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BMC Psychiatry
Published in: BMC Psychiatry 1/2018

Open Access 01-12-2018 | Research article

Trajectories of antidepressant medication use in individuals before and after being granted disability pension due to common mental disorders- a nationwide register-based study

Authors: Syed Rahman, Michael Wiberg, Kristina Alexanderson, Jussi Jokinen, Antti Tanskanen, Ellenor Mittendorfer-Rutz

Published in: BMC Psychiatry | Issue 1/2018

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Abstract

Background

Early retirement caused by disability pension (DP) due to common mental disorders (CMDs) is frequent in European countries. Inadequate treatment, e.g., suboptimal antidepressant (AD) medication before DP can be crucial in such DP. This explorative study aimed to disentangle trajectories of AD based on defined daily dose (DDD) before and after granted DP, and to characterize the trajectories by socio-demographics and medical factors.

Methods

All 4642 individuals in Sweden aged 19–64 with incident DP due to CMD in 2009–2010 were included. Trajectories of annual DDDs of AD were analysed over a 6-year period by a group-based trajectory method. Associations between socio-demographic or medical factors and different trajectories were estimated by chi2-test and multinomial logistic regression.

Results

Five trajectories of ADs were identified. Three groups, comprising 34%, 34%, and 21% of the cohort, had constant AD levels before and after DP with mean annual DDDs of 29, 234, and 580, respectively. Two groups, each including 6% of the cohort, had increasing levels of DDDs, levelling off at around 1150 and 785 DDDs after DP. Particularly age, outpatient care due to mental diagnoses and DP diagnoses were significantly associated with different trajectories (p < 0.05). All the groups had a larger proportion of older individuals (> 50%, 45–64 years), except for the ‘increasing low’ group, where younger individuals were in majority (> 60%, 18–44 years), who more frequently exited labour market due to ‘anxiety disorders’, with lower education and more specialised healthcare before DP than the other groups.

