Cause Of Work Disability Research Articles

Analyzing complaints of arm, neck, and shoulder pain among academicians in Malaysia: a cross-sectional study on prevalence and contributing factors

OBJECTIVES: Complaints of arm, neck, and shoulder (CANS) have been recognized as an important cause of work disability. Therefore, it is essential to identify those health risk factors for the development of CANS before they escalate into a disabling musculoskeletal condition. This study aims to ascertain the association between individual, physical, and psychosocial risk factors and the occurrence of CANS among academics in Malaysia. METHODS: A cross-sectional study design was adopted, enrolling 296 academic staff working at a private university in Malaysia using a convenient sampling approach. A content-validated questionnaire was distributed among selected academic staff to gather their feedback on the prevalence and contributing factors of CANS, and the survey was conducted for a period of six months. The chi-square test was used to analyze the association between risk factors and CANS, and multiple logistic regression was used to predict the risk factors of CANS. This study links all the health risk factors to CANS in Malaysian academicians. RESULTS: Of the academic staff who participated in this study, 63.5% reported an annual prevalence of CANS. Physical risk factors, including work experience, adopting a static head-down posture, time spent per day in teaching, and the number of hours spent in front of a computer, are associated with CANS (p<0.05). However, the utility of back support (p=0.878) and footrests (p=0.078) does not show any association with the occurrence of CANS (p>0.05). Besides job demand, other psychosocial factors do not show any significant association with CANS. DISCUSSION: The study found that 63.5% of academic staff suffer from arm, shoulder, and neck pain, which is linked to physical risk factors such as work experience, static posture, teaching time and computer use. Back support and footrests had no significant influence on the complaints. Addressing physical risk factors is key to reducing these conditions among academic staff.

Unmet Needs in Preventive Treatment of Migraine.

Migraine represents the most common cause of work disability in young women and the second one in the general population. Preventive treatment can reduce the frequency of attacks and their intensity, consequently improving the quality of life. Despite this, global health systems have shown important gaps in addressing optimal management of preventive therapy. Despite numerous adverse effects of traditional medications for migraine prevention being well known, these medications continue to be considered the standard of care for prophylaxis of this disease in many contexts. On the other hand, the widespread use of calcitonin gene-related peptide (CGRP) receptor antagonists, which have marked a breakthrough in prophylactic therapy of migraine, has been limited because of their high cost. We also highlight important shortcomings in migraine management by general practitioners (GPs) and poor patient education on the disease with a consequent delay in referring selected patients to dedicated headache centres. Over the next few years, we expect the headache medicine community to mobilize to address these gaps in preventive treatment of migraine.

Assessing MSDs before Introduction of a Cobot: Psychosocial Aspects and Employee’s Subjective Experience

Musculoskeletal disorders (MSDs) are one of the main causes of work disability (EU-OSHA, 2019; WHO, 2019). Several solutions, including the cobotic system (EUROGIP, 2017), have been put forward to improve unhealthy working conditions and prevent MSDs. We sought to identify the MSD risk factors of workers on a screen-printed glass production line prior to introduction of a cobot. We used a mixed data collection technique: video observations and assessment of MSD risk factors by expert ergonomists, and then self-confrontation interviews with six production-line operators and subjective perception of risk factors. The two types of assessment (by experts and by operators) showed that the most demanding risk factors were physical (e.g., work posture) and psychosocial (e.g., mental workload). Certain risk factors were viewed differently by the experts and the operators. One question remains: How can a cobot make work more meaningful for operators?

Prevalence of Carpal Tunnel Syndrome among Dentists of Faisalabad

Background: Dentists in their practice are daily exposed to work-related vibrations. The important cause of work disability is carpal tunnel syndrome. Methods: In this cross-sectional study data from 100 dentists was collected using convenient sampling technique. Prior to data collection consent form was sent to the respective dental section of government hospitals of Faisalabad. The dentists who met the inclusion criterion were invited to participate in the study. The Diagnosis was made according to clinical tests of Phalen and Tinel. Age, sex, years of experience, working hours per week and the type of procedure were then be considered as dependent variables Results: Overall, prevalence rate of 60% of carpal tunnel syndrome among old aged dentists was observed. Conclusion: The risk of carpel tunnel syndrome increases with age. It also concluded that 60% prevalence rate was found in the dentists. Older dentists of age 35-50 year were included in more risk group than younger 20-25 year. Keywords: Carpal tunnel syndrome, Phalen’s sign, Tinel’s sign, endodontic file

