Application For Disability Pension Research Articles

Medication and rehabilitation of persons applying for disability pension due to depression: a register-based retrospective study from Finland

Purpose To investigate how drug therapies and rehabilitation options have been utilised before applying for a disability pension due to depression. Methods A retrospective register-based study of the 3604 persons who applied for a disability pension from the Social Insurance Institution of Finland (Kela) in 2019. In Finland, disability pension is usually preceded by an incapacity for work lasting for 1 year, during which time therapeutic procedures, which were analysed here, are applied. Results Approximately half (56.0%) of the applicants had reimbursed purchases of two or more antidepressants during the 12 months preceding the disability pension application. Psychotherapy was received by 13.8% and 19.2% of the applicants 1 and 5 years before application, respectively. The share of applicants receiving some form of rehabilitation 1 year before application was 24.8% and 39.0% in the 5 years preceding application. During the 4 months before application, 19.6% of the applicants had no antidepressant purchases. In total, 12.2% of the applicants had both antidepressant treatment and psychotherapy in the year preceding the application, and 9.9% had neither psychotherapy nor antidepressant treatment. Conclusion Before applying for disability pension, only a minority of the applicants had received effective treatment for depression in the form of psychotherapy and antidepressants. However, most of the applicants had received some form of treatment, but it appears to have been insufficient.

Analysis of Decisions on Incapacity for Work Issued at the Polish Social Insurance Institution (ZUS) in Relation to Persons with Multiple Sclerosis Before and After the Introduction of Current Drug Treatment Programmes for Multiple Sclerosis in Poland

Aim: The aim of the study was to analyse the decisions on incapacity for work issued at the Polish Social Insurance Institution (ZUS) in the years 2009-2011 and 2016-2018 in relation to people with MS, before and after the introduction of MS drug treatment programmes in Poland, which in connection with the application for rehabilitation or disability pension were examined by a ZUS certifying doctor or ZUS medical board. Materials and Methods: The analysis covered 100 cases, in which in the years 2009-2011 and 2016-2018, in connection with the application for a rehabilitation benefit or a disability pension, a ZUS certifying doctor or ZUS medical board issued a decision on incapacity for work in relation to the same person with the diagnosed SM. Statistical analysis was performed using IBM SPSS Statistics. Results: There were 20% less medical decisions confirming deterioration of health condition related to persons covered by drug programmes compared to the group of persons not participating in these programmes. The asymptotic (two-sided) significance of the cross-tabulation association measure was p = 0.053. In the case of an increase in the number of no-change-in-disability decisions in the group of people covered by the drug programme, the asymptotic (two-sided) significance of the cross-tabulation association measure was p = 0.087. Conclusions: 1. The introduction of immunological therapy that modifies the natural course of multiple sclerosis in patients under the MS drug treatment programmes has significantly reduced the development of their motor disability. 2. As a result, people who have become incapable of work due to this disease have maintained their job or have returned to work, which is particularly important for young patients who are likely to remain economically active for many years to come. 3. Such measures have a significant impact on reducing the number of benefits from the social insurance system.

Sources of income following a rejected disability pension application: a sequence analysis study

Purpose: To identify different income trajectories after a rejected disability pension application and to analyze socio-demographic and disability process related determinants of these trajectories.Methods: Finnish residents aged 18–58 years with a first rejected disability pension application in 2010 (N = 3683) were followed for 48 months with register data. We performed a sequence analysis of six income sources (employment, unemployment benefit, sickness allowance, rehabilitation benefit, awarded disability pensions, other/unknown). Multinomial logistic regression was used in analyses.Results: Four clusters were identified, displaying unemployment, awarded disability pension, employment, or unknown source as the primary source of post-rejection income. Transitions between income sources were frequent, especially in the employment and unemployment clusters. Using the awarded pension cluster as the reference group, previous unemployment raised the odds of unemployment cluster membership the most. Similarly, previous employment raised the odds of employment cluster the most. A somatic rather than mental disorder and being under 50 years old raised the odds of being in the unemployment and employment clusters.Conclusions: After a rejected disability pension, main income paths include unemployment benefits, re-applied disability pension, and fragmented employment. Labor market and sickness history and age are associated with the probability of these paths.Implications for RehabilitationRejected disability pension applicants should be offered medical or vocational rehabilitation, to enable sustained labor market participation.Partial disability pension, supported by rehabilitation is one solution when a full-time labor market participation is not a realistic option.

