BackgroundAnxiety and depression are the most common psychiatric disorders and are the cause of a large and increasing amount of sick-leave in most developed countries. They are also implicated as an increasing mortality risk in community surveys. In this study we addressed, whether sick leave due to anxiety, depression or comorbid anxiety and depression was associated with increased risk of retirement due to permanent disability and increased mortality in a cohort of German workers.Methods128,001 German workers with statutory health insurance were followed for a mean of 6.4 years. We examined the associations between 1) depression/anxiety-related sick leave managed on an outpatient basis and 2) anxiety/depression-related psychiatric inpatient treatment, and later permanent disability/mortality using Cox proportional hazard regression models (stratified by sex and disorder) adjusted for age, education and job code classification.ResultsOutpatient-managed depression/anxiety-related sick leave was significantly associated with higher permanent disability (hazard ratio (95% confidence interval)) 1.48 (1.30, 1.69) for depression, 1.25 (1.07, 1.45) for anxiety, 1.91 (1.56, 2.35) for both). Among outpatients, comorbidly ill men (2.59 (1.97,3.41)) were more likely to retire early than women (1.42 (1.04,1.93)). Retirement rates were higher for depressive and comorbidly ill patients who needed inpatient treatment (depression 3.13 (2,51, 3,92), both 3.54 (2.80, 4.48)). Inpatient-treated depression was also associated with elevated mortality (2.50 (1.80, 3.48)). Anxiety (0.53 (0.38, 0.73)) and female outpatients with depression (0.61 (0.38, 0.97)) had reduced mortality compared to controls.ConclusionsDepression/anxiety diagnoses increase the risk of early retirement; comorbidity and severity further increase that risk, depression more strikingly than anxiety. Sickness-absence diagnoses of anxiety/depression identified a population at high risk of retiring early due to ill health, suggesting a target group for the development of interventions.
BackgroundKhat consumption is widespread in Yemeni society and causes problems both in economic development and public health. Preventive measures have been largely unsuccessful and the cultivation continues to proliferate. The gender-specific motives for khat use and abstinence were studied to create a toe-hold for more specific interventions.MethodsIn a quota sample with equal numbers of males, females, abstainers and consumers, 320 subjects were interviewed on their specific opinions about khat and its impact on subjective and public health, and on social and community functioning. Strata were compared in their acceptance and denial of opinions. Notions that could predict abstinence status or gender were identified with multivariate logistic regression analysis.ResultsMale khat users had a strong identification with khat use, while females were more ambivalent. The notion that khat consumption is a bad habit (odds ratio (OR) 3.4; p < 0.001) and consumers are malnuorished (OR 2.2; p = 0.046) were associated with female gender among khat users. Among the females worries about health impact (OR 3.2; p = 0.040) and loss of esteem in the family (OR 3.1; p = 0.048) when using khat predicted abstinence. Male abstainers opposed khat users in the belief that khat is the cause of social problems (OR 5.1, p < 0.001). Logistic regression reached an accuracy of 75 and 73% for the prediction of abstinence and 71% for gender among consumers. (All models p < 0.001.)ConclusionsDistinct beliefs allow a differentiation between males, females, khat users and abstainers when targeting preventive measures. In accordance to their specific values female khat users are most ambivalent towards their habit. Positive opinions scored lower than expected in the consumers. This finding creates a strong toe-hold for gender-specific public health interventions.
Mental illnesses, among which depression and anxiety are most common, are the leading cause for permanent disability. It is of interest to know what case characteristics determine if a person returns to the work force in spite of mental illness to tailor specific interventions. So far, there has been little research into this field. In the present study a sample of 202 workers who had permanent disability due to depression/anxiety were followed-up on. 22% started some kind of work during follow-up in a period of 30 to 75 months. Logistic regression analyses showed that quick progression into disability, short period of disability, younger age, adequacy of income replacement through insurance benefits and no previous disability predicted return to work. These findings also allow to identify individuals at high risk for progression into permanent disability that can benefit from supporting interventions.
BackgroundAlcohol use disorders (AUDs) are associated with the highest all-cause mortality rates of all mental disorders. The majority of patients with AUDs never receive inpatient treatment for their AUD, and there is lack of data about their mortality risks despite their constituting the majority of those affected. Absenteeism from work (sick leave) due to an AUD likely signals worsening. In this study, we assessed whether AUD-related sick leave was associated with mortality in a cohort of workers in Germany.Methods128,001 workers with health insurance were followed for a mean of 6.4 years. We examined the associations between 1) AUD-related sick leave managed on an outpatient basis and 2) AUD-related psychiatric inpatient treatment, and mortality using survival analysis, and Cox proportional hazard regression models (separately by sex) adjusted for age, education, and job code classification. We also stratified analyses by sick leave related to three groups of alcohol-related conditions (all determined by International Classification of Diseases 9th ed. (ICD-9) codes): alcohol abuse and dependence; alcohol-induced mental disorder; and alcohol-induced medical conditions.ResultsOutpatient-managed AUD-related sick leave was significantly associated with higher mortality (hazard ratio (HR) 2.90 (95% Confidence interval (CI) 2.24-3.75) for men, HR 5.83 (CI 2.90-11.75) for women). The magnitude of the association was similar for receipt of AUD-related psychiatric inpatient treatment (HR 3.2 (CI 2.76-3.78) for men, HR 6.5 (CI 4.41-9.47) for women). Compared to those without the conditions, higher mortality was observed consistently for outpatients and inpatients across the three groups of alcohol-related conditions. Those with alcohol-related medical conditions who had AUD-related psychiatric inpatient treatment appeared to have the highest mortality.ConclusionsAlcohol use disorder-related sick leave as documented in health insurance records is associated with higher mortality. Such sick leave does not necessarily lead to any specific AUD treatment. Therefore, AUD-related sick leave might be used as a trigger for insurers to intervene by offering AUD treatment to patients to try to reduce their risk of death.
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