Subsequent Disability Pension Research Articles

Differences in labour market marginalisation among young immigrant groups and Swedish-born youth

Abstract Background There is a knowledge gap regarding the risk for labour market marginalisation among younger cohorts of refugees and non-refugee immigrants. We investigated if the risk of long-term unemployment (LTU) and disability pension (DP) differs between young refugees and non-refuge immigrants compared to the Swedish-born. The role of age at arrival, duration of residency and morbidity in this association was also investigated. Methods All 19- to 25-year-olds residing in Sweden on 31 December 2004 (1691 refugees who were unaccompanied by a parent at arrival, 24,697 accompanied refugees, 18,762 non-refugee immigrants and 621,455 Swedish-born individuals) were followed from 2005 to 2016 regarding LTU (>180 days annually) and DP using nationwide register data. Cox regression models were used to estimate crude and multivariate-adjusted (adjusted for several socio-demographic, labour market and health-related covariates) hazard ratios (aHRs) with 95% confidence intervals. Results Compared to the Swedish-born, all migrant groups had around a 1.8-fold higher risk of LTU (range aHR=1.71-1.83) and around a 30% lower risk of DP (range aHR=0.66-0.76). Older age at arrival was associated with a higher risk of LTU only for non-refugee immigrants. Both older age at arrival and a shorter duration of residency were associated with a lower risk of DP for all migrant groups. Psychiatric morbidity had the strongest effect on subsequent DP, with no significant differences between migrant groups and the Swedish-born (range aHR=5.1-6.1). Conclusions Young immigrants had a higher risk of LTU and a lower risk of DP than their Swedish-born peers. No differences between the different immigrant groups were found. Age at arrival, psychiatric morbidity and duration of residency are strong determinants of being granted DP. Key messages

Differences in labour market marginalisation between refugees, non-refugee immigrants and Swedish-born youth: Role of age at arrival and residency duration.

We investigated if the risk of long-term unemployment (LTU) and disability pension (DP) differs between young refugees and non-refuge immigrants compared to the Swedish-born. The role of age at arrival, duration of residency and morbidity in this association was also investigated. All 19- to 25-year-olds residing in Sweden on 31 December 2004 (1691 refugees who were unaccompanied by a parent at arrival, 24,697 accompanied refugees, 18,762 non-refugee immigrants and 621,455 Swedish-born individuals) were followed from 2005 to 2016 regarding LTU (>180 days annually) and DP using nationwide register data. Cox regression models were used to estimate crude and multivariate-adjusted (adjusted for several socio-demographic, labour market and health-related covariates) hazard ratios (aHRs) with 95% confidence intervals. Compared to the Swedish-born, all migrant groups had around a 1.8-fold higher risk of LTU (range aHR=1.71-1.83) and around a 30% lower risk of DP (range aHR=0.66-0.76). Older age at arrival was associated with a higher risk of LTU only for non-refugee immigrants. Both older age at arrival and a shorter duration of residency were associated with a lower risk of DP for all migrant groups. Psychiatric morbidity had the strongest effect on subsequent DP, with no significant differences between migrant groups and the Swedish-born (range aHR=5.1-6.1). Young immigrants had a higher risk of LTU and a lower risk of DP than their Swedish-born peers. No differences between the different immigrant groups were found. Age at arrival, psychiatric morbidity and duration of residency are strong determinants of being granted DP.

Disability pension and mortality in individuals with specific somatic and mental disorders: examining differences between refugees and Swedish-born individuals

BackgroundMore than half a million refugees have arrived to Sweden during the last decade. The aim was to investigate differences between refugees and Swedish-born individuals regarding different specific somatic and...

Childbirth, morbidity, sickness absence and disability pension: a population-based longitudinal cohort study in Sweden

ObjectiveTo investigate associations of morbidity with subsequent sickness absence (SA) and disability pension (DP) among initially nulliparous women with no, one or several childbirths during follow-up.DesignLongitudinal register-based cohort study.SettingSweden.ParticipantsNulliparous women,...

