effect between back pain and common mental disorders (CMDs) in relation to future disability pension (DP).MethodAll 4 823 069 individuals aged 16–64 years, living in Sweden in December 2004, not pensioned in 2005 and without ongoing sickness absence at the turn of 2004/2005 formed the cohort of this register-based study. Hazard ratios (HRs) and 95% confidence intervals (CIs) for DP (2006–2010) were estimated. Exposure variables were back pain (M54) (sickness absence or inpatient or specialized outpatient care in 2005) and CMD (F40-F48) [sickness absence or inpatient or specialized outpatient care or antidepressants (N06a) in 2005].ResultsHRs for DP were 4.03 (95% CI 3.87–4.21) and 3.86 (95% CI 3.68–4.04) in women and men with back pain. HRs for DP in women and men with CMD were 4.98 (95% CI 4.88–5.08) and 6.05 (95% CI 5.90–6.21). In women and men with both conditions, HRs for DP were 15.62 (95% CI 14.40–16.94) and 19.84 (95% CI 17.94–21.94). In women, synergy index, relative excess risk due to interaction, and attributable proportion were 1.24 (95% CI 1.13–1.36), 0.18 (95% CI 0.11–0.25), and 2.08 (95% CI 1.09–3.06). The corresponding figures for men were 1.45 (95% CI 1.29–1.62), 0.29 (95% CI 0.22–0.36), and 4.21 (95% CI 2.71–5.70).ConclusionsCo-morbidity of back pain and CMD is associated with a higher risk of DP than either individual condition, when added up, which has possible clinical implications to prevent further disability and exclusion from the labour market.

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Abstract MP27: Weight Change, BMI, and Mortality Among Survivors of Myocardial Infarction: Analysis of Two Prospective US Cohort Studies

Circulation ◽

10.1161/circ.137.suppl_1.mp27 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Laila Al-Shaar ◽

Yanping Li ◽

Eric Rimm ◽

JoAnn E Manson ◽

Frank Hu ◽

...

Keyword(s):

Myocardial Infarction ◽

Weight Change ◽

Normal Weight ◽

Health Study ◽

Obese Patients ◽

Cox Models ◽

Hazard Ratios ◽

Before And After ◽

Cvd Mortality

Background: The relation between BMI, weight change and mortality among survivors of Myocardial Infarction (MI) remains controversial, with some studies reporting favorable survival outcomes among overweight and obese patients, as compared to those with normal weight. We aim to examine the relationship between BMI reported shortly before and after MI diagnosis in addition to weight change with all-cause and cardiovascular disease (CVD) mortality among MI survivors. Methods: Using the data from Nurses’ Health Study (NHS) and Health Professionals Follow up Study (HPFS) cohorts, we studied 4278 participants who were free of CVD and cancer before their MI. Weight change (in BMI units) was categorized as loss of (> 4, 2-4, <2-0 (reference)), or gain of (0.1-2, or >2) units. Multivariable Cox models were used to estimate hazard ratios and 95 % confidence interval for mortality across BMI/weight change categories. Results: During up to 36 (NHS) and 28 (HPFS) years of follow-up post-MI, there were 2071 all-cause and 835 CVD deaths. Overweight patients with BMI before or after MI of 25-27.49 kg/m 2 had decreased mortality as compared to normal weight patients (22.5-24.9 kg/m 2 ). All-cause mortality increased progressively with higher BMI. Obese patients (BMI≥30) had the highest risk of CVD mortality (HR=1.35; 95% CI, 1.06-1.73). Among MI patients who had never smoked (N=1484) or were younger than 65 years of age at the time of diagnosis (N=1873), no survival advantage was observed for overweight/obese patients. Compared to stable weight (a BMI reduction of 0-1.99 units) from before to after MI, a reduction of 2-4 or >4 BMI units was associated with increased mortality (HR=1.12; 95% CI, 0.96-1.29 and 1.42; 95% CI, 1.17-1.71 respectively, Figure). Conclusions: We observed a J-shaped association between BMI and mortality among all MI patients, but not among those who had never smoked or were younger than 65 years of age. Weight loss associated with acute MI, potentially related to disease severity, is an important predictor of higher mortality.

