Disability pension due to common mental disorders and subsequent suicidal behaviour: a population-based prospective cohort study

• Published in: BMJ open Vol. 6; no. 4; p. e010152
• Main Authors: Rahman, Syed Ghulam, Alexanderson, Kristina, Jokinen, Jussi, Mittendorfer-Rutz, Ellenor
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 04.04.2016; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Adult; Age differences; Anxiety disorders; Cohort analysis; common mental disorder; Comorbidity; Country of birth; disability pension; Disability pensions; Disabled Persons - psychology; Female; Gender; Humans; Insurance agencies; Labor market; Male; Medicin och hälsovetenskap; Mental disorders; Mental Disorders - complications; Mental Health; Middle Aged; Multivariate Analysis; Pensions - statistics & numerical data; Population; Population-based studies; Prospective Studies; Regression Analysis; Risk Factors; Sick leave; Social research; Sociodemographics; Stress; suicide; Suicide - statistics & numerical data; suicide attempt; Suicide, Attempted - statistics & numerical data; Suicides & suicide attempts; Sweden - epidemiology; Young Adult; Sweden; disability pension; MENTAL HEALTH; Sick leave; suicide attempt; common mental disorder; suicide
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2015-010152

ObjectiveAdverse 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.DesignPopulation-based prospective cohort study based on Swedish nationwide registers.MethodsA 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.ResultsDuring 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).ConclusionsDepressive 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.