Differences in predictors of permanent work disability between immigrants and natives: a cohort study of adults with sick leave due to common mental disorders.
Immigrants with common mental disorders (CMDs) are reported to have a higher risk of disability pension (DP) compared with native residents; however, the reasons for this are not fully understood. This study aimed to investigate (1) differences in morbidity (3 measures) and socioeconomic status in native Swedes, 'Western' and 'non-Western' immigrants with CMDs and (2) interactions between morbidity and socioeconomic status and immigrant status regarding subsequent DP.



The study was a prospective population-based cohort study using national register data. Crude and multivariate HRs with 95% CIs were calculated using the Cox regression (2007-2010).



All individuals aged 18-59 with an incident sick-leave spell due to CMDs during 2006 were included in the study (N=66 097). The study population was divided into 3 groups based on country of birth: (1) Sweden, (2) immigrants from 'Western' countries (EU25, Norway, Iceland, North America and Oceania) and (3) immigrants from 'non-Western' countries (east Europe, Africa, Asia and South America).



Particularly, immigrants born in non-Western countries had higher levels of morbidity and lower socioeconomic status than natives (p>0.001). No significant differences in the associations between specialised psychiatric and somatic care with regard to subsequent DP were found between immigrants and native Swedes. Being prescribed more than 1 type of psychiatric medication was associated with higher HRs for DP in immigrants from Western (HR 3.34; CI 2.3 to 4.9) and non-Western countries (3.6; 1.9 to 6.4) than in native Swedes (2.55; 2.3 to 2.8) (pinteraction=0.003). Low education was a marginally stronger predictor for DP in non-Western immigrants than in native Swedes and Western immigrants (pinteraction=0.03).



Morbidity measured by medication, but not by specialised healthcare, was a stronger predictor for DP in immigrants than in native Swedes, warranting scrutiny of differences in care and treatment in immigrants and native Swedes with CMDs.
Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Laura
L
Werlen
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
Magnus
M
Helgesson
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
Ellenor
E
Mittendorfer-Rutz
D000293:Adolescent; D000328:Adult; D000349:Africa; D000569:Americas; D001208:Asia; D006233:Persons with Disabilities; D054242:Emigrants and Immigrants; D005006:Ethnicity; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000188:drug therapy; D008875:Middle Aged; D044349:Oceania; D010415:Pensions; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D018582:Sick Leave; D012923:Social Class; D013548:Sweden; D055815:Young Adult
Common Mental Disorders; Disability, Insurance; Emigrants and Immigrants; Psychotropic Drugs; Sick Leave