Psychotherapy and change in mental health-related work disability - A prospective population level register-based study in Finland

Abstract Introduction Mental disorders are a major cause of work disability among working age population. Psychotherapy has been shown to be an effective treatment for mental disorders, but the evidence mainly comes from small scale randomised trials with a relatively short follow-up. Objectives We used population-based register data to examine the association between statutory rehabilitative psychotherapy and change in depression or anxiety related work disability using a quasi-experimental interrupted time series analysis. Methods All those who started rehabilitative psychotherapy in 2011-2014 comprised the study group. The study group included 10436 participants who were followed from three years prior to four years after the onset of rehabilitative psychotherapy, resulting in 83488 observations. Annual total number of mental health related work disability months was calculated based on total number of annual compensated sickness absence and disability pension days. Results The onset of rehabilitative psychotherapy marked a decline in depression or anxiety related work disability as compared to the counterfactual trend. Specifically, a 20% decrease in the level (incidence rate ratio, IRR 0.80; 95% CI 0.76-0.85) as well as a 48% decrease in the slope (IRR 0.52; 95% CI 0.50-0.54) of work disability was detected. The decline was steepest in the oldest age-group Conclusions Providing statutory psychotherapy may decrease work disability at the population level. Further evidence for causal inference and the potential heterogeneity of the association is required.

Effectiveness of ergonomic interventions on work activity limitations in adults with rheumatoid arthritis: A systematic review.

Rheumatoid arthritis (RA) is one of the leading causes of work disability in the United States. Ergonomic interventions offer an individualized treatment approach, and when used in conjunction with pharmacological treatment interventions, may improve work outcomes and improve the overall quality of life for individuals with RA. To identify the current body of evidence regarding the effectiveness of ergonomic interventions in reducing work activity limitations in adults with RA. A systematic review was conducted to identify articles of ergonomic interventions targeting working adults with RA. The CONsolidated Standards of Reporting Trials (CONSORT) checklist and Non-Pharmacological Treatment (NPT) Extension evaluated the reporting quality of each randomized controlled trial (RCT), and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) evaluated the quality of the evidence. Six studies were identified and reviewed for the quality of their reporting on evidence related to work activity limitations. Sixty-six percent of the items on the CONSORT checklist were fully reported by all studies and analysis through the GRADE framework demonstrated moderate confidence that the reported effects of ergonomic interventions on work activity limitations in the studies are accurate. This review revealed varied results for the effectiveness of ergonomic interventions on work activity limitations and at-work productivity. The results of this review indicate a need for further investigation. Future studies should focus on reviewing specific ergonomic interventions to determine the dosage needed to see results in reducing work activity limitations for working adults with RA.

Psychotherapy and change in mental health-related work disability: a prospective Finnish population-level register-based study with a quasi-experimental design

BackgroundMental disorders are a major cause of work disability among the working-age population. Psychotherapy has shown to be an effective treatment for mental disorders, but the evidence is mainly based...

Association of clinically relevant carpal tunnel syndrome with type of work and level of education: a general-population study

Carpal tunnel syndrome (CTS) is a common cause of work disability. The association with occupational load and education level has not been established in general-population studies. The purpose of this study was to investigate the association of clinically relevant CTS with work and education. From the Healthcare Register of Skane region (population 1.2 million) in southern Sweden we identified all individuals, aged 17–57 years, with first-time physician-made CTS diagnosis during 2004–2008. For each case we randomly sampled 4 referents, without a CTS diagnosis, from the general population matched by sex, age, and residence. We retrieved data about work and education from the national database. The study comprised 5456 individuals (73% women) with CTS and 21,667 referents. We found a significant association between physician-diagnosed CTS and type of work and level of education in both women and men. Compared with white-collar workers, the odds ratio (OR) for CTS among blue-collar workers was 1.67 (95% CI 1.54–1.81) and compared with light work, OR in light-moderate work was 1.37 (1.26–1.50), moderate work 1.70 (1.51–1.91), and heavy manual labor 1.96 (1.75–2.20). Compared with low-level education, OR for CTS in intermediate level was 0.82 (0.76–0.89) and high-level 0.48 (0.44–0.53). In women and men there is significant association with a dose–response pattern between clinically relevant CTS and increasing manual work load and lower education level. These findings could be important in design and implementation of preventive measures.

