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Unemployment and initiation of psychotropic medication: a case-crossover study of 2 348 552 Norwegian employees
  1. Silje L Kaspersen1,2,
  2. Kristine Pape1,
  3. Solveig O Ose2,
  4. David Gunnell3,
  5. Johan Håkon Bjørngaard1,4
  1. 1Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
  2. 2Department of Health, SINTEF Technology & Society, Trondheim, Norway
  3. 3School of Social and Community Medicine, University of Bristol, Bristol, UK
  4. 4Forensic Department and Research Centre Bröset, St. Olav's University Hospital, Trondheim, Norway
  1. Correspondence to Silje L Kaspersen, Department of Public Health and General Practice, Norwegian University of Science and Technology, P.O. Box 8905, Trondheim 7491, Norway; silje.kaspersen{at}


Objectives The study investigated initiation of psychotropic medication in relation to unemployment in the months before, during and after job loss, to detect the period of greatest risk.

Methods The Norwegian working population in 2004 (N=2 348 552) was observed from 2005 to 2010 through administrative registries linked to the Norwegian Prescription Database. A case-crossover design was used to analyse within-person relative risk of incident purchases of prescribed psychotropic drugs in relation to timing of unemployment. Control periods were defined 12, 24 and 36 months before the drug purchase. Supplementary analyses were performed on medication for cardiovascular disease, diabetes, obesity, thyroid disorder, pain and musculoskeletal conditions.

Results Purchases of all psychotropic drugs increased 1–3 months before job loss. Antidepressants had the highest estimate in the month before job loss (OR 2.68, 95% CIs 2.39 to 3.01), followed by hypnotics/sedatives (OR 2.21, 95% CI 1.97 to 2.48), anxiolytics (OR 2.18, 95% CI 1.91 to 2.48) and antipsychotics (OR 2.09, 95% CI 1.76 to 2.48). Rises were greatest in men. Risk of starting psychotropic medication remained raised during a spell of unemployment, but returned to close-to-baseline levels following re-employment. Drugs used to treat somatic and pain conditions showed similar trends but with weaker associations.

Conclusions Concerns about impending unemployment may influence mental health several months prior to job loss, especially around the time of notification. The clinical implications of this might be a strengthening of preventive health initiatives early in the unemployment process.

  • Depression
  • Job insecurity
  • Job loss
  • Anxiety
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  • Contributors SLK designed the study protocol, administered the data collection process, wrote the statistical analysis plan/PhD protocol (in which the study was included), cleaned and analysed the data, and wrote most of the text in the paper. She is guarantor. KP and JHB contributed in designing the PhD protocol, analysed the data, and drafted and revised the paper. SOO contributed by designing the PhD protocol, gave suggestions on data purchases and drafted and revised the paper. DG gave advices in the analysis process, drafted and revised the paper. Consultants at Statistics Norway and the Norwegian Prescription Database prepared the data, including identifying the study participants in the registries and cooperated on registry linkages. We would also like to thank the three reviewers who contributed with useful comments in the review process.

  • Funding The study was part of the corresponding author's PhD project (project number 25052900) funded by the Liaison Committee between the Central Norway Regional Health Authority and the Norwegian University of Science and Technology (NTNU), including funding of data collection and registry linkage. All coauthors declare that the present study was performed independent of funders.

  • Competing interests All authors confirm that the recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals (ICMJE Recommendations 2013) were followed. We declare that (1) SLK and KP have support from the Liaison Committee between the Central Norway Regional Health Authority and the Norwegian University of Science and Technology (PhD position and postdoctoral funding) for the submitted work; (2) SLK, KP, SOO, DG and JHB have no relationships with any companies that might have an interest in the submitted work in the previous 3 years; (3) their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; (4) DG is a NIHR Senior Investigator; (5) SLK is an employee (researcher) at SINTEF Technology and Society, Department of Health. The authors declare no other relationships or activities that could appear to have influenced the submitted work.

  • Ethics approval The study was approved by the Norwegian Regional Committee for Medical Research Ethics (ref 2012/1941b).

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

  • Data sharing statement No additional data is available due to restrictions from the Norwegian Data Protection Authority (Reference 13/00023-2/EOL).

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