Disability pension due to common mental disorders and subsequent suicidal behaviour: a population-based prospective cohort study

Abstract

ObjectiveAdverse health outcomes, including suicide, in individuals on disability pension (DP) due to mental diagnoses have been reported. However, scientific knowledge on possible risk factors for suicidal behaviour (suicide attempt and suicide) in this group, such as age, gender, underlying DP diagnoses, comorbidity and DP duration and grade, is surprisingly sparse. This study aimed to investigate associations of different measures (main and secondary diagnoses, duration and grade) of DP due to common mental disorders (CMD) with subsequent suicidal behaviour, considering gender and age differences.DesignPopulation-based prospective cohort study based on Swedish nationwide registers.MethodsA cohort of 46 515 individuals aged 19–64 years on DP due to CMD throughout 2005 was followed-up for 5 years. In relation to different measures of DP, univariate and multivariate HRs and 95% CIs for suicidal behaviour were estimated by Cox regression. All analyses were stratified by gender and age.ResultsDuring 2006–2010, 1036 (2.2%) individuals attempted and 207 (0.5%) completed suicide. Multivariate analyses showed that a main DP diagnosis of ‘stress-related mental disorders’ was associated with a lower risk of subsequent suicidal behaviour than ‘depressive disorders’ (HR range 0.4–0.7). Substance abuse or personality disorders as a secondary DP diagnosis predicted suicide attempt in all subgroups (HR range 1.4–2.3) and suicide in women and younger individuals (HR range 2.6–3.3). Full-time DP was associated with a higher risk of suicide attempt compared with part-time DP in women and both age groups (HR range 1.4–1.7).ConclusionsDepressive disorders as the main DP diagnosis and substance abuse or personality disorders as the secondary DP diagnosis were risk markers for subsequent suicidal behaviour in individuals on DP due to CMD. Particular attention should be paid to younger individuals on DP due to anxiety disorders because of the higher suicide risk.

Trajectories of antidepressant medication use in individuals before and after being granted disability pension due to common mental disorders- a nationwide register-based study

“…CMD was defined as ‘depressive episode’ (F32), ‘recurrent depressive disorder’ (F33), ‘phobic anxiety disorder’ (F40), ‘other anxiety disorder’ (F41), ‘obsessive-compulsive disorder’ (F42), and ‘reaction to severe stress and adjustment disorder’ (F43) [21–24], based on the corresponding codes of the International Classification of Diseases (ICD) version 10 [25]. …”

Stepped care in primary care – guided self-help and face-to-face cognitive behavioural therapy for common mental disorders: a randomized controlled trial

“…Depression and low self-rated health are risk factors for longer sick leave periods (Nielsen et al, 2012) and only 20% of people who have been on sick leave for at least six months will return to work in the following five years. Further, long periods of sick leave may itself affect a person's health, wellbeing and access to the labour market negatively (Rahman, Alexanderson, Jokinen, & Mittendorfer-Rutz, 2016;Vingard, Alexanderson, & Norlund, 2004).…”

Mental disorders and suicidal behavior in refugees and Swedish-born individuals: is the association affected by work disability?

“…Several studies have shown associations between mental disorders and SA [21,22,24], that in turn is a risk factor for suicidal behavior [25][26][27]. A number of studies have shown that DP, due to mental disorders, is associated with both suicide attempt and suicide [28][29][30]. Moreover, DP has been demonstrated as a strong risk indicator for suicidal behavior among certain groups, including multiple sclerosis (MS) [31].…”