Effectiveness of Ergonomic Interventions on Work Activity Limitations in Adults with Rheumatoid Arthritis: A Systematic Review

<h3>Research Objectives</h3> Rheumatoid arthritis (RA) is one of the leading causes of work disability in the United States. Ergonomic interventions offer an individualized treatment approach, and when used in conjunction with pharmacological treatment interventions, may improve work outcomes and improve the overall quality of life for individuals with RA. To identify the current body of evidence regarding the effectiveness of ergonomic interventions in reducing work activity limitations in adults with RA. <h3>Design</h3> A systematic review was conducted to identify articles of ergonomic interventions targeting working adults with RA. The CONsolidated Standards of Reporting Trials (CONSORT) checklist and Non-Pharmacological Treatment (NPT) Extension evaluated the reporting quality of each randomized controlled trial (RCT), and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) evaluated the quality of the evidence. <h3>Setting</h3> N/A. <h3>Participants</h3> N/A. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> N/A. <h3>Results</h3> Six studies were identified and reviewed for the quality of their reporting on evidence related to work activity limitations. Sixty-six percent of the items on the CONSORT checklist were fully reported by all studies and analysis through the GRADE framework demonstrated moderate confidence that the reported effects of ergonomic interventions on work activity limitations in the studies are accurate. This review revealed varied results for the effectiveness of ergonomic interventions on work activity limitations and at-work productivity. <h3>Conclusions</h3> The results of this review indicate a need for further investigation. Future studies should focus on reviewing specific ergonomic interventions to determine the dosage needed to see results in reducing work activity limitations for working adults with RA.

Working Time Characteristics and Mental Health among Corrections and Transportation Workers.

Mental health disorders are a leading cause of work disability and while the psychosocial workplace environment plays a critical role, working time characteristics are also implicated. We sought to examine the association between working time characteristics and mental health in a cohort of two unionized, full-time worker populations, correctional supervisors, and transportation maintainers. Using a cross-sectional study design, we surveyed workers on working time characteristics across seven domains including length of the shift, the intensity or proximity of sequential shifts, the time of day, and social aspects of work hours including predictability, variability, control, and free time. Burnout symptoms (Oldenburg Burnout Inventory) and depressive symptoms (eight-item Centers for Epidemiologic Studies Depression Scale) were assessed along with the psychosocial work environment and health behaviors. We used log-binomial regression models to estimate prevalence ratios and 95% confidence intervals after adjusting for age, gender, and company. A total of 318 workers were surveyed. The majority (72%) of workers reported a fixed shift. The prevalence of burnout symptoms was higher among workers reporting more frequent shift intensity (working 6 or more days in a row) (PR: 1.15, 95% CI: 1.01, 1.31; P = 0.04). Low psychological demands and high worker social support were associated with fewer burnout symptoms, independent of working time characteristics. The prevalence of depressive symptoms was higher in workers reporting more frequent unpredictable work (PR: 1.17, 95% CI: 1.01, 1.35; P = 0.04) and was lower among workers reporting increased schedule control (PR: 0.86, 95% CI: 0.77, 0.96; P = 0.01). Higher worker social support as well as sufficient sleep and adequate exercise were associated with fewer depressive symptoms, independent of working time characteristics. Different working time characteristics were associated with work-related mental health (i.e. burnout) as well as general mental health (i.e. depressive symptoms). Work intensity was associated with the prevalence of burnout symptoms and the results suggest that the mechanism may be through the need for recovery from the psychosocial exposures of work. Both schedule control and predictability were associated with depressive symptoms and the results suggest that work-life imbalance and lack of recovery may be implicated. Comprehensive prevention policies that consider work organization along with the psychosocial work environment and work-life balance may help to improve workers' mental health.

How does Gender Influence Sustainable Return to Work Following Prolonged Work Disability? An Interpretive Description Study.

A sustainable return to work (S-RTW) following prolonged work disability poses different challenges, depending on gender. This article provides a synthesis of gender differences in the issues and factors influencing the S-RTW of workers following such a disability. Using an interpretive description method, an integrative review was conducted of the literature on gender differences in S-RTW issues and factors associated with four major causes of work disability. The initial review concerned the 2000-2016 literature; it was subsequently updated for November 2016-March 2020. To explore and contextualise the results, four focus groups were held with stakeholders representing the workplace, insurance, and healthcare systems and workers. Qualitative thematic analysis was performed. A total of 47 articles were reviewed, and 35 stakeholders participated in the focus groups. The prevailing traditional gender roles were found to have a major gender-specific influence on the attitudes, behaviours, processes and outcomes associated with S-RTW. These differences related to the (1) cumulative workload, (2) work engagement, and (3) expressed and addressed needs. The results highlight the importance of taking into account both professional and personal aspects when integrating gender issues into the assessment of workers' needs and subsequently into interventions.

