title: Disability pension due to common mental disorders and subsequent suicidal behaviour: a population-based prospective cohort study.
abstract: OBJECTIVE
  Adverse health outcomes, including suicide, in individuals on disability pension (DP) due to mental diagnoses have been reported. However, scientific knowledge on possible risk factors for suicidal behaviour (suicide attempt and suicide) in this group, such as age, gender, underlying DP diagnoses, comorbidity and DP duration and grade, is surprisingly sparse. This study aimed to investigate associations of different measures (main and secondary diagnoses, duration and grade) of DP due to common mental disorders (CMD) with subsequent suicidal behaviour, considering gender and age differences.
  
  
  METHODS
  Population-based prospective cohort study based on Swedish nationwide registers.
  
  
  METHODS
  A cohort of 46,515 individuals aged 19-64 years on DP due to CMD throughout 2005 was followed-up for 5 years. In relation to different measures of DP, univariate and multivariate HRs and 95% CIs for suicidal behaviour were estimated by Cox regression. All analyses were stratified by gender and age.
  
  
  RESULTS
  During 2006-2010, 1036 (2.2%) individuals attempted and 207 (0.5%) completed suicide. Multivariate analyses showed that a main DP diagnosis of 'stress-related mental disorders' was associated with a lower risk of subsequent suicidal behaviour than 'depressive disorders' (HR range 0.4-0.7). Substance abuse or personality disorders as a secondary DP diagnosis predicted suicide attempt in all subgroups (HR range 1.4-2.3) and suicide in women and younger individuals (HR range 2.6-3.3). Full-time DP was associated with a higher risk of suicide attempt compared with part-time DP in women and both age groups (HR range 1.4-1.7).
  
  
  CONCLUSIONS
  Depressive disorders as the main DP diagnosis and substance abuse or personality disorders as the secondary DP diagnosis were risk markers for subsequent suicidal behaviour in individuals on DP due to CMD. Particular attention should be paid to younger individuals on DP due to anxiety disorders because of the higher suicide risk.
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Syed Ghulam
authors.initials: SG
authors.lastname: Rahman
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Alexanderson
authors.affiliation: Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
authors.forename: Jussi
authors.initials: J
authors.lastname: Jokinen
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ellenor
authors.initials: E
authors.lastname: Mittendorfer-Rutz
mesh_terms: D000328:Adult; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D015999:Multivariate Analysis; D010415:Pensions / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
keywords: MENTAL HEALTH; Sick leave; common mental disorder; disability pension; suicide; suicide attempt