Sickness allowance, unemployment and rehabilitation after a rejected disability pension application

Sickness allowance, unemployment and rehabilitation after a rejected disability pension application

Labor market position after a rejection of a disability pension application: a register-based cohort study

Purpose: To study labor market positions of rejected disability pension applicants and to examine which characteristics predict ending up in these positions after the rejection.Methods: Nationwide Finnish register data was used to describe employment, unemployment and disability pension trajectories of rejected applicants (n = 5740) from four years before to four years after the rejection. Demographic, occupational and health-related determinants of labor market position after the rejection were examined among those employed and not employed at the time of the rejection.Results: The proportion of the employed steeply decreased and that of unemployed increased before the rejection of a disability pension application. Four years after the rejection, 30% of the rejected applicants were employed, 24% were unemployed and 30% received disability pension. Employment at the time of the rejection, younger age, shorter unemployment history, public sector employment and milder work disability increased future employment. Manual work, public sector employment and previous long-term unemployment predicted future unemployment. Apart from higher age, associations with receiving disability pension were relatively weak.Conclusions: For many rejected disability pension applicants return to work is challenging. Special efforts should be targeted to support the remaining work ability and to promote employment opportunities of the rejected applicants.Implications for RehabilitationEmployment, unemployment and receiving disability pension were equally common labor market positions four years after the rejection.Rejected DP applicants with unemployment history need special efforts to increase their employability.As a disability pension application, even if rejected, clearly indicates some degree of work ability problems, rehabilitation should be targeted at this time point to support employment.

The Association of Low Income with Functional Status and Disease Burden in German Patients with Rheumatoid Arthritis: Results of a Cross-sectional Questionnaire Survey Based on Claims Data.

To assess the influence of income on self-reported disease and work productivity outcomes. Persons with rheumatoid arthritis (RA) diagnosis (International Classification of Diseases, 10th ed. codes M05/M06) on health insurance claims data in at least 2 quarters of 2013 were randomly selected. They were mailed questionnaires covering RA diagnosis, household income, functional capacity [Hannover functional status questionnaire (FFbH), 0-100], RA Impact of Disease questionnaire (RAID; 0-10), self-reported swollen joint count (SJC; 0-48), tender joint count (TJC; 0-50), and effect of RA on work productivity (change of work, fewer working hours, sick leave, application for disability pension, and others). Weighted multivariable linear regression models were used to assess the association between income and disease outcomes. A total of 1492 persons of working age who confirmed RA diagnosis were available for analysis. The mean age was 55 years, 82% were women, and 74% were under rheumatologic care. A total of 27%, 52%, and 21% had a low (< €1500), medium (€1500-3200), and high monthly income (> €3200), respectively. Respondents with low income had the worst mean FFbH, RAID, SJC, and TJC values. This was confirmed in the regression model: mean FFbH low versus high income -8.65 (95% CI -9.72 to -7.58), RAID 0.73 (0.59-0.86), and SJC 3.47 (2.86-4.08). Sick leave (8.7%/3.5%/1.8%) and disability pension (18.1%/9.6%/6.9%) were more frequent in patients with low versus medium versus high income (p < 0.05). The association of low income with a higher disease burden, more functional disability, and higher rates of work loss emphasizes the need to focus on these outcomes when choosing treatment strategies for patients in the lower income groups.