Linking Work-Life Occupational Exposures With Distress and Mortality Before and After Retirement

Mental health problems have surpassed musculoskeletal injuries as causes of work disability. Workers in certain occupations may have high risks for mental health problems and premature death even after retirement. People in high risk occupations for many years may be particularly vulnerable, along with groups with higher health risks such as rural residents. Little research examines their occupation-related risks. No research has examined how occupational exposures affect mental health in retirement. We studied these life course risks using the nationally representative Panel Study of Income Dynamics, following participants 36 years beginning 1981, with annual measures of occupation and distress (n=16,994; 129,880 occupation measures; 415 deaths). We estimated hazards of developing distress in occupations hypothesized to have high and low distress risks, adjusted for factors associated with occupational choice and mental health including age, education, income, race/ethnicity, sex, childhood and midlife health, and family trauma. Compared to low risk occupations, working in high risk occupations was associated with 20% elevated odds of distress (adjusted odds ratio, OR 1.20, 95% confidence interval, CI 1.13 1.28) and 55% elevated risk of death (hazard ratio 1.55, CI 1.11-2.16). Each additional year in a high risk occupation increased the odds by 5%. Rural residents had the highest occupation-related distress risk (adjusted OR 3.05, CI 2.39-3.97). At ages 70+ each additional past exposure year was associated with 2% higher distress risk (p<0.05), and 4.6% higher mortality (p<0.05). Workers in certain occupations have high risks of psychological distress and death, even after retirement.

Expert panel survey among occupational health and safety professionals in Denmark for prevention and handling of musculoskeletal disorders at workplaces

Occupational health and safety (OHS) professionals have a key role in supporting the health and work ability of employees, including preventing and handling musculoskeletal disorders (MSDs) at workplaces. MSDs are the leading cause of work disability, productivity loss and sickness absence in Europe. This may be due to limited consensus on use of effective OHS practices as facilitation of evidence-based practices increases quality of provided services. This study explored consensus of OHS professionals’ practices and examined OHS professionals’ request for development of evidence-based guidelines for prevention and handling of MSDs at workplaces. This was done by 1) field observations and interviews with OHS professionals working with ergonomics or MSDs at workplaces, 2) development and pilot testing of a panel survey, 3) a three-round expert panel survey and 4) workshop with OHS stakeholders within the OHS organisations in Denmark. The findings indicate limited consensus of OHS practices and a request for development of practice- and evidence-based guidelines for prevention and handling of work-related MSDs in Denmark. The study also presents an end user involving process for increased uptake and implementation of guidelines.

The impact of income support systems on healthcare quality and functional capacity in workers with low back pain: a realist review.

Low back pain (LBP) is a leading cause of work disability. While absent from work, workers with LBP may receive income support from a system such as workers' compensation or social security. This study examines how and in what contexts income support systems impact the healthcare quality for people with work disability and LBP and their functional capacity. We performed a realist review. Five initial theories about the relationship between income support systems and outcomes were developed, tested, and refined by acquiring and synthesising academic literature from purposive and iterative electronic database searching. This process was supplemented with gray literature searches for policy documents and semistructured interviews with experts in income support, health care, and LBP. Income support systems influence healthcare quality through funding restrictions, healthcare provider administrative burden, and allowing employers to select providers. They also influence worker functional capacity through the level of participation and financial incentives for employers, measures to prove the validity of the worker's LBP, and certain administrative procedures. These mechanisms are often exclusively context-dependent, and generate differing and unintended outcomes depending on features of the healthcare and income support system, as well as other contextual factors such as socioeconomic status and labour force composition. Research and policy design should consider how income support systems may indirectly influence workers with LBP through the workplace.

Insights into the Sustainable Return to Work of Aging Workers with a Work Disability: An Interpretative Description Study.

