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Mental disorders and suicidal behavior in refugees and Swedish-born individuals: is the association affected by work disability?

Authors
  • Björkenstam, Emma1, 2, 3
  • Helgesson, Magnus4
  • Amin, Ridwanul4
  • Lange, Theis5, 6
  • Mittendorfer-Rutz, Ellenor4
  • 1 Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden. [email protected] , (Sweden)
  • 2 Department of Community Health Sciences, Fielding School of Public Health and California Center for Population Research, University of California Los Angeles, Los Angeles, CA, USA. [email protected]
  • 3 Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden. [email protected] , (Sweden)
  • 4 Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden. , (Sweden)
  • 5 Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark. , (Denmark)
  • 6 Center for Statistical Science, Peking University, Beijing, China. , (China)
Type
Published Article
Journal
Social psychiatry and psychiatric epidemiology
Publication Date
Aug 01, 2020
Volume
55
Issue
8
Pages
1061–1071
Identifiers
DOI: 10.1007/s00127-019-01824-5
PMID: 31897579
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Among potential pathways to suicidal behavior in individuals with mental disorders (MD), work disability (WD) may play an important role. We examined the role of WD in the relationship between MD and suicidal behavior in Swedish-born individuals and refugees. The study cohort consisted of 4,195,058 individuals aged 16-64, residing in Sweden in 2004-2005, whereof 163,160 refugees were followed during 2006-2013 with respect to suicidal behavior. Risk estimates were calculated as hazard ratios (HR) with 95% confidence intervals (CI). The reference groups comprised individuals with neither MD nor WD. WD factors (sickness absence (SA) and disability pension (DP)) were explored as potential modifiers and mediators. In both Swedish-born and refugees, SA and DP were associated with an elevated risk of suicide attempt regardless of MD. In refugees, HRs for suicide attempt in long-term SA ranged from 2.96 (95% CI: 2.14-4.09) (no MD) to 6.23 (95% CI: 3.21-12.08) (MD). Similar associations were observed in Swedish-born. Elevated suicide attempt risks were also observed in DP. In Swedish-born individuals, there was a synergy effect between MD, and SA and DP regarding suicidal behavior. Both SA and DP were found to mediate the studied associations in Swedish-born, but not in refugees. There is an effect modification and a mediating effect between mental disorders and WD for subsequent suicidal behavior in Swedish-born individuals. Also for refugees without MD, WD is a risk factor for subsequent suicidal behavior. Particularly for Swedish-born individuals with MD, information on WD is vital in a clinical suicide risk assessment.

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