Role of social benefits for future long-term sickness absence, disability pension and unemployment among individuals on sickness absence due to mental diagnoses: a competing risk approach

Annina Ropponen,Sanna Kärkkäinen,Mo Wang,Jurgita Narusyte,Victoria Blom,Gunnar Bergström,Pia Svedberg,Lisa Mather

doi:10.1007/s00420-021-01825-5

Abstract

PurposeTo investigate associations between social benefits and disability pension (DP), long-term sickness absence (LTSA, ≥ 90 days), or unemployment among Swedish twins with sickness absence (SA) due to mental diagnoses.MethodsThis population-based prospective twin study included register data on first incident SA spell (< 90 days) due to mental diagnoses (ICD 10 codes F00-F99) during the follow-up 2005–2016. SA < 90 days due to other diagnoses than mental diagnoses or any other social insurance benefit was identified for the preceding year of the first incident SA spell due to mental diagnoses (coded yes/no). Comparing those with any previous social benefits vs without, cumulative incidence curve to compare time to an event, and Cox proportional hazards models for cause-specific hazard ratios (HR, 95% confidence intervals, CI) treating first incident DP, LTSA and unemployment as competing risks were modeled.ResultsDuring follow-up, 21 DP, 1619 LTSA, and 808 unemployment events took place. Compared to those without, those with at least one benefit had a higher risk for DP (HR 5.03; 95%CI 1.80, 14.01), LTSA (1.67; 1.50, 1.84) and unemployment (1.24; 1.03, 1.50). The cumulative incidence for DP was very low, < 1%, for LTSA 80% with any previous social benefits vs. 60% without, and for unemployment ≤ 5%.ConclusionSocial benefits received during the preceding year of SA due to mental diagnoses (< 90 days) predict DP, LTSA, and unemployment. Hence, previous social benefits may provide means for early identification of persons at risk for exit from labor market.

Highlights

Mental disorders have become the leading causes of sickness absence (SA) in developed countries (Arends et al 2014; OECD 2013)
During follow-up, altogether 21 disability pension (DP), 1619 LTSA, and 808 unemployment events took place. Compared to those without any previous social benefits, those with at least one benefit had a higher risk for DP as shown in Table 2 both for subdistribution hazard ratios (SHR) and cause-specific hazard ratios (CSHR)
Our results indicate that previous social benefits (i.e. < 90 days not due to mental diagnoses, rehabilitation, preventive SA, part- or full-time unemployment, occupational injury, or activity replacement in the year prior to the first SA spell < 90 days) increased the risk of LTSA, DP and unemployment

Summary

Introduction

Mental disorders have become the leading causes of sickness absence (SA) in developed countries (Arends et al 2014; OECD 2013). > 6 weeks as set being the limit in the International Archives of Occupational and Environmental Health systematic review (Dekkers-Sanchez et al 2008) are less likely to return to work, and more likely to leave the labor market via early retirement or DP, even when controlling for morbidity (Dekkers-Sanchez et al 2008; Norder et al 2017; Ubalde-Lopez et al 2017) Those with mental disorders have higher risk of not being employed and poor mental health is an important predictor of labor market non-participation (Fleischmann et al 2018; Hakulinen et al 2016; Mather et al 2015; Prang et al 2016; Topor et al 2019). We need to know more about the consequences for the individuals on SA due to mental diagnoses in terms of labor market participation

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