Different diagnostic groups and labour market marginalization among refugee youths

Abstract Background Refugees are at increased risk of labor market marginalization (LMM), which is of high Public Health importance. However, little is known whether specific multimorbidity patterns increase the risk of LMM in this group. We sought to examine whether different diagnostic groups associate with subsequent unemployment and disability pension in refugee youth as compared to their counterparts born in Sweden. Methodology We analyzed 249,245 individuals between the age of 16 and 26 at 31.12.2011 from a combined Swedish registry. Refugees were matched to five second-generation-native-born Swedes. LMM was defined as disability pension or > 180 days of unemployment, 2012-2015. Relative risks (RR) were calculated for 114 diagnostic groups (2009-11) with regard to the two outcome measures. Results The mean age was 23±1.7 years, 2,841 (1.1%) received disability pension and 16,323 (6.5%) individuals experienced unemployment. The majority of diagnostic groups was associated with a higher risk for unemployment and a lower risk for disability pension in refugees. Hypertensive diseases and external causes of morbidity showed higher risk ratios of unemployment for refugees compared to Swedish-born: RRs (95% Confidence Interval) 6.8 (3.16, 14.6) and 6.31 (4.45, 8.94), respectively. Diabetes and mental disorders were associated with higher risk estimates for disability pension in refugees: RRs (95% CI) 2.4 (1.02, 5.6) and 1.8 (0.80, 3.9), respectively. Conclusions Diagnoses are differentially associated with LMM in refugee youth as compared to Swedish-born individuals. In order to prevent LMM in refugees, early intervention for the identified diseases is important. Key message The importance of diagnostic groups for subsequent LMM differs for young refugees and Swedish-born individuals. Findings are also divergent regarding the measure of LMM.

Adverse outcomes of chronic widespread pain and common mental disorders in individuals with sickness absence \u2013 a prospective study of Swedish twins

BackgroundChronic widespread pain (CWP) and common mental disorders (CMDs) are common public health problems, but little is known about the role of CWP and CMDs on future adverse outcomes among work disabled individuals. The aims of the study were to investigate the associations between CWP and CMDs with subsequent disability pension (DP), long-term unemployment (> 90 days) and all-cause mortality in individuals with sickness absence (SA) and whether the associations were explained by familial factors.MethodsIn this prospective cohort study, 7884 Swedish twins born between 1933 and 1985 were included and baseline data were gathered from a questionnaire in 1998 to 2006. Register data were used for obtaining information regarding demographics, SA, DP, unemployment and mortality. Cox proportional hazards regressions were used to calculate Hazard Ratios (HR) with 95% Confidence Intervals (CI) for the associations between CWP and/or CMDs with DP, unemployment and mortality, while conditional Cox models for twin pairs provided control for familial confounding.ResultsHaving either CWP or CMDs among those with a history of SA was associated with a higher risk of DP and all-cause mortality than individuals without CWP and CMDs after controlling for socio-demographic and health factors. Moreover, sick-listed individuals with both CWP and CMDs had a higher risk of DP while those who only had CMDs had a higher risk of long-term unemployment compared to those without CWP and CMDs. The association between CMDs with DP and long-term unemployment was no longer significant when controlling for familial factors.ConclusionsCMDs was a risk factor for DP, unemployment and mortality among individuals with SA, while CWP seems to be important in relation to future DP and mortality. Familial factors played a role in the associations between CMDs and DP and CMDs and unemployment.

Unemployment Trajectories and the Early Risk of Disability Pension among Young People with and without Autism Spectrum Disorder: A Nationwide Study in Sweden.

Depression and anxiety are associated with unemployment and disability pension, while autism spectrum disorder (ASD) is less studied. We aimed to first identify unemployment trajectories among young adults with and without ASD, and then to examine their social determinants. Finally, we used the trajectories as determinants for subsequent disability pension. We used a population-based cohort, including 814 people who were 19–35 years old, not on disability pension, and who had their ASD diagnosis between 2001 and 2009. A matched reference population included 22,013 people with no record of mental disorders. Unemployment follow-up was the inclusion year and four years after. Disability pension follow-up started after the unemployment follow-up and continued through 2013. We identified three distinctive trajectories of unemployment during the follow-up: (1) low, then sharply increasing (9%,) (2) low (reference, 67%), and (3) high then slowly decreasing (24%). People with ASD had higher odds of belonging belong to the trajectory groups 1 (OR 2.53, 95% CI 2.02–3.18) and 3 (OR 3.60, 95% CI 3.08–4.19). However, the mean number of unemployment days was relatively low in all groups. A disability pension was a rare event in the cohort, although memberships to groups 1 and 3 were associated with the risk of a future disability pension. More knowledge is needed about factors facilitating participation in paid employment among people with ASD.