Work Ability Index Predicts Application for Disability Pension After Work-Related Medical Rehabilitation for Chronic Back Pain

ObjectiveTo determine whether the Work Ability Index (WAI), a short 7-item self-report questionnaire addressing issues of perceived disability, impairment, and expectations for resuming work, predicts application for disability pension, recommendations for further treatment, and other adverse work-related criteria in patients with chronic back pain after rehabilitation. DesignCohort study with 3-month follow-up. SettingSeven inpatient rehabilitation centers. ParticipantsPatients (N=294; 168 women; mean age, 49.9y) with chronic back pain. InterventionThe WAI was completed at the beginning of rehabilitation. All patients were treated according to the German rehabilitation guidelines for chronic back pain and work-related medical rehabilitation. Main Outcome MeasureApplication for disability pension, as assessed by a postal questionnaire 3 months after discharge. ResultsReceiver operating characteristic curve analysis of the association between the WAI at baseline and subsequent application for disability pension revealed an area under the curve of .80 (95% confidence interval [CI], .62–.97). Youden index was highest when the WAI cutoff value was ≤20 points (sensitivity, 72.7%; specificity, 82.2%; total correct classification, 81.7%). After adjusting for age and sex, persons with a baseline WAI score of ≤20 points had 15.6 times (95% CI, 3.6–68.2) higher odds of subsequent application for disability pension, 4.9 times (95% CI, 1.5–16.8) higher odds of unemployment, and 6 times (95% CI, 2.4–15.2) higher odds of long-term sick leave at follow-up. ConclusionsThe WAI could help rehabilitation professionals identify patients with back pain with a high risk of a subsequent application for disability pension.

Fibromyalgi

Unexplained pain and aches have been well known for centuries. In the modern time the concept fibrositis/ fibromyalgia has been applied to the phenomenon of idespread pain without known aetiology. Fibromyalgia (FM) is characterised by widespread, diffuse pain that is moving around. Typical for this condition is also morning stiffness and non restorative sleep, positive tender points (TP) and a number of associated, unspecific symptoms as feeling of swollenness, headache, depression etc.Positive TP are defined anatomic locations that feel painful when being palpated with a pressure of 4 kg/cm2. The TP have been considered as the hallmark of FM and is central in the classification criteria constructed to identify the disease (ACR-90 criteria).FM is not considered as a specific disease entity, but rather a continuum with respect of pain distribution, number of positive TP and number and intensity of associated symptoms. Nevertheless, due to the often overwhelming impact of pain and fatigue in those who fulfil the criteria, it is appropriate to keep FM as a diagnosis.During the last two decades about a dozen epidemiological studies has been performed to describe the prevalence in the general population. The average results lie between three and four percent with a range from 1.2% to 6.6%. The differences is probably mainly due to discrepancies in applied methodology, but one cannot rule out that some populations may have more FM than others. Incidence is not well known, one study performed on women indicates a high incidence.Mortality has until recently not been studied. There are now some few studies with somewhat scattered results. However, the major finding is higher mortality among individuals with FM, especially due to cancer.Whether this is a function of lifestyle or the presence of pain remains to be clarified. The main risk factor is the female gender; only about 10-30% of the FM population are men. Studies have shown that depression, longstanding localised pain especially in the back and the presence of a relatively large number of associated symptoms also are risk factors. FM develops in the majority of cases over many years. This knowledge may contribute to prevent FM before it actually manifests as such. FM has a large co-morbidity, especially with inflammatory rheumatological diseases. It is important to be aware of this to avoid overtreatment in patients with longstanding inflammatory diseases that have developed FM in addition. On the other hand it is also important to know that patients with FM also may get inflammatory diseases. It is an especially big overlap between FM and Sjögren’s syndrome. FM is a frequent condition that has a big impact on working ability. In Norway about five present of all who are receiving disability pension do have the diagnosis of FM. In spite of that approximately 50% of females’ application for disability pension are refused, FM is the most common diagnosis among those who are receiving pension. The development of the criteria has opened for international research on a considerable scale. This has lead to better understanding of the aetiopathogenesis and promising treatment possibilities in the future.

