Early labor force exits in patients with treatment-resistant depression: an assessment of work years lost in a Danish nationwide register-based cohort study

Abstract

Background: Depression is one of the leading causes of premature workforce exit in many Western countries, but little is known about the extent to which treatment-resistance reduces number of work-years. We compared the risk of premature workforce exit among patients with treatment-resistant depression (TRD) relative to non-TRD patients and estimated work years lost (WYL) before scheduled retirement age. Methods: The study population, identified in the Danish National Prescription Registry, included all individuals born and living in Denmark who redeemed their first antidepressant (AD) prescription for depression at age 18–60 years between 2005 and 2012. TRD was defined as failure to respond to at least two different treatment trials. Premature workforce exit was measured using disability pension records. We used Cox regression to estimate the hazard ratio (HR) for premature workforce exit in TRD relative to non-TRD patients, adjusting for calendar year, psychiatric and somatic comorbidity, and educational level. Differences in WYL in patients with TRD and all depression patients were estimated through a competing risks model. Results: Out of the total sample of patients with depression ( N = 129,945), 7478 (5.75%) were classified as having TRD. During follow up, 17% of patients with TRD and 8% of non-TRD patients received disability pension, resulting in a greater than three-fold larger risk of premature workforce exit [adjusted HR (aHR) 3.23 95% confidence interval (CI) 3.05–3.43]. The TRD group lost on average six work-years (95% CI 5.64–6.47) more than the total sample due to early labor force exit. The association between TRD and age at premature workforce exit was inversely U-shaped; the hazard rate of premature workforce exit for patients with TRD compared with non-TRD patients was highest in the age groups 31–35, 36–40, and 41–45 years. Conclusion: Patients with TRD constitute a small group within depression patients, but contribute disproportionally to societal costs due to premature workforce exit at a young age.

Healthcare utilization, costs, and productivity losses in treatment-resistant depression in Finland – a matched cohort study

“…Our study also showed a marked difference in employment as persons with TRD were associated with 36% lower odds of being employed than their comparators during 4 years follow-up after TRD. This is in line with previous studies reporting two times higher risk for disability pension, [13] and three-fold larger risk of premature workforce exit [11] and thus, showing a considerably decreased ability to attend working life. Besides high cost burden for the society and additional costs for lost tax payments and lost productivity, decreased participation in working life will also result into lifelong individual economic consequences as retirement-pension is earnings based and lower employment rate will result into a lower retirement-pension.…”

“…Some definitions of TRD also include psychotherapy but detailed data on psychotherapy is lacking from many data sources and thus, cannot be included. TRD has been associated with multiple adverse outcomes as compared to regular major depressive disorder, including higher risk of suicides, [7] all-cause mortality, [8,9] substance use disorders, [10] early labor force exit, [11] and lower quality of life and greater functional and work impairment [12]. Higher risk of disability pension [11,13] and more frequent healthcare resource utilization in TRD [14][15][16][17](Brenner et.…”

Depression and loneliness may predict work inefficiency among professionally active adults

“…Depressive symptoms may increase upon retiring, as distinct from increasing the probability of early retirement (Segel-Karpas et al 2018a ). A clinical diagnosis of treatment-resistant depression has been associated with a three-fold increased risk of premature workforce exit, with an average of six years of work lost (Bang Madsen et al 2020 ).…”

Healthcare resource utilization in patients with treatment-resistant depression—A Danish national registry study

“…Treatment-resistant depression (TRD) is often defined as a patient's failure to respond to at least two consecutive antidepressant treatments in a single depressive episode, taken at adequate doses for an adequate length of time [5], though no consensus of adequacy of dose and duration exists [6]. It is a complex condition associated with comorbidities [7], higher risk of hospitalization and longer admission [8], increased suicidality and self-harm [9][10][11], increased risk of premature workforce exit [12], reduced quality of life, and poorer prognosis [13,14] compared with non-TRD MDD patients. A recent Danish nation-wide cohort study found that 15.8% of MDD patients developed TRD within 12 months of first hospital contact for major depression, corresponding to an incidence of 187.7 (185.7; 189.9) per 1,000 person-years [15].…”