Sleep disturbance and work-related mental strain: A national prospective cohort study of the prediction of subsequent long-term sickness absence, disability pension and mortality

Aims: Sleep disturbances and work-related mental strain are linked to increased sickness absence and disability pension (DP), but we have no information on synergy effects. The aim of this study was to examine the combined (and separate) association of the two predictors with subsequent long-term work disability and mortality. Methods: A total of 45,498 participants aged 16–64 years were interviewed in the Swedish Surveys of Living Conditions between 1997 and 2013, and were followed up on long-term sickness absence (LTSA; >90 days/year), DP and mortality via national registers until 2016. Crude and multivariable Cox analyses were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results: For LTSA, the HRs for sleep disturbances and work-related mental strain were 1.6 (95% CI 1.5–1.7) and 1.3 (95% CI 1.2–1.4), respectively. For DP, the HRs were 2.0 (95% CI 1.8–2.2) and 1.4 (95% CI 1.2–1.5). Mortality was only predicted by sleep disturbances (HR=1.2, 95% CI 1.1–1.4). No synergy effect was seen. Conclusions: Work-related mental strain and, in particular, sleep disturbances were associated with a higher risk of subsequent LTSA and DP, but without synergy effects. Sleep disturbances were also associated with mortality. Exposure to interventions tackling sleep disturbance and prevention of workplace stress may reduce work disability.

Effects of sickness absence on disability pension risk: Finnish register study of two native groups

Abstract Background Sickness absence and disability pension have a close connection and both describe the health of working-aged populations. The aim of this paper was to study if Swedish and Finnish speakers differ in the risk of disability pension after first-time sickness absence. This may reveal new aspects how to support health and work ability promotion activities. Methods The longitudinal register data used come from Statistics Finland. They consist of random samples of 5 % of all Finnish speakers and 20 % of all Swedish speakers, observed throughout the period 1989-2010. The analyses concerned non-retired individuals aged 16-60 years who were under risk of first-time sickness absence that extended 10 days. Discrete-time hazard models were estimated to both language groups to evaluate how first-time sickness absence, time since absence, length of absence, and various socio-economic control variables affected the disability pension risk. Results The disability pension risk was extremely high immediately after the sickness absence receipt and remained elevated thereafter approximately 20 times higher as compared to non-recipients. A strong interrelation between first-time sickness absence and the risk of subsequent disability pension was found for both language groups and the risk was persistent in the very long term. The risk pattern looked similar to both Swedish and Finnish speakers and we did not observe any differences between women and men. Conclusions Paid sickness absence is illustrative of strong health selection and a notable risk for reduced work ability even in the more distant future. The currently implemented policies in Finland, which require statements about rehabilitation plans soon after individuals have entered a sickness spell, can be considered beneficial for both the individual and society. Comparison of the language groups shows that the disability pension process after sickness absence is operating similarly to both groups. Key messages Sickness absence requiring medical certificate is an indicator of possible long-term work disability. Timing of rehabilitation process during the sickness absence is critical.

Determinants of work disability following lumbar spine decompression surgery.