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Determinants of work disability following lumbar spine decompression surgery

Scandinavian Journal of Public Health ◽

10.1177/1403494818785055 ◽

2018 ◽

Vol 47 (3) ◽

pp. 281-292 ◽

Cited By ~ 3

Author(s):

Mo Wang ◽

Ellenor Mittendorfer-Rutz ◽

Thomas E. Dorner ◽

Konstantinos A. Pazarlis ◽

Annina Ropponen ◽

...

Keyword(s):

Risk Factors ◽

Lumbar Spine ◽

Sickness Absence ◽

Work Disability ◽

Disability Pension ◽

Lumbar Fusion ◽

Decompression Surgery ◽

Preoperative Pain ◽

Hazard Ratios

Aims: Scientific knowledge about risk factors for work disability in terms of long-term sickness absence and disability pension following lumbar spine decompression surgery remains insufficient. This study aimed to investigate the associations between socio-demographic, work-related, and medical characteristics with subsequent long-term sickness absence (>90 days) and disability pension for individuals who underwent lumbar spine decompression surgery. Methods: A prospective cohort study of all individuals aged 19–60 years with diagnosed dorsopathies, who underwent lumbar spine decompression surgery 2008–10 in Sweden ( n=7373) was performed. Univariate and multivariate hazard ratios with 95% confidence intervals regarding long-term sickness absence and disability pension with a 3-year follow-up period were estimated by Cox proportional regression. Results: Low educational level, being a non-European immigrant and preoperative sickness absence were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2–3.8). Female sex was a risk factor for long-term sickness absence (hazard ratios: 1.3) whereas age >44 years and being a Nordic immigrant were risk factors for disability pension (hazard ratios: 1.9–2.6). Medical factors as common mental disorders, other mental disorders, prescribed psychiatric medication and somatic comorbidity were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2–3.4). A simultaneous lumbar fusion surgery and high preoperative pain severity were risk factors for long-term sickness absence (hazard ratios 1.2–1.8). Conclusions: To prevent long-term work disability after lumbar spine decompression surgery, specific focus is required on older and female patients, those with mental or somatic comorbidities, high levels of preoperative pain or sickness absence, with a simultaneous lumbar fusion surgery, a low educational level or a non-European immigrant background.

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Suicide attempt following sickness absence and disability pension due to common mental disorders: a prospective Swedish twin study

Social Psychiatry and Psychiatric Epidemiology ◽

10.1007/s00127-019-01803-w ◽

2019 ◽

Vol 55 (8) ◽

pp. 1053-1060 ◽

Cited By ~ 1

Author(s):

M. Wang ◽

L. Mather ◽

P. Svedberg ◽

E. Mittendorfer-Rutz

Keyword(s):

Mental Disorders ◽

Suicide Attempt ◽

Sickness Absence ◽

Disability Pension ◽

Depressive Disorders ◽

Proportional Hazards ◽

Common Mental Disorders ◽

Cox Proportional Hazards ◽

Shared Environment ◽

Familial Factors

Abstract Purpose The aim of this study was to investigate if sickness absence and disability pension (SA/DP) in general and due to specific common mental disorders (CMDs) are associated with subsequent suicide attempt among women and men by taking familial factors (genetics and shared environment) into consideration. Methods This register-based cohort study includes 4871 twin pairs 18–65 years of age discordant for SA/DP due to CMDs 2005–2010. Twins were followed up for suicide attempt from inpatient and specialised outpatient care until December 2012. Conditional Cox proportional hazards regression models, adjusting for familial factors, were used to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results SA/DP due to CMDs was associated with a higher risk of suicide attempt (HR 3.14, CI 2.51–3.93). The risk of suicide attempt was five times higher among men and three times higher among women, compared to the SA/DP unaffected co-twins. In the diagnosis-specific analysis, SA/DP due to anxiety disorders resulted in the highest HR (4.09, CI 2.37–7.06) for suicide attempt, followed by depressive disorders (HR 3.70, CI 2.66–5.14) and stress-related disorders (HR 1.96, CI 1.35–2.84). The stratified analysis on zygosity indicates that there seems to be a genetic influence on the associations between SA/DP due to CMDs and suicide attempt, particularly among women and among those with SA/DP due to depressive disorders. Conclusions SA/DP due to CMDs was a risk factor for suicide attempt among women and men. Genetic factors might explain part of the associations for women and for those with SA/DP due to depressive disorders.

