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The importance of clinical and labour market histories in psychiatric disability retirement: analysis of the comprehensive Finnish national-level RETIRE data.

Authors
  • Pirkola, S1, 2
  • Nevalainen, J3
  • Laaksonen, M4
  • Fröjd, S3
  • Nurmela, K3
  • Näppilä, T3
  • Tuulio-Henriksson, A5
  • Autio, R3
  • Blomgren, J6
  • 1 Faculty of Social Sciences, Health Sciences Unit, Tampere University, Arvo Ylpön Katu 34, 33014, Tampereen Yliopisto, Finland. [email protected] , (Finland)
  • 2 Department of Psychiatry, Tampere University Central Hospital, Tampere, Finland. [email protected] , (Finland)
  • 3 Faculty of Social Sciences, Health Sciences Unit, Tampere University, Arvo Ylpön Katu 34, 33014, Tampereen Yliopisto, Finland. , (Finland)
  • 4 The Finnish Centre for Pensions, Helsinki, Finland. , (Finland)
  • 5 Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland. , (Finland)
  • 6 The Social Insurance Institution of Finland, Helsinki, Finland. , (Finland)
Type
Published Article
Journal
Social psychiatry and psychiatric epidemiology
Publication Date
Aug 01, 2020
Volume
55
Issue
8
Pages
1011–1020
Identifiers
DOI: 10.1007/s00127-019-01815-6
PMID: 31807792
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Despite the stable incidence of mental disorders in Finland and Europe, mental health-related occupational disability has been increasing. We unveiled the paths to permanent psychiatric disability, recovery, or death, by analysing sequences of labour market participation. The RETIRE register database includes information regarding all persons (n = 42,170) awarded an ICD-10 psychiatric disability pension between 2010 and 2015 in Finland. We identified clusters of typical paths of pre-retirement labour market history. Controlling for major mental disorders, age, and sex, we evaluated factors associated with returning to work (RTW), or death, over a 5-year follow-up period. Only 10.5% of the disabled subjects returned to work within the follow-up. Half of them ended up with a permanent disability pension. Seven distinguishable paths to disability were identified. Subjects in the cluster characterized by steady employment were relatively often females, lost their work ability due to affective disorders, and had the highest rate of returning to work (16.3%). Mortality was highest (9%) among the cluster characterized by long-term unemployment. Distributions of major diagnostic groups, as well as age and sex, differed between clusters. After their adjustment in the analysis of RTW or death, the identified labour market history paths prior to losing work ability remained as important independent prognostic factors for both outcomes. The complex retirement process involves identifiable clinical and contextual associating factors. Labour market history patterns associate with varying prognoses after psychiatric retirement. Prolonged unemployment appears as a predictor of relatively poor prognoses, whereas employment indicates the opposite.

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