Scientific knowledge about risk factors for work disability in terms of long-term sickness absence and disability pension following lumbar spine decompression surgery remains insufficient. This study aimed to investigate the associations between socio-demographic, work-related, and medical characteristics with subsequent long-term sickness absence (>90 days) and disability pension for individuals who underwent lumbar spine decompression surgery. A prospective cohort study of all individuals aged 19-60 years with diagnosed dorsopathies, who underwent lumbar spine decompression surgery 2008-10 in Sweden ( n=7373) was performed. Univariate and multivariate hazard ratios with 95% confidence intervals regarding long-term sickness absence and disability pension with a 3-year follow-up period were estimated by Cox proportional regression. Low educational level, being a non-European immigrant and preoperative sickness absence were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2-3.8). Female sex was a risk factor for long-term sickness absence (hazard ratios: 1.3) whereas age >44 years and being a Nordic immigrant were risk factors for disability pension (hazard ratios: 1.9-2.6). Medical factors as common mental disorders, other mental disorders, prescribed psychiatric medication and somatic comorbidity were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2-3.4). A simultaneous lumbar fusion surgery and high preoperative pain severity were risk factors for long-term sickness absence (hazard ratios 1.2-1.8). To prevent long-term work disability after lumbar spine decompression surgery, specific focus is required on older and female patients, those with mental or somatic comorbidities, high levels of preoperative pain or sickness absence, with a simultaneous lumbar fusion surgery, a low educational level or a non-European immigrant background.

Potentially traumatic events as predictors of disability pension: A 10-year follow-up study in Norway.

Are potentially traumatic events associated with subsequent disability pension? Traumatic exposure and post-traumatic stress disorder (PTSD) may represent a disabling state with both personal and professional consequences for the affected individual. Despite this, there is a scarcity of research studying the effects of traumatic exposure on disability pension. This study examined the differences in risk for disability pension among unexposed, exposed to trauma and PTSD cases. An ambidirectional Norwegian cohort study, consisting of 1238 individuals aged 18-66 years who were at risk of disability pension, were interviewed using the Composite International Diagnostic Interview, and linked with registry data on disability pension. Registry follow-up in the Norwegian Insurance Database lasted ten years following interview in 2000-01. The risk of disability pension after traumatic exposure, divided into accidental and premeditated, was assessed by Cox proportional hazards regression analysis. In 10 years, 9.5% of the cohort had been granted disability pension. Overall exposure to traumatic events did not alter the risk of disability pension. However, among women, exposure to premeditated traumas did increase the risk (HR 2.96 (95% CI 1.54-5.68)), and was an independent risk factor. Fulfilling criteria for PTSD caseness further increased the risk (HR 4.69 (95% CI 1.78-12.40)). There was no increased risk found between traumatic exposure and disability pension for men. Exposure to trauma, particularly premeditated trauma, seems to be an independent risk factor for disability pension in women.

Labour-market marginalisation after mental disorders among young natives and immigrants living in Sweden

BackgroundThe aim was to investigate the associations between mental disorders and three different measures of labour-market marginalisation, and differences between native Swedes and immigrants.MethodsThe study comprised 1,753,544 individuals, aged 20–35 years, and resident in Sweden 2004. They were followed 2005–2011 with regard to disability pension, sickness absence (≥90 days) and unemployment (≥180 days). Immigrants were born in Western countries (Nordic countries, EU, Europe outside EU or North-America/Oceania), or in non-Western countries (Africa, Asia or South-America). Mental disorders were grouped into seven subgroups based on a record of in- or specialised outpatient health care 2001–2004. Hazard ratios (HRs) with 95% confidence intervals (CIs) were computed by Cox regression models with both fixed and time-dependent covariates and competing risks. We also performed stratified analyses with regard to labour-market attachment.ResultsIndividuals with mental disorders had a seven times higher risk of disability pension, a two times higher risk of sickness absence, and a 20% higher risk of unemployment than individuals without mental disorders. Individuals with personality disorders and schizophrenia/non-affective psychoses had highest risk estimates for having disability pension and long-term sickness absence, while the risk estimates of long-term unemployment were similar among all subgroups of mental disorders. Among persons with mental disorders, native Swedes had higher risk estimates for disability pension (HR:6.6; 95%CI:6.4–6.8) than Western immigrants (4.8; 4.4–5.2) and non-Western immigrants (4.8; 4.4–5.1), slightly higher risk estimates for sickness absence (2.1;2.1–2.2) than Western (1.9;1.8–2.1), and non-Western (1.9;1.7–2.0) immigrants but lower risk estimates for unemployment (1.4;1.3–1.4) than Western (1.8;1.7–1.9) and non-Western immigrants (2.0;1.9–2.1). There were similar risk estimates among sub-regions within both Western and non-Western countries. Stratification by labour-market attachment showed that the risk estimates for immigrants were lower the more distant individuals were from gainful employment.ConclusionsMental disorders were associated with all three measures of labour-market marginalisation, strongest with subsequent disability pension. Native Swedes had higher risk estimates for both disability pension and sickness absence, but lower risk estimates for unemployment than immigrants. Previous labour-market attachment explained a great part of the association between immigrant status and subsequent labour-market marginalisation.