Warum stellen Versicherte trotz erhaltenem erwerbsbezogenen Leistungsvermögen einen Antrag auf Rente wegen Erwerbsminderung? – Eine qualitative Studie an Patienten nach kardialen Ereignissen

The central question of this study is why workers in the employable age group apply for disability pension although from a medical point of view their vocational ability is maintained. The aim is to identify factors in the system and of the applicant which may serve as subjective prognostic indicators for maintaining employment and for determining influences which may be of prognostic value for a pension application. Concomitantly, it is aimed to obtain guidelines for practical rehabilitation and to generate impulses for further research in this field. Within a qualitative research project 16 problem-focused interviews with patients insured by "Deutsche Rentenversicherung Nord" and treated in a cardiac rehabilitation centre in Mecklenburg-Vorpommern were undertaken. Patients with either a positive or a negative subjective prognosis concerning employment were interviewed. In addition, the interviews were followed by a questionnaire one year later. The results show differences and similarities in the motivation of patients applying for disability pension. This can be traced back to psychosocial variables, sociodemographic characteristics, moderating factors and the effects of socialisation. Physical impairment was of secondary importance to the patients' motivation to apply for disability pension. The results of the follow-up questionnaire show that an existing job significantly improves the subjective prognosis for maintaining gainful employment. The application for disability pension offers the affected individual a possibility to ensure a basic existence in the case of illness and unemployment. The identified factors may be influenced by modifying the interventions and improving medical counselling during the rehabilitation period.

Application for disability pension and change in use of prescribed drugs. A regional Danish cohort study

To investigate if a pending application for disability pension had an influence on the applicant's purchase of medical drugs, with a particular focus on musculoskeletal disorders and the use of painkillers. We performed a registry-based follow-up study including 12,020 applicants for disability pension in a Danish county from 1995 to 2000 and linked this information to a database of drug prescriptions. Purchase of drug was calculated for the 6-month period just before the decision and for the 6-month period 2 years later. Changes in a 2-year time period were estimated by differences in purchase rates. Furthermore, the proportion of applicants with an increased purchase of drugs and the proportion of applicants who ceased buying drugs were estimated. The results were stratified by diagnosis and result of application (awarded/rejected). The analyses were furthermore restricted to musculoskeletal disorders and the use of painkillers. At baseline 81% had a purchase and after the 2-year time period 11% ceased buying prescribed drugs. Half of all applicants increased the purchase of drugs. For musculoskeletal disorders one third had an increased purchase rate of painkillers while one fourth ceased purchase of drugs with variations in different diagnostic subgroups. The major changes of drug purchase after a pending application for disability pension are probably ascribed to characteristics of the diseases underlying the disability.

Delay of diagnosis and treatment in psychiatric patients applying for a disability pension - a challenge for all of us.

In an earlier study in 2002 we showed that of 101 persons applying for a disability pension for psychiatric reasons, a psychiatric diagnosis that affected their ability to work, could only be confirmed in 83%. Furthermore, and even more importantly, only 64% of these cases were receiving any psychiatric treatment and only 20% adequate drug therapy. Since this time there has been a great deal of discussion on the increasing numbers of people receiving a disability allowance in Switzerland. We evaluated whether, compared to the 2002 situation, application behaviour, expressed in more accurate diagnoses and treatment plans before filing the application for disability pension, has changed. We examined 124 of 132 subjects who were assessed for the Swiss Invalidity Insurance at the psychiatric outpatient department of the University Hospital, Basel in 2004. Eight persons did not agree to participate in the study. The results were compared with the results of our earlier study. There were some significant differences between the 2002 and 2004 applicants. In 2004, there was a tendency to an even lower proportion of subjects with a psychiatric diagnosis affecting their ability to work (73% vs 83%, p <.1). Of these applicants, significantly more than in the previous study reported taking specific psychiatric medication (74% vs 50%, p <.01). However, the proportion of patients, who were sufficiently medicated as documented by adequate drug serum levels (37%) or who were receiving any form of psychotherapy in a broad sense (30%), was still fairly low. Furthermore, there was a lower proportion of affective disorders as the primary diagnosis (49% vs 62%, p <.1). The findings from our earlier study, namely, that psychiatric applicants for a disability pension were not sufficiently diagnosed and treated before the application, could largely be replicated. Only minor changes could be observed over the last couple of years, with psychotropic medications being taken by more applicants, which might partly be due to the ongoing discussion.