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Sleep disturbance and work-related mental strain: A national prospective cohort study of the prediction of subsequent long-term sickness absence, disability pension and mortality

Scandinavian Journal of Public Health ◽

10.1177/1403494820911813 ◽

2020 ◽

Vol 48 (8) ◽

pp. 888-895

Author(s):

Torbjörn Åkerstedt ◽

Ellenor Mittendorfer-Rutz ◽

Syed Rahman

Keyword(s):

Sleep Disturbance ◽

Sickness Absence ◽

Work Disability ◽

Disability Pension ◽

Sleep Disturbances ◽

Workplace Stress ◽

Mental Strain ◽

Work Related ◽

Synergy Effects

Aims: Sleep disturbances and work-related mental strain are linked to increased sickness absence and disability pension (DP), but we have no information on synergy effects. The aim of this study was to examine the combined (and separate) association of the two predictors with subsequent long-term work disability and mortality. Methods: A total of 45,498 participants aged 16–64 years were interviewed in the Swedish Surveys of Living Conditions between 1997 and 2013, and were followed up on long-term sickness absence (LTSA; >90 days/year), DP and mortality via national registers until 2016. Crude and multivariable Cox analyses were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results: For LTSA, the HRs for sleep disturbances and work-related mental strain were 1.6 (95% CI 1.5–1.7) and 1.3 (95% CI 1.2–1.4), respectively. For DP, the HRs were 2.0 (95% CI 1.8–2.2) and 1.4 (95% CI 1.2–1.5). Mortality was only predicted by sleep disturbances (HR=1.2, 95% CI 1.1–1.4). No synergy effect was seen. Conclusions: Work-related mental strain and, in particular, sleep disturbances were associated with a higher risk of subsequent LTSA and DP, but without synergy effects. Sleep disturbances were also associated with mortality. Exposure to interventions tackling sleep disturbance and prevention of workplace stress may reduce work disability.

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Sickness absence and disability pension in relation to first childbirth: three cohorts in Sweden

European Journal of Public Health ◽

10.1093/eurpub/ckz186.158 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

C Bjorkenstam ◽

C Orellana ◽

K Laszlo ◽

P Svedberg ◽

M Voss ◽

...

Keyword(s):

Pregnant Women ◽

Sickness Absence ◽

Young Women ◽

Disability Pension ◽

Age Groups ◽

Population Based ◽

Multiple Births ◽

First Birth ◽

Period Effects ◽

Before And After

Abstract Background Childbirth is suggested to be associated with elevated levels of sickness absence (SA) and disability pension (DP). However, knowledge about patterns of SA/DP before and after childbirth as compared to patterns among women who remain nulliparous is limited. We aimed to compare SA/DP across several periods among women with different childbirth status. Methods We analysed three population-based cohorts of all women aged 18-39 years who had not previously given birth and who lived in Sweden on 31 December 1994, 1999, or 2004, respectively. We compared crude and standardized annual mean SA and DP net days during three years preceding to three years after the date of first childbirth, among women having (1) their first and only birth during the subsequent three years, (2) their first birth and at least another delivery, and (3) no childbirths before, nor during the study period. Results Despite an increase in SA in the year preceding the first childbirth, women who gave birth, and especially women with multiple births, tended to have lower levels of SA/DP days throughout the years than women without childbirths. SA/DP days varied across age groups; young women (aged 18-24 years) without childbirths had fewer SA days, but more DP days than their same-aged counterparts who gave birth, regardless of year. These results did not differ across the three cohorts, suggesting that the results were not affected by period effects. Conclusions Women with more than one childbirth had fewer days of SA and DP, as compared to women with one childbirth and to women having no births. Thus, childbirth does not seem to be associated with higher levels of SA and DP. Some of these results can be due to a health selection into giving birth, especially having more births. Key messages Except for the year before delivery, i.e., when pregnant, women giving birth had fewer SA and DP days than women with no births. Thus, childbirth does not seem to be associated with higher SA and DP. Women who had more than one childbirth had less SA/DP days than those with one childbirth.

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Trajectories of antidepressant use and characteristics associated with trajectory groups among young refugees and their Swedish-born peers with diagnosed common mental disorders—findings from the REMAIN study

Social Psychiatry and Psychiatric Epidemiology ◽

10.1007/s00127-021-02139-0 ◽

2021 ◽

Author(s):

S. Rahman ◽

S. Filatova ◽

L. Chen ◽

E. Björkenstam ◽

H. Taipale ◽

...