Differences in predictors of permanent work disability between immigrants and natives: a cohort study of adults with sick leave due to common mental disorders

ObjectivesImmigrants with common mental disorders (CMDs) are reported to have a higher risk of disability pension (DP) compared with native residents; however, the reasons for this are not fully understood....

Predicting disability pension - depression as hazard: a 10 year population-based cohort study in Norway.

Disability pension (DP) is an escalating challenge to individuals and the welfare state, with mental health problems as imminent hazard. The objective of the present paper was to determine if a diagnosis of depression increased the risk of subsequent DP, and whether the risk differed by gender. A population cohort of 1230 persons were diagnostically interviewed (Composite International Diagnostic Interview, CIDI) in a population study examining mental health, linked to the DP registry and followed for 10 years. The risk for DP following depression was estimated using Cox regression. Life-time depression, as well as current depression, increased the risk of subsequent DP for both genders. The fully adjusted [baseline health, health behavior and socio-economic status (SES)] hazard ratios (HRs) for life-time depressed men and women were 2.9 [95% confidence interval (CI) 1.5-5.8] and 1.6 (95% CI 1.0-2.5) respectively. Men were significantly older at time of DP. There are reasons to believe that depression went under-recognized and under-treated. To augment knowledge in the field, without underestimating depression as risk for DP, a deeper understanding of the nature and effects of other distress is needed.

Efficiency in integrated care for depression: are the health services adapted to care needs?

Introduction: Depressive disorders are one of today's major public health challenges in the Western world, with population prevalence upwards of 10 %. Yet only 10 % of people suffering from depressive symptoms seek professional help. Some are not in need of treatment, but many would benefit from professional help. There is an apparent incongruity between the need for and the use of specialist mental health services, and thus low efficiency in integrated care. The objective of this paper was to examine efficiency in integrated care related to patterns of helpseeking. Specifically, we examined the relationship between case-level depression and helpseeking for mental illness. Additionally, we examined disability pension as endpoint. Analyses were stratified on gender, and adjusted for age, rural vs. urban, SES, social network and somatic disease. Finally, we investigated associations between mental health care services satisfaction, perceived treatment benefits, thoughts about future help-seeking and depression. Methods: The data utilized in the present study stemmed from the OsLof (Oslo and Lofoten) study, initiated in 1989 as a cross-sectional population based study examining mental health of men and women, aged 18 and above. The cohort for these analyses consisted of 1,634 subjects interviewed in 2000-01. The study included questions of service use, attitudes towards and perceptions of mental health care services. To obtain an accurate diagnosis based on ICD-10 criteria an updated electronic version – CIDI-M 1.1, of the Composite International Diagnostic Interview (CIDI) was used. We included affectiveand depressive disorders (ICD-10 codes F31.4 F34.1) and organic depressive disorder (ICD-10 code F06.32). Education was used as indicator of SES. Social network was measured by an index contained in the questionnaire. Somatic illness was assessed by the questionnaire. The extensive self-reported data were linked with registry data (FD-Trygd) on disability pension throughout year 2010. Results: While 11.4% of women experienced depression in the previous 12 months, only 51.2% of these sought specialist help even though all had seen a general physician at least once. Results were similar for men. The adjusted OR for help-seeking was 5.21 (95% CI: 3.21, 8.45) and 7.53 (95% CI: 4.07, 13.94) for women and men respectively. The adjusted OR for disability pension was 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 1 International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-117105 – http://www.ijic.org/ 1.42 (95% CI: 1.23, 1.63) and 1.04 (95% CI: 0.84, 1.29) for women and med respectively. The odds of being satisfied with mental health care services among women was 1.05 (95% CI: 0.64, 1.71) for those not depressed during the previous 12 months compared to those depressed. For men, the OR = 0.99 (95% CI: 0.55, 1.79). For both women (OR = 5.02 (95% CI: 3.05, 8.26)) and men (OR = 3.23 (95% CI: 1.42, 7.39)), having been depressed during the previous 12 months, the estimated chance of perceived beneficial treatment is higher than for others. The odds of seeking psychiatrist help in the future is higher among those having been depressed during the previous 12 months (OR = 1.40 (95% CI: 0.90, 2.19)), for women. For men, the odds of seeking psychiatrist help in the future is equal (OR = 1.00 (95% CI: 0.57, 1.74)). Discussions: Fulfilling the requirements for a diagnosis of depression during the previous 12 months was positively related to having sought psychiatrist help, adjusted for age, rural vs. urban, SES, social network and somatic disease, for both women and men. For women, we found an increased adjusted OR of subsequent disability pension. It is unclear whether the mental health care services are adapted to the latent needs of the population. Any associations between efficiency of integrated care and disability pension still remains to be investigated. Conclusions: It may be construed that in order to combat depression as a public health challenge, early intervention and effective integrated care is requisite. We see gender differences in how depression impacts disability pensioning. Lessons learned: Depression and symptoms of depression affects men and women differently. Having this knowledge, it is essential that gender specific coping and care strategies are developed in order to achieve higher efficiency in integrated care. Limitations: Earlier research on the same data has shown that the study population is healthier than the general population. This will likely lead to an underestimation of the actual help-seeking in the population. It must be noted that this study was not designed to study care outcomes and efficiencies. Suggestions for future research:To optimize individual patient recovery and efficient integrated care, more work is needed to conclude on the most beneficial strategy.

