title: Socio-economic differences in long-term psychiatric work disability: prospective cohort study of onset, recovery and recurrence.
abstract: OBJECTIVE
  To examine the associations between socio-economic position (SEP) and the onset of psychiatric work disability, return to work and recurrence of disability.
  
  
  METHODS
  Prospective observational cohort study (1997-2005) including register data on 141 917 public-sector employees in Finland. Information on International Classification of Diseases, 10th Revision diagnosis-specific psychiatric work disability (≥90 days) was obtained from national registers.
  
  
  RESULTS
  During a mean follow-up of 6.3 years, 3938 (2.8%) participants experienced long-term psychiatric work disability. Of these, 2418 (61%) returned to work, and a further 743 (31%) experienced a recurrent episode. SEP was inversely associated with onset of disability owing to depressive disorders, anxiety disorders, personality disorders, schizophrenia and substance-use disorders. No association was found between SEP and disability owing to bipolar disorders or reaction to severe stress and adjustment disorders. High SEP was associated with a greater likelihood of a return to work following depressive disorders, personality disorders, schizophrenia and substance-use disorders, but not bipolar disorders, anxiety disorders or reaction to severe stress and adjustment disorders. Low SEP predicted recurrent episodes of work disability.
  
  
  CONCLUSIONS
  High SEP is associated with lower onset of work disability owing to mental disorders, as well as return to work and lower rates of recurrence. However, the socio-economic advantage is diagnosis-specific. SEP predicted neither the onset and recovery from disability owing to bipolar disorders and reaction to severe stress and adjustment disorders, nor recovery from disability owing to anxiety disorders. SEP should be taken into account in the attempts to reduce long-term work disability owing to mental disorders.
authors.affiliation: Unit of Expertise in Work and Organizations, Finnish Institute of Occupational Health, Helsinki, Finland. marianna.virtanen@ttl.fi
authors.forename: Marianna
authors.initials: M
authors.lastname: Virtanen
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.forename: Tuula
authors.initials: T
authors.lastname: Oksanen
authors.forename: Paula
authors.initials: P
authors.lastname: Salo
authors.forename: Katinka
authors.initials: K
authors.lastname: Tuisku
authors.forename: Laura
authors.initials: L
authors.lastname: Pulkki-Råback
authors.forename: Jaana
authors.initials: J
authors.lastname: Pentti
authors.forename: Marko
authors.initials: M
authors.lastname: Elovainio
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
mesh_terms: D000041:Absenteeism; D000328:Adult; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000534:rehabilitation; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012923:Social Class