Abstract
BackgroundWe investigated the regional differences in all mental disorder disability pensions (DP) between 2010 and 2015 in Finland, and separately in mood disorders and non-affective psychotic disorder DP. We also studied the contribution of several district-level contextual and mental health service factors to mental disorder DP.MethodsSubjects were all those granted mental disorder DP for the first time between 2010 and 2015 in Finland (N = 36,879). Associations between the district-level contextual and mental health service factors and regional DP risks collected from the year 2015 were studied with negative binomial regression analysis in the Finnish hospital districts. The population number on the age (18 to 65 years), gender, occupational status and residential hospital district of the Finnish population from 2015 was used as exposure in the model.ResultsSignificant differences in the regional mental disorder DP risks between and within hospital districts did not appear to follow the traditional Finnish health differences. A lower risk of DP was associated with contextual indicators of higher regional socioeconomic level. Furthermore, population density as a proxy for access to mental health services indicated a higher regional DP risk for lower density in all mental (IRR 1.10; 95% CI 1.06–1.14) and mood disorder (IRR 1.12; 95% CI 1.08–1.16) DP. Both the highest and the lowest regional numbers of all mental health outpatient visits were associated with a higher DP risk in all mental and mood disorder DP, whereas particularly low regional numbers of inpatient treatment periods and of patients were associated with a lower risk of DP.ConclusionsIn this comprehensive population-level study, we found evidence of significant regional variation in mental disorder DP and related district-level factors. This variation may at least partly relate to differences in regional mental health service systems and treatment practices. Adapting to the needs of the local population appears to be indicated for both regional mental health service systems and treatment practices to achieve optimal performance.
Highlights
We investigated the regional differences in all mental disorder disability pensions (DP) between 2010 and 2015 in Finland, and separately in mood disorders and non-affective psychotic disorder DP
A higher risk of overall mental disorder DP compared to the national level of risk was found in the hospital districts of North Savo (IRR 1.17; 95% Confidence Interval (CI) 1.07–1.28), North Ostrobothnia (IRR 1.22; 95% confidence interval (95% CI) 1.13–1.31), South Ostrobothnia (IRR 1.15; 95% CI 1.05–1.25) and Kainuu (IRR 1.19; 95% CI 1.05–1.36)
A lower risk of mental disorder DP was found in Helsinki and Uusimaa (HUS) (IRR 0.85; 95% CI 0.78– 0.93), Päijät-Häme (IRR 0.86; 95% CI 0.78–0.95) and Vaasa (IRR 0.76; 95% CI 0.68–0.84)
Summary
We investigated the regional differences in all mental disorder disability pensions (DP) between 2010 and 2015 in Finland, and separately in mood disorders and non-affective psychotic disorder DP. Significant regional differences in many Western countries have been reported in overall DP [3,4,5,6,7,8,9] and in mental disorder-related sickness absence and DP [10,11,12,13,14]. Previous research has suggested local area unemployment [3, 7, 8] and socioeconomic gradient [17] as important contextual factors for overall DP, but compositional factors have mostly been identified as more significant for mental disorder sickness absence and DP rates than contextual factors [16, 18]. One Norwegian study did not find associations between the provision of psychiatric care (represented by the number of staff and availability of beds) and regional differences in mental disorder DP [20]
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