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

Riku Perhoniemi,Annamari Tuulio-Henriksson,Jenni Blomgren,Mikko Laaksonen

doi:10.1007/s00127-020-01850-8

Abstract

PurposePsychotropic drug consumption as a proxy measure of mental health problems during a disability pension process has only been studied among awarded applicants. This study examined psychotropic drug purchase trajectories among awarded and rejected disability pension applicants. Analyses were conducted in different diagnostic and sociodemographic groups.MethodsA representative 70% sample of Finnish adults applying for disability pension due to a mental disorder in 2009–2011 (N = 18,087) was followed for 4 years in 3-month periods both before and after the pension decision. Register data on purchased drugs measured in defined daily doses (DDDs), gender, age, occupational class, unemployment history, and diagnostic group were used. The DDD levels and trends were analyzed using growth curve models.ResultsPsychotropic drug purchases increased before the pension decision and decreased gradually thereafter among both awarded and rejected applicants. The average DDD level was higher for rejected than awarded applicants before the decision but lower thereafter. The high pre-decision level for rejected applicants was explicit with a lower socioeconomic status. The pre-decision increase in DDDs was steeper for awarded applicants. Changes in DDDs before and after the decision were most prominent for depression, bipolar disorders, schizophrenia, and anxiety disorders.ConclusionAwarded and rejected disability pension applicants differed partly in their trajectories of psychotropic drug consumption. For awarded applicants, the steep rise of consumption prior to the award possibly reflects worsening occupational capacity. Early high consumption for rejected applicants signals long running mental health problems and calls for earlier support.

Highlights

Mental disorders are a major cause for occupational disability worldwide
As there is a lack of studies comparing psychotropic drug purchases between major mental disorders, we conducted our analyses in different diagnostic groups
Our results show that among both awarded and rejected disability pension applicants, psychotropic drug purchases increase during the 4 years preceding the pension decision

Summary

Introduction

Mental disorders are a major cause for occupational disability worldwide. Disability benefits attributable to mental health problems have been increasing in many OECD countries during the past decades [1, 2]. In addition to mental health problems causing disability retirement or exit from the labor market, disability retirement can affect mental health. A decline in mental health can be a consequence of a loss of meaningful roles in life [3,4,5]. The process of applying for disability pension may be a risk for mental health, as it involves decreasing work ability and uncertainty over application outcome. Øverland et al [6] found an inversed U-shaped temporal curve in self-reported psychological symptoms among Norwegian disability retirees, with an increase in

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