title: Early retirement in cancer patients with or without comorbid mental health conditions: a prospective cohort study.
abstract: BACKGROUND
  The authors investigated whether cancer patients who have comorbid mental health disorders (MD) are at greater risk of early retirement compared with those who do not have MD.
  
  
  METHODS
  Individuals ages 18 to 55 years from a consecutive sample of patients who were admitted for inpatient oncologic treatment were interviewed using structured clinical interviews to ascertain MD. The patients were followed for 15 months, and the date of early retirement was documented. Rates of early retirement per 100 person-years (py) in patients with and without MD were compared using multivariate Poisson regression models.
  
  
  RESULTS
  At baseline, 491 patients were interviewed, and 150 of those patients (30.6%) were diagnosed with MD. Forty-one patients began full early retirement during follow-up. In patients with MD, the incidence of early retirement was 9.3 per 100 py compared with 6.1 per 100 py in mentally healthy patients. The crude rate ratio (RR) was 1.5 (95% confidence interval [CI], 0.8-2.8). The effect of MD on early retirement was modified in part by income: in patients with low income, the adjusted RR was 11.7, whereas no effect was observed in higher income groups. Patients with depression were at greater risk of retirement when they had higher income (RR, 3.4; P = .05). The effects of anxiety (RR, 2.4; P = .05), adjustment disorders (RR, 1.7; P = .21), and alcohol dependence (RR, 1.8; P = .40) on early retirement were equal across income groups.
  
  
  CONCLUSIONS
  Mental health conditions are risk factors for early retirement in cancer patients, although this effect differs according to the type of disorder and the patient's income level.
authors.affiliation: Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center, Mainz, Germany; Division of Psychosocial Oncology, University of Leipzig, Leipzig, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Singer
authors.forename: Alexandra
authors.initials: A
authors.lastname: Meyer
authors.forename: Sabine
authors.initials: S
authors.lastname: Wienholz
authors.forename: Susanne
authors.initials: S
authors.lastname: Briest
authors.forename: Anna
authors.initials: A
authors.lastname: Brown
authors.forename: Andreas
authors.initials: A
authors.lastname: Dietz
authors.forename: Harald
authors.initials: H
authors.lastname: Binder
authors.forename: Sven
authors.initials: S
authors.lastname: Jonas
authors.forename: Kirsten
authors.initials: K
authors.lastname: Papsdorf
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Stolzenburg
authors.forename: Uwe
authors.initials: U
authors.lastname: Köhler
authors.forename: Jörg
authors.initials: J
authors.lastname: Raßler
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Zwerenz
authors.forename: Katharina
authors.initials: K
authors.lastname: Schröter
authors.forename: Anja
authors.initials: A
authors.lastname: Mehnert
authors.forename: Margrit
authors.initials: M
authors.lastname: Löbner
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
authors.forename: Steffi G
authors.initials: SG
authors.lastname: Riedel-Heller
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology; D001007:Anxiety / Q000453:epidemiology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D016017:Odds Ratio; D016012:Poisson Distribution; D011446:Prospective Studies; D012179:Retirement / Q000706:statistics & numerical data*
keywords: disability pension; mental health; neoplasms; occupation; psychiatric comorbidity; vocational rehabilitation