title: Medical and Social Determinants of Subsequent Labour Market Marginalization in Young Hospitalized Suicide Attempters.
abstract: BACKGROUND
  Individuals with a history of suicide attempt have a high risk for subsequent labour market marginalization. This study aimed at assessing the effect of individual and parental factors on different measures of marginalization.
  
  
  METHODS
  Prospective cohort study based on register linkage of 5 649 individuals who in 1994 were 16-30 years old, lived in Sweden and were treated in inpatient care for suicide attempt during 1992-1994. Hazard ratios (HRs) for labour market marginalization defined as long-term unemployment (>180 days), sickness absence (>90 days), or disability pension in 1995-2010 were calculated with Cox regression.
  
  
  RESULTS
  Medical risk factors, particularly any earlier diagnosed specific mental disorders (e.g., schizophrenia: HR 5.4 (95% CI: 4.2, 7.0), personality disorders: HR 3.9, 95% CI: 3.1, 4.9), repetitive suicide attempts (HR 1.6, 95% CI: 1.4, 1.9) were associated with a higher relative risk of disability pension. Individual medical factors were of smaller importance for long-term sickness absence, and of only marginal relevance to long-term unemployment. Country of birth outside Europe had an opposite effect on disability pension (HR 0.6, 95% CI: 0.4, 0.8) and long-term unemployment (HR 1.5, 95% CI: 1.3, 1.8). Female sex was positively correlated with long-term sickness absence (HR 1.6, 95% CI: 1.4, 1.7), and negatively associated with long-term unemployment (HR: 0.8, 95% CI: 0.7, 0.9).
  
  
  CONCLUSIONS
  As compared to disability pension, long-term sickness absence and unemployment was more strongly related to socio-economic variables. Marginalization pathways seemed to vary with migration status and sex. These findings may contribute to the development of intervention strategies which take the individual risk for marginalization into account.
authors.affiliation: Medical University Vienna, Center for Public Health, Institute of Social Medicine, Suicide Research Unit, Vienna, A-1090 Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Niederkrotenthaler
authors.affiliation: Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, 17 177 Stockholm, Sweden.|The Swedish Red Cross University College, Stockholm, Sweden.
authors.forename: Petter
authors.initials: P
authors.lastname: Tinghög
authors.affiliation: University of California, Merced, Merced, CA 95343, United States of America.
authors.forename: Sidra
authors.initials: S
authors.lastname: Goldman-Mellor
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, MD 21205, United States of America.
authors.forename: Holly C
authors.initials: HC
authors.lastname: Wilcox
authors.affiliation: Columbia University, NYS Psychiatric Institute, New York, NY 10032, United States of America.
authors.forename: Madelyn
authors.initials: M
authors.lastname: Gould
authors.affiliation: Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, 17 177 Stockholm, Sweden.
authors.forename: Ellenor
authors.initials: E
authors.lastname: Mittendorfer-Rutz
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D008297:Male; D010415:Pensions / Q000706:statistics & numerical data; D062707:Return to Work / Q000706:statistics & numerical data; D012737:Sex Factors; D013406:Suicide, Attempted / Q000191:economics* / Q000523:psychology / Q000706:statistics & numerical data; D013548:Sweden; D014478:Unemployment / Q000706:statistics & numerical data*