Physical health-related quality of life predicts disability pension due to musculoskeletal disorders: seven years follow-up of the Hordaland Health Study Cohort.

BackgroundMusculoskeletal diseases are characterized by a high degree of comorbidity with common mental disorders and are a major cause of health-related exclusion from working life. Using a prospective design we aimed to examine the relative importance of physical and mental health-related quality of life as predictors of disability pension due to musculoskeletal diseases.MethodsA subsample (N = 18581) born 1953–1957, participated in the The Hordaland Health Study (HUSK) during 1997–1999, and was followed through December 31st 2004. Baseline measures of health-related quality of life were estimated using the Physical (PCS) and Mental Component Summary (MCS) of the Short Form-12 (SF-12). Further information on education, occupation, smoking, physical activity, number of musculoskeletal pain sites and BMI were provided by questionnaires and health examination. The association between self-perceived physical and mental health and subsequent disability pension, obtained from the national database of health and social benefits was estimated using Cox regression analyses.ResultsParticipants reporting poor physical health (quartile 1) had a marked increased risk for disability pension due to musculoskeletal diseases (age and gender-adjusted hazard ratio = 22.1, 95% CI = 12.5–39.0) compared with those reporting good/somewhat good physical health (quartiles 4 and 3 combined). Adjustment for socioeconomic status and lifestyle factors slightly attenuated the association (hazard ratio = 16.7), and adding number of reported pain sites weakened the association even more (hazard ratio = 7.1, 95% CI = 3.8–12.8). Also, participants reporting poor mental health had a higher risk for disability pension due to musculoskeletal diseases (age and gender adjusted hazard ratio = 1.8, 95% CI = 1.3–2.6); however, in the final model the risk was not statistically significant.ConclusionsThe physical component in health-related quality of life (SF-12) was a strong predictor of disability pension due to musculoskeletal diseases, whereas the mental component played a less prominent role.

Smokers’ increased risk for disability pension: social confounding or health-mediated effects? Gender-specific analyses of the Hordaland Health Study cohort

BackgroundStudies indicate that cigarette smokers have an increased risk for disability pension, presumably mediated by adverse health effects. However, smoking is also related to socioeconomic status. The current study examined...

