Identification of alcohol abuse and transition from long-term unemployment to disability pension.
OBJECTIVE
The aim of the study was to reveal potential gaps and inconsistencies in the identification of alcohol abuse in health care and in employment services and to analyse the granting of disability pensions with respect to the alcohol abuse identification pattern.


METHODS
The material consisted of documentary information on 505 long-term unemployed subjects with low employability sent to the development project entitled 'Eligibility for a Disability Pension' in 2001-2006 in Finland. The dichotomous variables 'Alcohol abuse identified in employment services' and 'Alcohol abuse identified in health care' were cross-tabulated to obtain a four-class variable 'Alcohol abuse identification pattern'. Logistic regression analyses were conducted to ascertain the association of alcohol abuse identification pattern with the granting of disability pensions.


RESULTS
Alcohol abuse was detected by both health care and employment services in 47% of those identified as abusers (41% of examinees). Each service systems also identified cases that the other did not. When alcohol abuse was identified in health care only, the OR for a disability pension being granted was 2.8 (95% CI 1.5-5.2) compared with applicants without identified alcohol abuse. The result remained the same and statistically significant after adjusting for confounders.


CONCLUSIONS
Alcohol abuse identified in health care was positively associated with the granting of a disability pension. Closer co-operation between employment services and health care could help to identify those long-term unemployed individuals with impaired work ability in need of thorough medical examination.
School of Health Sciences, University of Tampere, Tampere, Finland Department of Adult Psychiatry, Tampere University Hospital, Tampere, Finland Non-Institutional Mental Health Services, City of Tampere, Finland kirsti.nurmela@staff.uta.fi.
Kirsti
K
Nurmela
School of Health Sciences, University of Tampere, Tampere, Finland Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland.
Virpi
V
Heikkinen
School of Health Sciences, University of Tampere, Tampere, Finland.
Risto
R
Hokkanen
Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Finland.
Aarne
A
Ylinen
School of Health Sciences, University of Tampere, Tampere, Finland Clinic of Occupational Medicine, Tampere University Hospital, Tampere, Finland Finnish Institute of Occupational Health, Tampere, Finland.
Jukka
J
Uitti
Department of Adult Psychiatry, Tampere University Hospital, Tampere, Finland.
Aino
A
Mattila
School of Health Sciences, University of Tampere, Tampere, Finland.
Matti
M
Joukamaa
School of Health Sciences, University of Tampere, Tampere, Finland Institute of advanced social research, University of Tampere, Tampere, Finland.
Pekka
P
Virtanen
D000328:Adult; D000437:Alcoholism / Q000175:diagnosis*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008875:Middle Aged; D010415:Pensions; D013997:Time Factors; D014478:Unemployment / Q000706:statistics & numerical data*; D014938:Work Capacity Evaluation; D055815:Young Adult
Alcohol abuse; disability pension; employment services; health care; identification; retirement; unemployment; work ability; work capacity evaluation