Purpose A sustainable return to work (S-RTW) following prolonged work disability poses particular challenges as workers age. This article provides a synthesis of the factors and issues involved in a S-RTW process for aging workers following such a disability. Methods Using interpretive description methods, a critical review was conducted of the literature specifying return-to-work factors and issues for aging workers with regard to four major causes of work disability (musculoskeletal disorders, common mental disorders, cancer or other chronic diseases). The initial review concerned the 2000-2016 literature, and was subsequently updated for November 2016-December 2018. To further explore and contextualise the results of this literature review, four focus groups were held with stakeholders, representing the workplace, insurance, and healthcare systems and workers. Qualitative thematic analysis was performed. Results Fifty-five articles were reviewed and 35 stakeholders participated in the focus groups. Returning to work and staying at work appear to be particularly challenging for aging workers, who face notable issues and stigma concerning their ability to meet work demands, as well as their mobilisation and engagement in these processes. Such findings echo in many ways the main assertions of the literature on aging at work, except those regarding the transformation of capacities with aging, which is not mentioned in relation to workers with a work disability. The influence of healthcare and compensation systems on the S-RTW of aging work-disabled workers has also received little attention to date. Conclusions The results underscore that aging workers with a disability are frequently vulnerable in terms of their health or their jobs. Intersectoral efforts are needed to remedy this situation to keep them at work.

Association between lifestyle and musculoskeletal pain: cross-sectional study among 10,000 adults from the general working population

BackgroundWork-related musculoskeletal pain is a major cause of work disability and sickness absence. While pain is a multifactorial phenomenon being influenced by work as well as lifestyle, less is known about the association between specific lifestyle factors and the type of musculoskeletal pain. The aim of the study was to investigate if a dose-response association existed between lifestyle factors and musculoskeletal pain intensity in the low back and neck-shoulder.MethodsCurrently employed wage earners (N = 10,427) replied in 2010 to questions about work environment, lifestyle and health. Logistic regression analyses adjusted for various confounders tested the association of alcohol intake, physical activity, fruit and vegetable intake, and smoking (explanatory variables) with low back pain and neck-shoulder pain intensity (outcomes variables, scale 0–9, where ≥4 is high pain).ResultsThe minimally adjusted model found that physical activity and fruit and vegetable intake were associated with lower risk of musculoskeletal pain, while smoking was associated with higher risk of musculoskeletal pain. In the fully adjusted model, physical activity ≥5 h per week was associated with lower risk of low back pain and neck-shoulder pain with risk ratios (RR) of 0.95 (95% CI 0.90–1.00) and 0.90 (95% CI 0.82–0.99), respectively. No association was found between alcohol intake and pain.ConclusionBeing physically active associated with lower risk of having musculoskeletal pain, while smoking habits and healthy eating were associated with higher pain when adjusting for age and gender. Considering the continuously increasing retirement age in many societies, initiatives to promote healthy habits should still be a political priority to help the workers to stay healthy and cope to their work.

Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol

BackgroundMusculoskeletal disorders (MSDs) are the leading cause of work disability and sickness absence worldwide. The prevalence of MSDs increases with age, consequently challenging sustainable employability among the growing ageing workforce. Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted. This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks, respectively.MethodsWe will search the following bibliographic databases: PubMed (including the database ‘MEDLINE’) and Web of Science Core Collection (including the databases ‘Science Citation Index Expanded’, ‘Social Sciences Citation Index’ and ‘Arts & Humanities Citation Index’). Manual searches will also be performed. We will include randomised controlled trials (RCTs) and non-RCTs reported in English in which (1) participants are adult workers with MSD, (2) interventions are aiming at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and (3) interventions are initiated and/or carried out at the workplace. The review will adhere to the ‘Preferred Reporting Items for Systematic reviews and Meta-Analyses’ (PRISMA) guidelines for reporting systematic reviews and the Institute for Work and Health (IWH) guidelines for workplace-based interventions. For the primary evaluation of the review, the quality assessment and evidence synthesis will conform to the IWH guidelines. Secondary evaluation will include a meta-analysis (unless the included studies do not allow this due to heterogeneity) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach on the studies with pain intensity as an outcome.DiscussionThis systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD. RCTs are considered the most powerful experimental design in clinical trials, but solely including these may be too restrictive to understand effective workplace-based interventions where randomised and carefully controlled trials (RCTs) are not always possible. In order to maximize practical relevance, the selection process will, therefore, include both RCTs and non-RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders. The result of this work will form the basis for industry-specific evidence-based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces.Systematic review registrationInternational Prospective Register of Systematic Reviews (PROSPERO) number CRD42018116752.