Delay of diagnosis and treatment in psychiatric patients applying for a disability pension - a challenge for all of us.

In an earlier study in 2002 we showed that of 101 persons applying for a disability pension for psychiatric reasons, a psychiatric diagnosis that affected their ability to work, could only be confirmed in 83%. Furthermore, and even more importantly, only 64% of these cases were receiving any psychiatric treatment and only 20% adequate drug therapy. Since this time there has been a great deal of discussion on the increasing numbers of people receiving a disability allowance in Switzerland. We evaluated whether, compared to the 2002 situation, application behaviour, expressed in more accurate diagnoses and treatment plans before filing the application for disability pension, has changed. We examined 124 of 132 subjects who were assessed for the Swiss Invalidity Insurance at the psychiatric outpatient department of the University Hospital, Basel in 2004. Eight persons did not agree to participate in the study. The results were compared with the results of our earlier study. There were some significant differences between the 2002 and 2004 applicants. In 2004, there was a tendency to an even lower proportion of subjects with a psychiatric diagnosis affecting their ability to work (73% vs 83%, p <.1). Of these applicants, significantly more than in the previous study reported taking specific psychiatric medication (74% vs 50%, p <.01). However, the proportion of patients, who were sufficiently medicated as documented by adequate drug serum levels (37%) or who were receiving any form of psychotherapy in a broad sense (30%), was still fairly low. Furthermore, there was a lower proportion of affective disorders as the primary diagnosis (49% vs 62%, p <.1). The findings from our earlier study, namely, that psychiatric applicants for a disability pension were not sufficiently diagnosed and treated before the application, could largely be replicated. Only minor changes could be observed over the last couple of years, with psychotropic medications being taken by more applicants, which might partly be due to the ongoing discussion.

Effect of financial compensation on vocational rehabilitation

To examine how financial compensation affects the outcome of vocational rehabilitation. A registry-based follow-up study. A total of 1397 rehabilitees discharged from the 5 local rehabilitation agencies in Aarhus County, Denmark from 1 July 2000 to 31 December 2001. At submission demographic data was obtained as well as data on financial compensation, i.e. compensation for industrial injury, indemnity for off-duty injury and application for disability pension. Rehabilitation outcomes were recorded at discharge. Renouncing further attempts at rehabilitation was defined as a negative outcome; education, further rehabilitation or return-to-work on normal or less demanding terms were defined as a positive outcome. Rehabilitees with and without financial compensation were compared. Rehabilitees with involvement of financial compensation had an increased risk of a negative outcome compared with those without involvement of financial compensation. Adjustment for potential confounders did not change the association between financial compensation and negative outcome. The risk of a negative outcome rose with increasing age, with less than 1 year of labour market experience and with rented housing. Previous occupation as a skilled worker reduced the risk. Financial compensation was associated with an increased risk of a negative vocational rehabilitation outcome.

Diabetes Mellitus and Disability Pension

Disability documents of all diabetic persons (n = 1,707) granted a disability pension in Sweden during 1980 were studied. The following factors were analysed: age, sex, civil status, profession, unemployment, being a housewife, immigration status, form for disability pension application, duration of diabetes, type of treatment, presence of classical late complications and age at onset of diabetes, obesity and alcohol problems. Functional handicaps and symptoms related to a clinically advanced diabetes mellitus could be regarded as the basis for the decision to grant a disability pension to 20-25% of the pensioners. For the remaining 75-80% neither the diabetic state nor its late complications could be held responsible for reduced work capacity. Rather, symptoms like angina pectoris and rheumatic symptoms and many other factors such as obesity, alcohol problems, being an immigrant, or being unemployed influenced the decision to grant a disability pension.