Insomnia Symptoms, Sleep Duration, and Disability Pensions: a Prospective Study of Swedish Workers

Previous studies have found insomnia and long sleep duration to be independently associated with subsequent disability pension (DP). However, the issue of a possible gender-based pattern in this context has received little attention. This study aims to assess the impact of insomnia symptoms and sleep duration on the DP rates among Swedish women and men during a 12-year follow-up period. The participants, from the general population of Malmö, Sweden, were enrolled from 1992 to 1994 (n = 4,319; participation rate 41%), aged 45-64, healthy, and employed ≥30h per week. Baseline inquiry data concerning psychosocial circumstances and self-reported sleep habits were compared with official register-based DP rates. Five hundred and nine persons were granted a DP. Insomnia symptoms, affirmed by 33% of the men and 41% of the women, were associated with receiving a DP; the hazard ratios in the fully adjusted model were 1.4 for both men [95% confidence interval (CI) 1.1, 1.9] and women (95% CI 1.1, 1.7). The fully adjusted hazard ratio for women sleeping ≥9h was 7.8 (95% CI 3.7, 16.6) for DP due to a mental disorder. In the age-adjusted analyses, the sub-domain "difficulties falling asleep" was related to DP due to mental disorders in men and DP due to cardiovascular diseases in women. The findings suggest that preventing and treating insomnia symptoms could reduce DP and that disease mechanisms linking sleep disturbances to DP may differ by gender.

The impact of ADHD symptoms and global impairment in childhood on working disability in mid-adulthood: a 28-year follow-up study using official disability pension records in a high-risk in-patient population

BackgroundIndividuals with ADHD have been associated with more employment difficulties in early adulthood than healthy community controls. To examine whether this association is attributable specifically to disturbance of activity and attention (ADHD) or to psychopathology in general, we wanted to extend existing research by comparing the rate of mid-adulthood working disabilities for individuals diagnosed with ADHD as children with the rate for clinical controls diagnosed with either conduct disorder, emotional disorder or mixed disorder of conduct and emotions.MethodsFormer Norwegian child-psychiatric in-patients (n = 257) were followed up 17–39 years after hospitalization by record linkage to the Norwegian national registry of disability pension (DP) awards. Based on the hospital records, the patients were re-diagnosed according to ICD-10. Associations between the diagnoses, other baseline factors and subsequent DP were investigated using Kaplan–Meier survival analyses and logrank testing.ResultsAt follow-up, 19% of the participants had received a DP award. In the logrank testing, ADHD was the only disorder associated with a subsequent DP, with 30% being disabled at follow-up (p = 0.01). Low psychosocial functioning (assessed by the Children’s Global Assessment Scale) at admission uniquely predicted future DP (p = 0.04).ConclusionsADHD in childhood was highly associated with later receiving a DP. Our finding of worse prognosis in ADHD compared with other internalizing and externalizing disorders in mid-adulthood supports the assumption of ADHD being specifically linked to working disability. Assessment of psychosocial functioning in addition to diagnostic features could enhance prediction of children who are most at risk of future disability.

Unemployment and disability pension-an 18-year follow-up study of a 40-year-old population in a Norwegian county

BackgroundThis study explored the association of unemployment and an increased risk of receiving disability pension, and the possibility that this risk is attributed to municipality-specific characteristics.MethodsA cohort of 7,985 40-42 year olds was followed for 18 years in national registers, identifying new episodes of unemployment and cases of disability pension. The association between an unemployment period and disability pension in the subsequent year was estimated using discrete time multilevel logistic regressions and clustering individuals by municipality. The association between unemployment and disability pension was adjusted for age in the follow up-period, sex, baseline health status, health behaviour and education level. A conditional intra-class correlation coefficient (ICC) was estimated as a measure of inter-municipality variance.ResultsIn the follow-up period, 2784 (35%) of the participants were granted disability pension. The crude odds ratio for receiving disability pension after unemployment (adjusted for age in follow-up period and sex only) was 1.42 (95% CI 1.1-1.8). Adjusting for baseline health indicators reduced the odds ratio of unemployment to 1.33 (CI 1.1-1.7). A fully adjusted model, including education level, further reduced the odds ratio of unemployment to 1.25 (CI 1.00-1.6). The ICC of the municipality level was approximately 2%.ConclusionsBecoming unemployed increased the risk of receiving subsequent disability pension. However, adjusting for baseline health status, health behaviour and education attenuated this impact considerably. The multilevel analysis indicated that a minor, yet statistically significant, proportion of the risk of disability pension can be attributed to the municipality of residence.