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Abstract
ObjectiveDepression is a major cause of disability in working populations and the reduction of socioeconomic inequalities in disability is an important public health challenge. We examined work disability due to depression with four indicators of socioeconomic status.MethodsA prospective cohort study of 125 355 Finnish public sector employees was linked to national register data on work disability (>9 days) due to depressive disorders (International Classification of Diseases, codes F32–F34) from January 2005 to December 2011. Primary outcomes were the onset of work disability due to depressive disorders and, among those with such disability, return to work after and recurrent episodes of work disability due to depression.ResultsWe found a consistent inverse socioeconomic gradient in work disability due to depression. Lower occupational position, lower educational level, smaller residence size, and rented (vs. owner-occupied) residence were all associated with an increased risk of work disability. Return to work was slower for employees with basic education (cumulative odds ratio = 1.21, 95% CI: 1.05–1.39) compared to those with higher education. Recurrent work disability episodes due to depression were less common among upper-grade non-manual workers (the highest occupational group) than among lower-grade non-manual (hazard ratio = 1.16, 95% CI: 1.07–1.25) and manual (hazard ratio = 1.14, 95% CI: 1.02–1.26) workers.ConclusionsThese data from Finnish public sector employees show persistent socioeconomic inequalities in work disability due to depression from 2005 to 2011 in terms of onset, recovery and recurrence.
Highlights
In addition to decreased quality of life, depression causes substantial work impairment and lost work days [1,2,3]
Few studies have studied the association of Socioeconomic status (SES) with work disability due to depression taking into account the different components of disability that is, onset, recovery, and recurrence
Most of the study participants were women (76%). We selected those cohort members (n = 130 533) who were working-aged (18–65 years) and who were not deceased, on disability pension, or on old-age pension at baseline (1 January 2005). Their records on employment and socioeconomic factors were linked to the work disability and drug prescription registers maintained by the Social Insurance Institution of Finland through the unique personal identification codes that are assigned to all citizens in Finland
Summary
In addition to decreased quality of life, depression causes substantial work impairment and lost work days [1,2,3]. Major depressive disorders ranked second on years lost due to disability in 2010 and the burden of major depressive disorder, measured with disability adjusted life years, has increased over time [4]. Socioeconomic status (SES) represents individuals’ access to social and economic resources, and education, occupation, and income or wealth, have been used as its indicators [5]. Lower income [7,8] and lower occupational position [9] are linked to a higher risk of depression and related work disability. Few studies have studied the association of SES with work disability due to depression taking into account the different components of disability that is, onset, recovery, and recurrence
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