Is disability pension a risk indicator for future need of psychiatric healthcare or suicidal behavior among MS patients- a nationwide register study in Sweden?

Jan Hillert,Jussi Jokinen,Ellenor Mittendorfer-Rutz,Petter Tinghög,Kristina Alexanderson,Philip Brenner,Charlotte Björkenstam

doi:10.1186/s12888-015-0668-6

Abstract

BackgroundMental disorders and suicidal behavior are common in patients with multiple sclerosis (MS), they also carry a higher risk of disability pension (DP). Our aim was to investigate if DP and other factors are associated with psychiatric disorders and suicidal behavior among MS patients, and whether DP is a stronger risk indicator among certain groups.MethodA prospective population-based cohort study with six-year follow-up (2005–2010), including 11 346 MS patients who in 2004 were aged 16–64 and lived in Sweden. Incidence rate ratios (IRR) with 95 % confidence intervals (CI) were calculated.ResultsMS patients on DP had a modestly higher risk of requiring psychiatric healthcare, IRR: 1.36 (95 % CI: 1.18-1.58). MS patients with previous psychiatric healthcare had a higher IRR for both psychiatric healthcare and suicidal behavior; 2.32 (2.18-2.47) and 1.91 (1.59-2.30), respectively. DP moderated the association between sex and psychiatric healthcare, where women on DP displayed higher risk than men, X2 4.74 (p = 0.03).ConclusionThe findings suggest that losing one’s role in work life aggravates rather than alleviates the burden of MS, as MS patients on DP seem to have a higher need for psychiatric healthcare, especially among women; which calls for extra awareness among clinicians.

Highlights

Mental disorders and suicidal behavior are common in patients with multiple sclerosis (MS), they carry a higher risk of disability pension (DP)
The findings suggest that losing one’s role in work life aggravates rather than alleviates the burden of MS, as MS patients on DP seem to have a higher need for psychiatric healthcare, especially among women; which calls for extra awareness among clinicians
In our cohort of 11 346 MS patients of working ages (70 % women), 6 399 were on DP at baseline 2004 (Table 1). It was more common among MS patients on DP to be older, 21 % was in the oldest age group (60–64 years), compared to 6 % among MS patients not on DP

Summary

Introduction

Mental disorders and suicidal behavior are common in patients with multiple sclerosis (MS), they carry a higher risk of disability pension (DP). Our aim was to investigate if DP and other factors are associated with psychiatric disorders and suicidal behavior among MS patients, and whether DP is a stronger risk indicator among certain groups. Multiple sclerosis (MS) is a disabling demyelinating autoimmune disorder and is the most common cause of neurological disability among young adults [1]. The higher risk of mental disorders in MS patients could reflect direct or indirect effects of an autoimmune disorder on the central nervous system, it could be due to medications used in the treatment, it could be due to the psychological impact of suffering from a chronic disease, or other mechanisms could be at hand [8]. The reported prevalence of depression among MS patients varies, widely [10]

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