Scandinavia, in common with much of Europe and the USA, is facing a conundrum: despite better health, more automation and less manual work, an increasing proportion of the working-age population is economically inactive and in receipt of disability benefits.1 ,2 The diagnosis associated with much of this increase is mental disorders, depression in particular, although the prevalence of mental disorders has not increased significantly among the general population.2 Increasing rates of disability pension in the young are particularly alarming; in Sweden, for example, newly granted pensions for mental disorders rose over fivefold (approximately 50/100 000 to over 250/100 000) in women aged 20–29 between 1990 and 2005.3

The systematic review and meta-analyses of Van Rijn et al in this edition of OEM examine associations between three health indicators (poor self-perceived health, poor mental health and self-reported chronic disease) and three subsequent routes of labour force exit; unemployment, disability pension and early retirement. The majority (29/44) of studies in this review are from Scandinavia; the rest from Europe and the USA.4

The results of this meta-analysis shed some light on the healthy population–high disability paradox. While the pooled relative risk of a disability pension was 80% higher among employees with pre-existing mental ill-health compared with those without, the mean population attributable fraction (PAF) was 11%, indicating that poor mental health made only a modest contribution to the decision …