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Original article
Socio-economic differences in long-term psychiatric work disability: prospective cohort study of onset, recovery and recurrence
  1. Marianna Virtanen1,
  2. Ichiro Kawachi2,
  3. Tuula Oksanen1,2,
  4. Paula Salo1,
  5. Katinka Tuisku1,3,
  6. Laura Pulkki-Råback1,4,
  7. Jaana Pentti1,
  8. Marko Elovainio5,
  9. Jussi Vahtera1,6,
  10. Mika Kivimäki1,4,7
  1. 1Unit of Expertise in Work and Organizations, Finnish Institute of Occupational Health, Helsinki, Finland
  2. 2Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA
  3. 3Department of Psychiatry, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
  4. 4Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
  5. 5Department of Service System, National Institute for Health and Welfare, Helsinki, Finland
  6. 6Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
  7. 7Department of Epidemiology and Public Health, University College London, London, UK
  1. Correspondence to Dr Marianna Virtanen, Finnish Institute of Occupational Health, Unit of Expertise in Work and Organizations, Topeliuksenkatu 41 a A, FIN-00250 Helsinki, Finland; marianna.virtanen{at}ttl.fi

Abstract

Objectives To examine the associations between socio-economic position (SEP) and the onset of psychiatric work disability, return to work and recurrence of disability.

Methods Prospective observational cohort study (1997–2005) including register data on 141 917 public-sector employees in Finland. Information on International Classification of Diseases, 10th Revision diagnosis-specific psychiatric work disability (≥90 days) was obtained from national registers.

Results During a mean follow-up of 6.3 years, 3938 (2.8%) participants experienced long-term psychiatric work disability. Of these, 2418 (61%) returned to work, and a further 743 (31%) experienced a recurrent episode. SEP was inversely associated with onset of disability owing to depressive disorders, anxiety disorders, personality disorders, schizophrenia and substance-use disorders. No association was found between SEP and disability owing to bipolar disorders or reaction to severe stress and adjustment disorders. High SEP was associated with a greater likelihood of a return to work following depressive disorders, personality disorders, schizophrenia and substance-use disorders, but not bipolar disorders, anxiety disorders or reaction to severe stress and adjustment disorders. Low SEP predicted recurrent episodes of work disability.

Conclusions High SEP is associated with lower onset of work disability owing to mental disorders, as well as return to work and lower rates of recurrence. However, the socio-economic advantage is diagnosis-specific. SEP predicted neither the onset and recovery from disability owing to bipolar disorders and reaction to severe stress and adjustment disorders, nor recovery from disability owing to anxiety disorders. SEP should be taken into account in the attempts to reduce long-term work disability owing to mental disorders.

  • Disability
  • inequalities
  • mental health
  • return to work
  • socio-economic
  • epidemiology
  • psychiatry
  • disability
  • longitudinal studies

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Footnotes

  • Funding The study was supported by Academy of Finland (grant nos 124322, 124271, 123621, 133535 and 129262) and the BUPA Foundation, UK.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Ethics Committee of the Finnish Institute of occupational health, Helsinki, Finland.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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