title: Trajectories of Work-Related Functional Impairment prior to Suicide.
abstract: BACKGROUND
  Work-related functional impairment in terms of sickness absence and disability pension (SA/DP) has been reported to be associated with subsequent suicide. However, there is only limited knowledge on SA/DP patterns prior to suicide. The aim was to identify trajectories of work-related functional impairment prior to suicide and to describe associations of socio-demographic and medical factors with such trajectories.
  
  
  METHODS
  This is a population-based retrospective cohort study of the 4 209 individuals aged 22-65 years who committed suicide during 2007-2010 in Sweden. Work-related functional impairment was measured as mean annual number of months of SA/DP. We analyzed trajectories of SA/DP during five years prior to suicide (i.e., 2002-2009) by a group-based trajectory method. Associations between socio-demographic and medical factors with different groups of trajectories were estimated by chi2-test and multinomial logistic regression.
  
  
  RESULTS
  Five different functional impairment trajectory groups were identified prior to suicide. One group had constant low levels of SA/DP (46%), while 30% had constant high levels of SA/DP. Two groups (16%) showed increasing number of SA/DP months. The remaining 7% showed decreasing number of SA/DP months before the suicide. Sex, age, educational level, family situation, and diagnosis-specific healthcare were significantly associated with different trajectory groups (Likelihood ratio X2 tests <0.05). A larger proportion of higher educated and younger men with a lower proportion of previous suicide attempts were found in the group with constant low levels. Opposite characteristics were displayed in the group with constant high levels.
  
  
  CONCLUSIONS
  This study identified five different groups of work-related functional impairment trajectories before suicide. These differences might be partly explained by the variations in socio-demographic profiles and health care consumptions five years before suicide.
authors.affiliation: Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mo
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Björkenstam
authors.affiliation: Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Alexanderson
authors.affiliation: Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Runeson
authors.affiliation: Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Petter
authors.initials: P
authors.lastname: Tinghög
authors.affiliation: Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ellenor
authors.initials: E
authors.lastname: Mittendorfer-Rutz
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000328:Adult; D000368:Aged; D006233:Persons with Disabilities / Q000523:psychology / Q000706:statistics & numerical data; D004651:Employment / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010415:Pensions / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult