Trajectories of work disability and unemployment among young adults with common mental disorders

Abstract

BackgroundLabour-market marginalisation (LMM) and common mental disorders (CMDs) are serious societal problems. The aims were to describe trajectories of LMM (both work disability and unemployment) among young adults with and without CMDs, and to elucidate the characteristics associated with these trajectories.MethodsThe study was based on Swedish registers and consisted of all individuals 19–30 years with an incident diagnosis of a CMD in year 2007 (n = 7245), and a matched comparison group of individuals without mental disorders during the years 2004–07 (n = 7245). Group-based trajectory models were used to describe patterns of LMM both before, and after the incident diagnosis of a CMD. Multinomial logistic regressions investigated the associations between sociodemographic and medical covariates and the identified trajectories.ResultsTwenty-six percent (n = 1859) of young adults with CMDs followed trajectories of increasing or constant high levels of work disability, and 32 % (n = 2302) followed trajectories of increasing or constant high unemployment. In the comparison group, just 9 % (n = 665) followed increasing or constant high levels of work disability and 21 % (n = 1528) followed trajectories of increasing or constant high levels of unemployment. A lower share of young adults with CMDs followed trajectories of constant low levels of work disability (n = 4546, 63%) or unemployment (n = 2745, 38%), compared to the level of constant low work disability (n = 6158, 85%) and unemployment (n = 3385, 50%) in the comparison group. Remaining trajectories were fluctuating or decreasing. Around 50% of young adults with CMDs had persistent levels of LMM at the end of follow-up. The multinomial logistic regression revealed that educational level and comorbid mental disorders discriminated trajectories of work disability, while educational level, living area and age determined differences in trajectories of unemployment (R2difference = 0.02–0.05, p < 0.001).ConclusionsA large share, nearly 50%, of young adults with CMDs, substantially higher than in the comparison group of individuals without mental disorders, display increasing or high persistent levels of either work disability or unemployment throughout the follow-up period. Low educational level, comorbidity with other mental disorders and living in rural areas were factors that increased the probability for LMM.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6141-y) contains supplementary material, which is available to authorized users.

Adverse outcomes of chronic widespread pain and common mental disorders in individuals with sickness absence – a prospective study of Swedish twins

“…On the other hand, we found that CMDs was a risk factor for unemployment for those with SA, which is in line with previous studies, showing that individuals with CMDs had higher levels of unemployment [ 30 , 33 ]. This may reflect the deteriorating levels of functioning of individuals with anxiety and depression together with few possibilities to adjust the work situation, contributing to work disability and exit from the labour market [ 34 , 35 ].…”

“…Epidemiological studies suggest that a bidirectional relationship exists between CWP and CMDs [ 27 ] and the negative health consequences of CWP and CMDs are numerous [ 4 , 28 ]. For example, individuals experiencing CWP or CMDs often report poor health-related quality of life, psychosomatic symptoms and work disability [ 29 , 30 ]. The association between CWP and CMDs with SA and DP has seldom been investigated but some studies have reported negative consequences with respect to work status [ 7 , 31 ].…”

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“…This was consistent with previous findings from the FVG Region, which indicated that psychotic disorders were significantly associated with being economically inactive [ 36 ]. Severe mental illness can highly impair work capacity and is also associated with high unemployment rates [ 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Further, economic insecurity is common among patients with severe mental disorders [ 43 , 44 ], as well as functional impairment, which prevents them from living an independent life [ 45 ].…”

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“…There is, however, relatively little research on early onset mental disorders and their contribution to unemployment and the early risk of permanent exit from paid employment, in terms of disability pension. Such research is largely focused on the most prevalent mental disorders including depression and anxiety [6], while much less is known about other mental disorders such as neurodevelopmental disorders including autism spectrum disorder (ASD) regarding these outcomes. Studying unemployment trajectories is evidently only relevant to people with or without ASD who are not receiving a disability pension and are at risk of unemployment and future enrolment in a disability pension.…”