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.

The findings are pointing to the importance of life-phase specific stressors for explaining depressive symptoms among mothers.

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This paper reports findings from a population sample of mothers with underage children living in Germany (n=3,129). The objective of the study was to analyze whether social and familiar living conditions are associated with enhanced health risks for mothers. The sample is representative with respect to German federal states, school education, marital status, age of mothers, and number of children. Health problems were assessed in terms of physical disabilities and discomforts, anxiety and depression, and self-rated health. About 27% of mothers perceived physical disabilities and discomfort, 21% reported high levels of anxiety, and 22% high levels of depression. About 6% assessed their health as poor or very poor. Particularly single motherhood, unemployment, sole responsibility for household and family as well as low income and low school education increased the risk of poor health. The findings suggest that for specific subgroups of mothers parenting may be a vulnerable phase of life reflecting the need for a life stage orientation in health inequality research.