Depression- and anxiety-related sick leave and the risk of permanent disability and mortality in the working population in Germany: a cohort study

Abstract

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.

Common mental disorders and cause-specific disability retirement

“…Several studies have focused on depression and anxiety, elicited by clinical inventories, for example, the Composite International Diagnostic Interview (CIDI). Such inventories allow for the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnoses and reflect less prevalent but more severe problems than GHQ-12 9 10 19–22 39. The associations between depression and anxiety and all-cause disability retirement have been broadly similar to ours before and after adjustments.…”

The influence of poor health on competing exit routes from paid employment among older workers in 11 European countries

“…However, our study is the first to present both relative and absolute risks of work displacement via specific exit routes among workers with poor health. Some studies have graphically shown the probability of labor force exit (35)(36)(37)(38)(39). However, these results were based on Kaplan-Meier curves which do not take competing events into account and, as also shown in the current study, will typically overestimate the absolute risk of different exit routes (32).…”

Aposentadoria por invalidez de trabalhadores da área da saúde de um hospital universitário Disability retirement of workers in the health field at a university hospital

“…21 Studies in Germany and the Netherlands identified MBD as one of the most important causes of absence from work and permanent disability, being depression a major contributor to early retirement. [22][23] In a research conducted in Brazil between 1999 to 2002, it was found that the CSD were the main cause for the benefit to disability retirement, representing 29.2% of concessions, followed by MSD (19.5%) and MBD (12.4%). Results that differ from the present study regarding CSD, which occupied the third place along with neoplasias.…”