title: The role of psychiatric, cardiometabolic, and musculoskeletal comorbidity in the recurrence of depression-related work disability.
abstract: BACKGROUND
  Comorbid psychiatric disorders, cardiovascular disease, chronic hypertension, diabetes, and musculoskeletal disorders are highly prevalent in depression. However, the extent to which these conditions affect the recurrence of depression-related work disability is unknown. The specific aims of the study were to investigate the extent to which comorbid other psychiatric disorders, cardiometabolic, and musculoskeletal conditions were associated with the recurrence of depression-related work disability among employees who had returned to work after a depression-related disability episode.
  
  
  METHODS
  A cohort study of Finnish public sector employees with at least one depression-related disability episode during 2005-2011 after which the employee had returned to work (14,172 depression-related work disability episodes derived from national health and disability registers for 9,946 individuals). We used Cox proportional hazard models for recurrent events.
  
  
  RESULTS
  Depression-related work disability recurred in 35% of the episodes that had ended in return to work from a previous episode, totaling 4,927 recurrent episodes among 3,095 (31%) employees. After adjustment for sex, age, socioeconomic status, and type of employment contract, comorbid psychiatric disorder (hazard ratio = 1.82, 95% CI 1.68-1.97), cardiovascular disease (1.39, 95% CI 1.04-1.87), diabetes (1.43, 95% CI 1.11-1.85), chronic hypertension (1.33, 95% CI 1.11-1.58), and musculoskeletal disorder (1.17, 95% CI 1.06-1.28) were associated with an increased risk of a recurrent episode compared to those without these comorbid conditions.
  
  
  CONCLUSIONS
  Recurrence of depression-related work disability is common. Employees with comorbid psychiatric, cardiometabolic, or musculoskeletal conditions are at an increased risk of recurrent depression-related work disability episodes.
authors.affiliation: Development of Work and Organizations, Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Jenni
authors.initials: J
authors.lastname: Ervasti
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
authors.forename: Jaana
authors.initials: J
authors.lastname: Pentti
authors.forename: Tuula
authors.initials: T
authors.lastname: Oksanen
authors.forename: Kirsi
authors.initials: K
authors.lastname: Ahola
authors.forename: Teija
authors.initials: T
authors.lastname: Kivekäs
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.forename: Marianna
authors.initials: M
authors.lastname: Virtanen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008659:Metabolic Diseases / Q000453:epidemiology*; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: cardiovascular disease; comorbidity; depression; diabetes; hypertension; musculoskeletal disorder