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Original research
Employment and earnings trajectories before and after sickness absence due to major depressive disorder: a nationwide case–control study
  1. Christian Hakulinen1,2,
  2. Petri Böckerman3,4,5,
  3. Laura Pulkki-Råback1,6,
  4. Marianna Virtanen7,8,
  5. Marko Elovainio1,2,9
  1. 1 Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
  2. 2 Service System Research Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
  3. 3 Labour Institute for Economic Research, Helsinki, Finland
  4. 4 School of Business and Economics, University of Jyväskylä, Jyväskylä, Finland
  5. 5 IZA (Institute for the Study of Labor), Bonn, Germany
  6. 6 Department of Child Psychiatry, University of Turku, Turku, Finland
  7. 7 School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
  8. 8 Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
  9. 9 Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
  1. Correspondence to Dr Christian Hakulinen, Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland; christian.hakulinen{at}


Objectives To examine employment and earnings trajectories before and after the first sickness absence period due to major depressive disorder (MDD).

Methods All individuals (n=158 813) in Finland who had a first sickness absence period (lasting longer than 9 days) due to MDD between 2005 and 2015 were matched with one randomly selected individual of the same age and gender with no history of MDD. Employment status and earnings were measured using register-based data annually from 2005 to 2015. Generalised estimating equations were used to examine the trajectories of employment and earnings before and after MDD diagnosis in men and women separately.

Results Sickness absence due to MDD was associated with increased probability of non-employment during and after the year of the first sickness absence period. In men, but not in women, the probability of being employed was lower 5 years before the sickness absence period due to MDD. When compared with the individuals in the control group, men had around 34% and women 15% lower earnings 1 year, and 40% and 23%, respectively, 5 years, after the first sickness absence period due to MDD. More severe MDD and longer duration of sickness absence period were associated with lower probability of being employed.

Conclusions Sickness absence due to MDD was associated with considerable reduction in employment and earnings losses. For men and individuals with more severe MDD, this reduction was before the first sickness period. This supports a reciprocal association between employment and earnings with MDD.

  • epidemiology
  • mental health
  • psychiatry
  • sickness absence

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  • Twitter @chakulinen, @pbockerman, @mariannavirta

  • Contributors CH analysed the data and wrote the first draft of the manuscript. All authors contributed to the concept and design of the study, interpretation of the results, manuscript revision and approved the final version of the manuscript. CH is the guarantor.

  • Funding This work was supported by the Academy of Finland (310 591 to CH), the Academy of Finland Flagship Programme (320162), Palkansaajasäätiö and the Yrjö Jahnsson Foundation.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The ethics committee of the Finnish Institute of Health and Welfare (THL/730/6.02.01/2018) approved the study. Data were linked with the permission of the Statistics Finland (TK-53-1696-16), the National Institute of Health and Welfare, and the Social Insurance Institution of Finland.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.