title: Depression- and anxiety-related sick leave and the risk of permanent disability and mortality in the working population in Germany: a cohort study.
abstract: BACKGROUND
  Anxiety and depression are the most common psychiatric disorders and are the cause of a large and increasing amount of sick-leave in most developed countries. They are also implicated as an increasing mortality risk in community surveys. In this study we addressed, whether sick leave due to anxiety, depression or comorbid anxiety and depression was associated with increased risk of retirement due to permanent disability and increased mortality in a cohort of German workers.
  
  
  METHODS
  128,001 German workers with statutory health insurance were followed for a mean of 6.4 years. We examined the associations between 1) depression/anxiety-related sick leave managed on an outpatient basis and 2) anxiety/depression-related psychiatric inpatient treatment, and later permanent disability/mortality using Cox proportional hazard regression models (stratified by sex and disorder) adjusted for age, education and job code classification.
  
  
  RESULTS
  Outpatient-managed depression/anxiety-related sick leave was significantly associated with higher permanent disability (hazard ratio (95% confidence interval)) 1.48 (1.30, 1.69) for depression, 1.25 (1.07, 1.45) for anxiety, 1.91 (1.56, 2.35) for both). Among outpatients, comorbidly ill men (2.59 (1.97,3.41)) were more likely to retire early than women (1.42 (1.04,1.93)). Retirement rates were higher for depressive and comorbidly ill patients who needed inpatient treatment (depression 3.13 (2,51, 3,92), both 3.54 (2.80, 4.48)). Inpatient-treated depression was also associated with elevated mortality (2.50 (1.80, 3.48)). Anxiety (0.53 (0.38, 0.73)) and female outpatients with depression (0.61 (0.38, 0.97)) had reduced mortality compared to controls.
  
  
  CONCLUSIONS
  Depression/anxiety diagnoses increase the risk of early retirement; comorbidity and severity further increase that risk, depression more strikingly than anxiety. Sickness-absence diagnoses of anxiety/depression identified a population at high risk of retiring early due to ill health, suggesting a target group for the development of interventions.
authors: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Centre for Mental Health, Carl-Neuberg-Str, 1, 30625, Hannover, Germany. wedegaertner.felix@mh-hannover.de
authors: Felix
authors: F
authors: Wedegaertner
authors: Sonja
authors: S
authors: Arnhold-Kerri
authors: Nicola-Alexander
authors: NA
authors: Sittaro
authors: Stefan
authors: S
authors: Bleich
authors: Siegfried
authors: S
authors: Geyer
authors: William E
authors: WE
authors: Lee
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D003866:Depressive Disorder / Q000453:epidemiology* / Q000401:mortality; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D012179:Retirement / Q000706:statistics & numerical data*; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data*