Trajectories of Work-Related Functional Impairment prior to Suicide

Abstract

BackgroundWork-related functional impairment in terms of sickness absence and disability pension (SA/DP) has been reported to be associated with subsequent suicide. However, there is only limited knowledge on SA/DP patterns prior to suicide. The aim was to identify trajectories of work-related functional impairment prior to suicide and to describe associations of socio-demographic and medical factors with such trajectories.MethodsThis is a population-based retrospective cohort study of the 4 209 individuals aged 22–65 years who committed suicide during 2007–2010 in Sweden. Work-related functional impairment was measured as mean annual number of months of SA/DP. We analyzed trajectories of SA/DP during five years prior to suicide (i.e., 2002–2009) by a group-based trajectory method. Associations between socio-demographic and medical factors with different groups of trajectories were estimated by chi2-test and multinomial logistic regression.ResultsFive different functional impairment trajectory groups were identified prior to suicide. One group had constant low levels of SA/DP (46%), while 30% had constant high levels of SA/DP. Two groups (16%) showed increasing number of SA/DP months. The remaining 7% showed decreasing number of SA/DP months before the suicide. Sex, age, educational level, family situation, and diagnosis-specific healthcare were significantly associated with different trajectory groups (Likelihood ratio X2 tests <0.05). A larger proportion of higher educated and younger men with a lower proportion of previous suicide attempts were found in the group with constant low levels. Opposite characteristics were displayed in the group with constant high levels.ConclusionsThis study identified five different groups of work-related functional impairment trajectories before suicide. These differences might be partly explained by the variations in socio-demographic profiles and health care consumptions five years before suicide.

Trajectories and characteristics of functional impairment before and after suicide attempt in young adults – a nationwide register-based cohort study

“…These findings are comparable to results from a recently published study, which showed five different trajectories of SA/DP before suicide [ 10 ]. However, a larger proportion of individuals (30%) in that previous study had stable high levels of SA/DP months over time before suicide, which was twice as much as among suicide attempters in the current study.…”

“…However, a larger proportion of individuals (30%) in that previous study had stable high levels of SA/DP months over time before suicide, which was twice as much as among suicide attempters in the current study. Also, this group of individuals had around 11 months of SA/DP during 4 years before suicide [ 10 ], which was moderately higher than the corresponding group in our findings. On the other hand, there was a larger proportion of young suicide attempters with constantly no or low level of SA/DP months (62%) in our study compared to the low SA/DP trajectory (46%) before suicide [ 10 ].…”

“…SA/DP may also fluctuate over time. Trajectory analysis offers the opportunity to elucidate this heterogeneity and the differential development of time-dependent phenomena [ 10 ]. In addition, a comparison with individuals without suicide attempt can provide important insights in peculiarities of SA/DP trajectories in young suicide attempters.…”

Trajectories and characteristics of work disability before and after acute myocardial infarction

“…We used the likelihood ratio tests to evaluate whether the characteristics were associated with all five trajectory groups in the full model including all covariates. Moreover, Nagelkerke pseudo-R 2 were estimated to measure the strength of these associations 18. Each factor was consecutively excluded and reincluded from the full model in order to calculate the differences in R 2 and to test the contribution of a given factor to the full model.…”

Application of latent growth modeling to identify different working life trajectories: the case of the Spanish WORKss cohort

“…These approaches have mostly been used to capture unknown heterogeneity in work-related factors and to see their association with some health outcomes. For example, to study the association between occupational complexity and cognition in later life (13), work characteristics and hypertension (14), absenteeism trajectories and health factors (15), or work functioning and return to work after sick leave (16), among other similar studies (17,18,19,20). In summary, these approaches allow us to address labor market changes from a life course perspective (21).…”