title: Common mental disorders and disability pension award: seven year follow-up of the HUSK study.
abstract: OBJECTIVE
  Rates of disability pension (DP) awards remain high in most developed countries. We aimed to estimate the impact of anxiety and depression on DPs awarded both for mental and for physical diagnoses and to estimate the relative contribution of sub case-level anxiety and depression compared with case-level symptom loads.
  
  
  METHODS
  Information from a large cohort study on mental and physical health in individuals aged 40-46 (N=15,288) was linked to a comprehensive national database of disability benefits. Case-level and sub case-level anxiety and depression were defined as scores on the Hospital Anxiety and Depression Scale of >or=8 and 5-7, respectively. The outcome was incident award of a DP (including ICD-10 diagnosis) during 1-7-year follow-up.
  
  
  RESULTS
  DP awards for all diagnoses were predicted both from case-level anxiety [HR 1.90 (95% CI 1.50-2.41)], case-level depression [HR 2.44 (95% CI 1.65-3.59] and comorbid anxiety and depression [HR 4.92 (95% CI 3.94-6.15)] at baseline. These effects were only partly accounted for by adjusting for baseline somatic symptoms and diagnoses. Anxiety and depression also predicted awards for physical diagnoses [HR 3.26 (95% CI 2.46-4.32)]. The population attributable fractions (PAF) of sub case-level anxiety and depression symptom loads were comparable to those from case-level symptom loads (PAF anxiety 0.07 versus 0.11, PAF depression 0.05 versus 0.06).
  
  
  CONCLUSIONS
  The long-term occupational impact of symptoms of anxiety and depression is currently being underestimated. Sub case-level symptom loads of anxiety and depression make an important and previously unmeasured contribution to DP awards.
authors.affiliation: Research Section of Mental Health Epidemiology, Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway. Ann.Knudsen@psych.uib.no
authors.forename: Ann Kristin
authors.initials: AK
authors.lastname: Knudsen
authors.forename: Simon
authors.initials: S
authors.lastname: Øverland
authors.forename: Helene Flood
authors.initials: HF
authors.lastname: Aakvaag
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Harvey
authors.forename: Matthew
authors.initials: M
authors.lastname: Hotopf
authors.forename: Arnstein
authors.initials: A
authors.lastname: Mykletun
mesh_terms: D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015331:Cohort Studies; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D004185:Disability Evaluation; D004608:Eligibility Determination; D005260:Female; D006801:Humans; D018868:Insurance, Disability / Q000706:statistics & numerical data*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D009664:Norway; D010415:Pensions / Q000706:statistics & numerical data*; D012803:Sick Role