Medical and Social Determinants of Subsequent Labour Market Marginalization in Young Hospitalized Suicide Attempters

Thomas Niederkrotenthaler,Sidra Goldman-Mellor,Holly C Wilcox,Ellenor Mittendorfer-Rutz,Petter Tinghög,Madelyn Gould,Giuseppe Sergi

doi:10.1371/journal.pone.0146130

Abstract

BackgroundIndividuals with a history of suicide attempt have a high risk for subsequent labour market marginalization. This study aimed at assessing the effect of individual and parental factors on different measures of marginalization.MethodsProspective cohort study based on register linkage of 5 649 individuals who in 1994 were 16–30 years old, lived in Sweden and were treated in inpatient care for suicide attempt during 1992–1994. Hazard ratios (HRs) for labour market marginalization defined as long-term unemployment (>180 days), sickness absence (>90 days), or disability pension in 1995–2010 were calculated with Cox regression.ResultsMedical risk factors, particularly any earlier diagnosed specific mental disorders (e.g., schizophrenia: HR 5.4 (95% CI: 4.2, 7.0), personality disorders: HR 3.9, 95% CI: 3.1, 4.9), repetitive suicide attempts (HR 1.6, 95% CI: 1.4, 1.9) were associated with a higher relative risk of disability pension. Individual medical factors were of smaller importance for long-term sickness absence, and of only marginal relevance to long-term unemployment. Country of birth outside Europe had an opposite effect on disability pension (HR 0.6, 95% CI: 0.4, 0.8) and long-term unemployment (HR 1.5, 95% CI: 1.3, 1.8). Female sex was positively correlated with long-term sickness absence (HR 1.6, 95% CI: 1.4, 1.7), and negatively associated with long-term unemployment (HR: 0.8, 95% CI: 0.7, 0.9).ConclusionsAs compared to disability pension, long-term sickness absence and unemployment was more strongly related to socio-economic variables. Marginalization pathways seemed to vary with migration status and sex. These findings may contribute to the development of intervention strategies which take the individual risk for marginalization into account.

Highlights

Disability pension and sickness absence have increased in Sweden and other member countries of the Organisation for Economic Co-operation and Development (OECD) over the last decades, in young people [1,2]
Any earlier diagnosed specific mental disorders (e.g., schizophrenia: Hazard ratios (HRs) 5.4, personality disorders: HR 3.9, 95% CI: 3.1, 4.9), repetitive suicide attempts (HR 1.6, 95% CI: 1.4, 1.9) were associated with a higher relative risk of disability pension
Country of birth outside Europe had an opposite effect on disability pension (HR 0.6, 95% CI: 0.4, 0.8) and long-term unemployment (HR 1.5, 95% CI: 1.3, 1.8)

Summary

Introduction

Disability pension and sickness absence have increased in Sweden and other member countries of the Organisation for Economic Co-operation and Development (OECD) over the last decades, in young people [1,2]. Unemployment has increased among young people in Sweden and throughout Europe and North America, and individuals with mental disorders are likely to have even more difficulties establishing themselves on the labour market as compared to individuals without functional disabilities [4,5,6]. Social insurance policies such as sickness absence and disability pensions are intended to provide financial support for individuals with impaired work capacity due to disease or injury [7]. This study aimed at assessing the effect of individual and parental factors on different measures of marginalization

Objectives

Methods

Results

Conclusion