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

Abstract

BackgroundEarly retirement caused by disability pension (DP) due to common mental disorders (CMDs) is frequent in European countries. Inadequate treatment, e.g., suboptimal antidepressant (AD) medication before DP can be crucial in such DP. This explorative study aimed to disentangle trajectories of AD based on defined daily dose (DDD) before and after granted DP, and to characterize the trajectories by socio-demographics and medical factors.MethodsAll 4642 individuals in Sweden aged 19–64 with incident DP due to CMD in 2009–2010 were included. Trajectories of annual DDDs of AD were analysed over a 6-year period by a group-based trajectory method. Associations between socio-demographic or medical factors and different trajectories were estimated by chi2-test and multinomial logistic regression.ResultsFive trajectories of ADs were identified. Three groups, comprising 34%, 34%, and 21% of the cohort, had constant AD levels before and after DP with mean annual DDDs of 29, 234, and 580, respectively. Two groups, each including 6% of the cohort, had increasing levels of DDDs, levelling off at around 1150 and 785 DDDs after DP. Particularly age, outpatient care due to mental diagnoses and DP diagnoses were significantly associated with different trajectories (p < 0.05). All the groups had a larger proportion of older individuals (> 50%, 45–64 years), except for the ‘increasing low’ group, where younger individuals were in majority (> 60%, 18–44 years), who more frequently exited labour market due to ‘anxiety disorders’, with lower education and more specialised healthcare before DP than the other groups.ConclusionThe heterogeneity among the five trajectory groups was partly explained by age, the severity of the mental disorder and the DP diagnoses. DDDs of ADs, though on different levels, varied marginally before and after granted DP in the majority. Moreover, AD levels were very low in one third of the individuals. Early identification and focus on the ‘increasing low’ group might be important in order to identify individuals at risk for further increase in annual DDDs of ADs even after granted DP, and might also contribute in prevention of DP. Further detailed research regarding different groups is warranted.

Psychotropic medication before and after disability retirement by pre-retirement perceived work-related stress

“…We observed a steep increase in the mean level of DDDs for psychotropic medications before disability retirement due to mental disorders both among those with high and low levels of pre-retirement ERI, which agrees with earlier findings. [2][3][4][5] Indeed, those with worsening mental health are likely to increase medication use, which is followed by admittance of disability pension and transition into disability retirement. This increase may also be explained by intensified treatment or rehabilitation activities when there is a threat of losing work ability.…”

“…1 Previous studies have shown that a key indicator of mental disorders, namely psychotropic medication use, tends to increase before the transition to disability retirement followed by decrease after the transition, particularly if retirement was due to mental disorders. [2][3][4][5] Moreover, in some studies this decrease has been greater among people from a higher socioeconomic background, 3 suggesting that socioeconomic differences in workrelated exposures may modify changes in psychotropic medication use around the retirement period. Some studies from Asia found that mental health problems may increase after transition from work to non-work, 6 and voluntary 7 or non-voluntary retirement, 8 but at least in three European studies, retirement has been associated with a decrease in mental fatigue 9 and sleep disturbances 10,11 and an improvement in mental well-being.…”

Use of sequence analysis for classifying individual antidepressant trajectories to monitor population mental health

“…Similar methods have been used in previous studies to classify trajectories of annual antidepressant dose over time [35]. The authors of that study use latent class model, which is shown provide similar groupings to the sequence analysis used in the current study [36].…”

“…The authors of that study use latent class model, which is shown provide similar groupings to the sequence analysis used in the current study [36]. The sample used in their study was very speci c -patients before and after being granted disability pension due to common mental disorders [35]. These individuals would have formed part of our 'out of labour force' group, which had the strongest relationship (OR 4.06; 95% CI 4.01 to 4.11) with having been prescribed most of the time and might explain why they found homogeneity in the pattern of the Daily De ned Dose (DDD) (i.e.…”

Consumption of psychotropic drugs among disability pension applicants with mental disorders: comparing awarded and rejected applicants in Finland

“…On the other hand, previous studies on psychotropics consumption and disability pension process based on mental disorders are inconclusive. Rahman et al [14] found only little general temporal variation in antidepressant purchases among Swedish disability retirees with common mental disorders, but instead found multiple trajectory groups.…”