Conclusion

The heterogeneity among the five trajectory groups was partly explained by age, the severity of the mental disorder and the DP diagnoses. DDDs of ADs, though on different levels, varied marginally before and after granted DP in the majority. Moreover, AD levels were very low in one third of the individuals. Early identification and focus on the ‘increasing low’ group might be important in order to identify individuals at risk for further increase in annual DDDs of ADs even after granted DP, and might also contribute in prevention of DP. Further detailed research regarding different groups is warranted.
Literature
1.
Järvisalo J, Anderson B, Boedeker W. Houtman I (eds.): mental disorders as a major challenge in prevention of work disability: experiences in FInland, Germany, the Netherlands and Sweden. Helsinki: Kela; 2005.
2.
Alexanderson K, Norlund A. Swedish council on technology assessment in health care (SBU). Chapter 1. Aim, background, key concepts, regulations, and current statistics. Scand J Pub Health Suppl. 2004;63:12–30.CrossRef
3.
Social Insurance in Figures 2015. In. Sweden: The Social Insurance Agency; 2015.
4.
OECD: Sickness, Disability and Work: Breaking the Barriers. A synthesis of findings across OECD countries. In. Paris; 2010.
5.
OECD. Sick on the job? Myths and realities about mental health and work. In. Paris: OECD Publishing; 2012.
6.
7.
8.
Knudsen AK, Harvey SB, Mykletun A, Overland S. Common mental disorders and long-term sickness absence in a general working population. The Hordaland health study. Acta Psychiatr Scand. 2013;127(4):287–97.CrossRefPubMed
9.
Knudsen AK, Overland S, Aakvaag HF, Harvey SB, Hotopf M, Mykletun A. Common mental disorders and disability pension award: seven year follow-up of the HUSK study. J Psychosom Res. 2010;69(1):59–67.CrossRefPubMed
10.
Kupfer DJ, Frank E, Phillips ML. Major depressive disorder: new clinical, neurobiological, and treatment perspectives. Lancet. 2012;379(9820):1045–55.CrossRefPubMed
11.
Rhebergen D, Batelaan NM, de Graaf R, Nolen WA, Spijker J, Beekman AT, Penninx BW. The 7-year course of depression and anxiety in the general population. Acta Psychiatr Scand. 2011;123(4):297–306.CrossRefPubMed
12.
Simon GE, Barber C, Birnbaum HG, Frank RG, Greenberg PE, Rose RM, Wang PS, Kessler RC. Depression and work productivity: the comparative costs of treatment versus nontreatment. J Occup Environ Med. 2001;43(1):2–9.CrossRefPubMed
13.
Apfel T, Richer-Rossler A. Delay of diagnosis and treatment in psychiatric patients applying for a disability pension - a challenge for all of us. Swiss Med Wkly. 2008;138(23–24):348–54.PubMed
14.
Beck A, Crain LA, Solberg LI, Unutzer J, Maciosek MV, Whitebird RR, Rossom RC. The effect of depression treatment on work productivity. Am J Manag Care. 2014;20(8):e294–301.PubMedPubMedCentral
15.
OECD: Mental health, disability and work: issues for discussion. In. Paris; 2010.
16.
Honkonen TI, Aro TA, Isometsa ET, Virtanen EM, Katila HO. Quality of treatment and disability compensation in depression: comparison of 2 nationally representative samples with a 10-year interval in Finland. J Clin Psychiatry. 2007;68(12):1886–93.CrossRefPubMed
17.
Hartvig P. Untreated psychiatric disability. A study of disabled persons with major psychiatric health impairment, having never received psychiatric treatment. Scand J Soc Med. 1978;6(3):117–24.CrossRefPubMed
18.
Laaksonen M, Metsa-Simola N, Martikainen P, Pietilainen O, Rahkonen O, Gould R, Partonen T, Lahelma E. Trajectories of mental health before and after old-age and disability retirement: a register-based study on purchases of psychotropic drugs. Scand J Work Environ Health. 2012;38(5):409–17.CrossRefPubMed
19.
Leinonen T, Lahelma E, Martikainen P. Trajectories of antidepressant medication before and after retirement: the contribution of socio-demographic factors. Eur J Epidemiol. 2013;28(5):417–26.CrossRefPubMed
20.
Oksanen T, Vahtera J, Westerlund H, Pentti J, Sjosten N, Virtanen M, Kawachi I, Kivimaki M. Is retirement beneficial for mental health?: antidepressant use before and after retirement. Epidemiology (Cambridge, Mass). 2011;22(4):553–9.CrossRef
21.
Deverill C KM: Common Mental Disorders. In: Adult psychiatric morbidity in England. edn. Edited by McManus S MH, Brugha T, Bebbington P,, R J. London: The NHS Information Centre for health and social care; 2009: 25–27.
22.
Koopmans PC, Bultmann U, Roelen CA, Hoedeman R, van der Klink JJ, Groothoff JW. Recurrence of sickness absence due to common mental disorders. Int Arch Occup Environ Health. 2011;84(2):193–201.CrossRefPubMed
23.
Rahman S, Alexanderson K, Jokinen J, Mittendorfer-Rutz E. Risk factors for suicidal behaviour in individuals on disability pension due to common mental disorders - a nationwide register-based prospective cohort study in Sweden. PLoS One. 2014;9(5):e98497.CrossRefPubMedPubMedCentral
24.
Rahman SG, Alexanderson K, Jokinen J, Mittendorfer-Rutz E. Disability pension due to common mental disorders and subsequent suicidal behaviour: a population-based prospective cohort study. BMJ Open. 2016;6(4):e010152.CrossRefPubMedPubMedCentral
25.
WHO: International Statistical Classification of Diseases and Related Health Problems, 10 revision (ICD 10). In.; 2010.