Keyword(s):

Mental Disorders ◽

Disability Pension ◽

Common Mental Disorders ◽

Multinomial Logistic Regression ◽

Common Mental Disorder ◽

Influential Factors ◽

Transcultural Psychiatry ◽

Refugee Youth ◽

Study Population ◽

Antidepressant Use

Abstract Purpose This study aimed to (1) identify the trajectories of prescribed antidepressants in refugee youth and matched Swedish-born peers diagnosed with common mental disorder (CMD) and (2) characterize the trajectories according to sociodemographic and medical factors. Methods The study population comprised 2,198 refugees and 12,199 Swedish-born individuals with both Swedish-born parents, aged 16–25 years in 2011, residing in Sweden and treated in specialised healthcare for CMD 2009–11. Group-based trajectory modelling was used to identify different trajectory groups of antidepressant use-based on annual defined daily dosages (DDDs). Multinomial logistic regression was applied to investigate the association of sociodemographic and medical characteristics with the identified trajectories. Nagelkerke pseudo-R2 values were estimated to evaluate the strength of these associations. Results Four trajectory groups of antidepressant use among young refugees were identified with following proportions and DDD levels in 2011: ‘low constant’ (88%, < 100), ‘low increasing’ (2%, ≈710), ‘medium decreasing’ (8%, ≈170) and ‘high increasing’ (2%, ≈860). Similar trajectories, however, with different proportions were identified in Swedish-born: 67%, 7%, 21% and 5%, respectively. The most influential factors discriminating the trajectory groups among refugees were ‘duration of stay in Sweden’ (R2 = 0.013), comorbid ‘other mental disorders’ (R2 = 0.009) and ‘disability pension’ (R2 = 0.007), while ‘disability pension’ (R2 = 0.017), comorbid ‘other mental disorders’ (R2 = 0.008) and ‘educational level’ (R2 = 0.008) were the most important determinants discriminating trajectory groups among Swedish-born youth. Conclusion The lower use of antidepressants in refugees with CMDs compared to their Swedish-born counterparts warrants health literacy programs for refugees and training in transcultural psychiatry for healthcare professionals.

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Mortality in persons with disability pension due to common mental disorders: A cohort study of Swedish construction workers

Scandinavian Journal of Public Health ◽

10.1177/1403494819884440 ◽

2019 ◽

Vol 48 (8) ◽

pp. 832-838

Author(s):

Mia Söderberg ◽

Linus Schiöler ◽

Mikael Stattin ◽

Alex Burdorf ◽

Bengt Järvholm

Keyword(s):

Relative Risk ◽

Confidence Interval ◽

Mental Disorder ◽

Psychiatric Diagnosis ◽

Disability Pension ◽

Common Mental Disorders ◽

Common Mental Disorder ◽

Construction Workers ◽

Relative Risks

Aims: This study investigated mortality in disability pensions due to common mental disorder, and variation over time after first receiving disability pension. Methods: Objectives were explored in 301,863 construction workers (97.2% men) recruited through healthcare examinations from 1971–1993. By linking with the Swedish National Insurance Agency registers, disability pensions until 2014 were identified. Common mental disorder was defined as disability pension diagnosis due to anxiety, stress-related disorders or moderate depression. Mortality was calculated in all-psychiatric diagnosis and diagnostic sub-groups, and compared to persons without disability pensions, using Poisson regression. Additional analyses were stratified by age at follow-up. Results: In total 6030 subjects received disability pensions based on psychiatric diagnoses, and 2624 constituted common mental disorder. Analyses in an all-psychiatric diagnosis displayed increased mortality risks in men (relative risk 3.6; 95% confidence interval 3.3–3.9) and women (relative risk 2.1; 95% confidence interval 1.6–2.6). Common mental disorder was associated with mortality, especially in men (relative risk 2.5; 95% confidence interval 2.2–2.8). Increased relative risks in alcohol and substance abuse were also observed. Results in analyses stratified by age at follow-up displayed persistent high relative risks for mortality in older ages (75–89 years) in men in all-psychiatric disability pensions diagnosis (relative risk 2.8; 95% confidence interval 2.1–3.7) and common mental disorder diagnosis (relative risk 2.6; 95% confidence interval 1.8–3.6), compared to men without disability pensions. Similar results were found in women, but few cases lowered the precision of estimates. Conclusions: This study shows that disability pension based on common mental disorders, often regarded as a ‘lighter’ psychiatric diagnosis, is a risk for early mortality in construction workers, even several years after first receiving disability pension.

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