The association of sociodemographic characteristics with work disability trajectories during and following long-term psychotherapy: a longitudinal register study

Abstract

Purpose This register-based study examined the trajectories of depression or anxiety disorder-related work disability during and following long-term psychotherapy and identified sociodemographic factors that indicate membership in different trajectory groups. Methods Data were drawn from national registers (Statistics Finland, Social Insurance Institution of Finland). Participants included a random sample of Finnish working-age individuals (18–55 years) who started psychotherapy treatment between 2011 and 2014 and were followed for 5 years: 1 year before and 4 years after the onset of psychotherapy (N = 3 605 individuals; 18 025 person-observations across five time points). Group-based trajectory modeling was applied to assign individuals to work disability trajectories by the number of annual mental health-related work disability months. Multinomial logistic regression was used to examine the associations between trajectory group membership and baseline sociodemographic factors of age, gender, occupational status, and geographical area of residence. Results Four mental health-related work disability trajectories were identified: stable very low (72%), decrease (11%), persistent low (9%) and persistent high (7%). Those with older age, female gender, lower occupational status, and living in sparsely populated geographical areas were more likely to belong to the most unfavorable trajectory group of persistent high work disability. The presence of multiple risk characteristics substantially increased the probability of belonging to the most adverse trajectory group. Conclusions Sociodemographic factors were associated with the course of mental health-related work disability in association with psychotherapy. Rehabilitative psychotherapy does not function as an equal support resource for work ability in all parts of the population.

Occupational Grade, Mental Distress, and the Use of Psychotherapy

“…15 A recent study on disability trajectories of rehabilitative psychotherapy recipients also found that manual workers who received therapy were more likely to remain on the path of prolonged disability than non-manual employees who received similar therapy. 16 In future studies we should, however, pay more attention to gender and also explicitly test the possibly cumulative effects of occupational grade and gender on gains from psychotherapy. For doing this, we need to move beyond the logic of conventional net effect analyses which estimate the isolated impact of individual variables on treatment outcomes, and instead focus on the effects of different occupational grade-gender configurations by using for example fuzzy-set analysis.…”