Risk and risk factors for disability pension among patients with treatment resistant depression\u2013 a matched cohort study

Heidi Taipale,Lena Brandt,Allitia Dibernardo,Ellenor Mittendorfer-Rutz,Johan Reutfors,Philip Brenner,Jari Tiihonen,Antti Tanskanen

doi:10.1186/s12888-020-02642-9

Abstract

BackgroundTreatment resistant depression (TRD) is common among patients with depression, and is associated with clinical and functional disability. However, the risk and risk factors for being granted disability pension (DP) among patients with TRD have not been investigated.MethodsAll antidepressant initiators in Sweden with a diagnosis of depression in specialized care were identified in nationwide registers 2006–2013 and followed regarding treatment trials. TRD was defined as the start of a third sequential trial. Patients with TRD who were not on DP (N = 3204) were matched by age, sex, history of depression, calendar year, and time for treatment start with 3204 comparators with depression and ongoing antidepressant treatment. A proportional Cox Regression was performed with DP as outcome, adjusted for various sociodemographic and clinical covariates.ResultsCompared to the comparison cohort, TRD was associated with a doubled risk for all-cause DP (aHR 2.07; 95%CI 1.83–2.35), DP due to depression (2.28; 1.82–2.85) and to any mental disorder (2.24; 1.95–2.57) but not due to somatic diagnoses (1.25; 0.84–1.86). Among significant risk factors for DP in TRD were female sex, being > 29 years of age, unemployment and a diagnosis of comorbid personality disorder (ICD-10 codes F60.0–9).ConclusionTRD is associated with an elevated risk for DP compared to other patients with depression, with large potential costs for the affected patients and for society. Clinical and therapeutic implications for patients with TRD who are granted DP should be further investigated. Limitation: No clinical data, e.g. type of depression or reason for treatment switch, was available for this study.

Highlights

Treatment resistant depression (TRD) is common among patients with depression, and is associated with clinical and functional disability
We identified all patients 18–65 years old with a dispensed prescription of an antidepressant (ATC [Anatomical Therapeutic Chemical]-code N06A), between the years of 2006–2013 in the Prescribed Drug Register (PDR) [35]
Covariates and outcomes listed in following sections were acquired from the Micro-Data for Analyses of Social insurance (MiDAS) register, held by the National Social Insurance Agency, which includes data on dates and diagnoses of sick leave episodes and disability pension (DP) [39], and sociodemographic data obtained from Statistics Sweden

Summary

Introduction

Treatment resistant depression (TRD) is common among patients with depression, and is associated with clinical and functional disability. The risk and risk factors for being granted disability pension (DP) among patients with TRD have not been investigated. The risk for onset of depression is highest between the ages of 16–43, with a median age of onset at 25 years [2]. The diagnosis of depression entails significant distress or impairment in social, occupational, or other important areas of functioning [4]. Depression is associated with a number of adverse outcomes for the afflicted individual, such as elevated risk for chronic somatic disease [5], impaired social and physical functioning [6], and death [7]. Depression inflicts a large cost on society due to direct and indirect

Objectives

Methods

Results

Discussion

Conclusion