Managing sickness absence of patients with musculoskeletal pain \u2013 a cross-sectional survey of Scandinavian chiropractors

BackgroundMusculoskeletal pain is a major cause of work disability. Many patients with musculoskeletal pain seek care from health care providers other than their general practitioners, including a range of musculoskeletal practitioners. Therefore, these musculoskeletal practitioners may play a key role by engaging in sickness absence management and work disability prevention. This study aimed to determine the prevalence of musculoskeletal practitioners’ practice behaviours, and their perceptions and beliefs about sickness absence management by using Scandinavian chiropractors as an example, as well as to examine the association between these characteristics and two different practice behaviours.MethodsAs part of a mixed-methods study, we surveyed members of the national chiropractic associations in Denmark, Norway, and Sweden in 2016. Descriptive statistics were used to describe prevalence. Multilevel logistic regression with backwards stepping was used to estimate odds ratios with 95% confidence intervals between each of the two practice behaviours and the characteristics.ResultsOut of the 802 respondents (response rate 56%), 372 were Danish, 349 Norwegian, and 81 Swedish. In Denmark and Norway, 38.7 and 37.8% always/often considered if sick leave was appropriate for their patient compared to 21.0% in Sweden (p = 0.007); and 86.5% of the Norwegian chiropractors always/often recommended to return-to-work versus 64.5 and 66.7% in Denmark and Sweden respectively (p < 0.001). In the final models, factors associated with the two practice behaviours were age, level of clinical experience, working as a teacher, the tendency to be updated on current legislations and policies using social services, contact with general practitioners, relevance of engagement in SAM, consideration of workplace factors, SAM as part of the clinical tool box, patient out-of-pocket fee, and recommending fast return-to-work.ConclusionsWhilst not always engaged in sickness absence management with regards to musculoskeletal pain, chiropractors favour a ‘return-to-work’ rather than a ‘stay-at-home’ approach. Several practice behaviours and perceptions and beliefs are associated with these outcomes; however, system or organisational barriers are linked to clinician non-engagement.

PMH27 - Age Disparities in Off-Label Use of Antipsychotics Among Wa Medicare-D Beneficiaries

Medicare, which covers all adults over age 65 and younger adults with work disabilities, is the largest public health insurance program in the US. Program drug costs have risen dramatically in the past two decades, due in part to a jump in prescribing of psychiatric medications. This study analyzes patterns of antipsychotic use among Washington state Medicare beneficiaries in 2013. We used Medicare claims data to ascertain the program enrollment status of Medicare beneficiaries, omitting decedents and beneficiaries who added or dropped drug coverage during the 12 month observation period. Our preliminary study sample consisted of all living WA adults (over age 21) continuously enrolled in Medicare Part D or Medicare Advantage in 2013 (N=614,632). We then used the Part D Drug Event file to identify beneficiaries within this subgroup who filled one or more antipsychotic prescriptions (N=39,541). About 6.4% of WA residents continuously enrolled in Medicare Part D or Medicare Advantage received one or more antipsychotic prescriptions. Younger Medicare beneficiaries (aged 21-64) were prescribed antipsychotics at nearly six times the rate of those over age 65 or older (20.0% vs. 3.4%). The majority of antipsychotic users (51.2%) did not appear to have an FDA indicated diagnosis of schizophrenia, major depression, or bipolar and manic disorders. Use for nonindicated diagnoses was more common in older age groups. For example, 84% of antipsychotic users over age 75 do not have an indicated diagnosis, but 51.9% have Alzheimer’s or another dementia. Most WA Medicare beneficiaries who use antipsychotics are under age 65. This group receives early Medicare coverage because they are unable to work due to a disabling health condition, and psychiatric conditions are a very common cause of work disability. Consequently, most younger beneficiaries use antipsychotics for indicated diagnoses.

Predictors of employment in young adults with psychiatric work disability.

Mental disorders are the leading cause of work disability among young adults in the industrialized world. Factors predicting employment after long-term psychiatric work disability are largely unknown. We linked personal and clinical information from the benefit applications and medical certificates of 1163 young adults (18-34 years) with a new-onset fixed-term psychiatric disability pension in 2008 with employment records between 2005 and 2013. The outcomes were starting employment during and being employed at the end of follow-up. Of the participants, 48% had been employed during and 22% were employed at the end of follow-up. Sustained employment history, university education (master's degree) and no recorded psychological symptoms in childhood were associated with both subsequent employment outcomes. Women and participants under 25 years were more likely to start employment. Depression and other mental disorders (vs psychotic diagnose) and having no comorbid mental disorders or substance abuse were associated with employment at the end of follow-up. Sustained employment history, university education and no recorded psychological symptoms during childhood predict a return to employment among young adults after a fixed-term psychiatric work disability pension. Pro-active interventions in psychological problems during childhood could enhance employment after a period of work disability.