Abstract
BackgroundDespite the magnitude and increase of sickness absence due to mental diagnoses, little is known regarding long-term health outcomes. The aim of this nationwide population-based, prospective cohort study was to investigate the association between sickness absence due to specific mental diagnoses and the risk of all-cause and cause-specific mortality. MethodsA cohort of all 4 857 943 individuals living in Sweden on 31.12.2004 (aged 16–64 years, not sickness absent, or on retirement or disability pension), was followed from 01.01.2005 through 31.12.2008 for all-cause and cause-specific mortality (suicide, cancer, circulatory disease) through linkage of individual register data. Individuals with at least one new sick-leave spell with a mental diagnosis in 2005 were compared to individuals with no sickness absence. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated by Cox regression, adjusting for age, sex, education, country of birth, family situation, area of residence, and pre-existing morbidity (diagnosis-specific hospital inpatient (2000–2005) and outpatient (2001–2005) care).ResultsIn the multivariate analyses, mental sickness absence in 2005 was associated with an increased risk for all-cause mortality: HR: 1.65, 95% CI: 1.47–1.86 in women and in men: 1.73, 1.57–1.91; for suicide, cancer (both smoking and non-smoking related) as well as mortality due to circulatory disease only in men. Estimates for cause-specific mortality ranged from 1.48 to 3.37. Associations with all-cause mortality were found for all mental sickness absence diagnostic groups studied.ConclusionsKnowledge about the prognosis of patients sickness absent with specific mental diagnoses is of crucial clinical importance in health care. Sickness absence due to specific mental diagnoses may here be used as a risk indictor for subsequent mortality.
Highlights
Worldwide, mental disorders are increasing [1,2]
The partial likelihood ratio test revealed that information on sick leave due to specific mental diagnoses improved the prediction of all-cause mortality compared to sick leave due to all mental diagnoses combined (p,0.001)
Sick-leave due to a mental diagnosis was associated with a 70% increase in risk of all-cause mortality for both women and men, after adjustment for socio-demographic variables and inpatient and specialised outpatient health care
Summary
Mental disorders are increasing [1,2]. By 2030, unipolar depressive disorder, for example, has been predicted to be the leading cause of DALYs (disability adjusted life years) in high-income countries [1]. Despite the magnitude of the public health problem of sickness absence due to mental diagnoses, little is known regarding long-term health outcomes. A limitation of these studies is that they were based on selected occupational cohorts, who tend to have lower mortality rates than the general population, [11] or on limited geographical areas. Despite the magnitude and increase of sickness absence due to mental diagnoses, little is known regarding long-term health outcomes. The aim of this nationwide population-based, prospective cohort study was to investigate the association between sickness absence due to specific mental diagnoses and the risk of all-cause and cause-specific mortality
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