26.
27.
28.
29.
30.
Jones BL, Nagin DS, Roeder K. A SAS procedure based on mixture models for estimating developmental trajectories. Sociol Methods Res. 2001;29(3):374–93.CrossRef
31.
Cote S, Tremblay RE, Nagin D, Zoccolillo M, Vitaro F. The development of impulsivity, fearfulness, and helpfulness during childhood: patterns of consistency and change in the trajectories of boys and girls. J Child Psychol Psychiatry Allied Discip. 2002;43(5):609–18.CrossRef
32.
33.
Quality and content of Patient registry. In. Sweden: The National Board of Health and Welfare; 2009.
34.
Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, Heurgren M, Olausson PO. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450.CrossRefPubMedPubMedCentral
35.
Cause of Death 2014. In. Sweden: The National Board of Health and Welfare; 2015.
36.
Ludvigsson JF, Almqvist C, Bonamy AK, Ljung R, Michaelsson K, Neovius M, Stephansson O, Ye W. Registers of the Swedish total population and their use in medical research. Eur J Epidemiol. 2016;31(2):125–36.CrossRefPubMed
37.
Wettermark B, Hammar N, Fored CM, Leimanis A, Otterblad Olausson P, Bergman U, Persson I, Sundstrom A, Westerholm B, Rosen M. The new Swedish prescribed drug register--opportunities for pharmacoepidemiological research and experience from the first six months. Pharmacoepidemiol Drug Saf. 2007;16(7):726–35.CrossRefPubMed
38.
Ljungdahl LO, Bjurulf P. The accordance of diagnoses in a computerized sick-leave register with doctor's certificates and medical records. Scand J Soc Med. 1991;19(3):148–53.CrossRefPubMed
39.
40.
Lauber C. Stigma and discrimination against people with mental illness: a critical appraisal. Epidemiologia e Psichiatria Sociale. 2008;17(1):10–3.PubMed
41.
Hensing G, Wahlstrom R. Swedish council on technology assessment in health care (SBU). Chapter 7. Sickness absence and psychiatric disorders. Scand J Pub Health Suppl. 2004;63:152–80.CrossRef
42.
Masand PS. Tolerability and adherence issues in antidepressant therapy. Clin Ther. 2003;25(8):2289–304.CrossRefPubMed
43.
David DJ, Gourion D. Antidepressant and tolerance: determinants and management of major side effects. L'Encephale. 2016;42(6):553–61.CrossRefPubMed
44.
Hung CI. Factors predicting adherence to antidepressant treatment. Curr Opin Psychiatry. 2014;27(5):344–9.CrossRefPubMed
45.
Trivedi MH, Morris DW, Wisniewski SR, Lesser I, Nierenberg AA, Daly E, Kurian BT, Gaynes BN, Balasubramani GK, Rush AJ. Increase in work productivity of depressed individuals with improvement in depressive symptom severity. Am J Psychiatry. 2013;170(6):633–41.CrossRefPubMed
46.
Hensing G, Bertilsson M, Ahlborg G, Jr., Waern M, Vaez M: Self-assessed mental health problems and work capacity as determinants of return to work: a prospective general population-based study of individuals with all-cause sickness absence. BMC Psychiatry 2013, 13:259.
47.
Bertilsson M, Love J, Ahlborg G, Jr., Hensing G: Health care professionals' experience-based understanding of individuals' capacity to work while depressed and anxious. Scand J Occup Ther 2015, 22(2):126–136.
48.
Clark A, Postel-Vinay F. Job security and job protection. Oxf Econ Pap. 2009;61(2):207–39.CrossRef
49.
Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602.CrossRefPubMed
50.
Copeland WE, Angold A, Shanahan L, Costello EJ. Longitudinal patterns of anxiety from childhood to adulthood: the great Smoky Mountains study. J Am Acad Child Adolesc Psychiatry. 2014;53(1):21–33.CrossRefPubMed
51.
Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49(10):980–9.CrossRefPubMedPubMedCentral
52.
Eisenberg D, Golberstein E, Gollust SE. Help-seeking and access to mental health care in a university student population. Med Care. 2007;45(7):594–601.CrossRefPubMed
53.
Burns BJ, Ryan Wagner H, Gaynes BN, Wells KB, Schulberg HC. General medical and specialty mental health service use for major depression. Int J Psychiatry Med. 2000;30(2):127–43.CrossRefPubMed
54.
Skaner Y, Nilsson GH, Arrelov B, Lindholm C, Hinas E, Wilteus AL, Alexanderson K. Use and usefulness of guidelines for sickness certification: results from a national survey of all general practitioners in Sweden. BMJ Open. 2011;1(2):e000303.CrossRefPubMedPubMedCentral
55.
Mittendorfer-Rutz E, Alexanderson K, Kjeldgård L, Wikman A. Sjukskrivning och risk för framtida sjuk- och aktivitetsersättning bland kvinnor och män [Report in Swedish]. Sickness absence and risk for future Disability pension among women and men [Translation]. Stockholm. Division of Insurance Medicine, Deaprtment of Clinical Neurosciencew, Karolinska Institutet. http://​ki.​se/​sites/​default/​files/​delrapport_​3_​hela_​1.​pdf. Accessed 23 Dec 2017.
Metadata
Title
Trajectories of antidepressant medication use in individuals before and after being granted disability pension due to common mental disorders- a nationwide register-based study
Authors
Syed Rahman
Michael Wiberg
Kristina Alexanderson
Jussi Jokinen
Antti Tanskanen
Ellenor Mittendorfer-Rutz
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2018
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-018-1628-8

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