title: Association of socio-demographic factors, sick-leave and health care patterns with the risk of being granted a disability pension among psychiatric outpatients with depression.
abstract: BACKGROUND
  Depression ranges among the leading causes of early exit from the labor market worldwide. We aimed to investigate the associations of socio-demographic factors, sickness absence, health care and prescription patterns with the risk of being granted a disability pension in psychiatric outpatients with depression.
  
  
  METHODS
  All non-retired patients aged 18-60 years and living in Sweden 31.12.2005 with at least one psychiatric outpatient care visit due to a depressive episode during 2006 (N = 18,034): were followed from 01.01.2007 to 31.12.2010 with regard to granting of all-cause and diagnosis-specific disability pension. Uni- and multivariate Rate Ratios (RR) and 95% Confidence Intervals (CI) were estimated for the various risk markers by Poisson Regression.
  
  
  RESULTS
  During the four years of follow-up, 3044 patients (16.8%) were granted a disability pension, the majority due to mental disorders (2558, 84%). In the multivariate analyses, being female, below 25 or above 45 years of age, with low educational level, living alone, residing outside big cities and being born outside Europe were predictive of a granted disability pension. Frequent in- and outpatient care due to mental disorders, prescription of antidepressants and long sickness absence spells were also associated with an increased risk of disability pension (range of RRs 1.10 to 5.26). Somatic health care was only predictive of disability pension due to somatic disorders. The risk of being granted a disability pension remained at the same level as at the start of follow-up for about 1.5 years, when it started to decrease and to level off at about 20% of the risk at the end of follow-up.
  
  
  CONCLUSIONS
  Identified risk markers should be considered when monitoring individuals with depression and when designing intervention programs.
authors: Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
authors: Ellenor
authors: E
authors: Mittendorfer-Rutz
authors: National Institute for Health and Welfare, Helsinki, Finland.
authors: Tommi
authors: T
authors: Härkänen
authors: Department of Clinical Neuroscience, Centre for psychiatric research, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Kuopio, Finland.
authors: Jari
authors: J
authors: Tiihonen
authors: Faculty of Medicine, Department of Public Health, University of Helsinki, Helsinki, Finland.
authors: Jari
authors: J
authors: Haukka
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology*; D006233:Persons with Disabilities; D005260:Female; D005500:Follow-Up Studies; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008875:Middle Aged; D010045:Outpatients; D010415:Pensions / Q000706:statistics & numerical data*; D011379:Prognosis; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data / Q000639:trends*; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult