pp_pi_eupha

Risk factors for suicidal behaviour in people on disability pension due to common mental disorder in Sweden.

In Collaboration with Prof Kristina Alexanderson, Associate Prof Jussi Jokinen and Associate Prof Ellenor Mittendorfer-Rutz

Syed Rahman ([email protected])Division of Insurance Medicine,Karolinska Institutet, Stockholm, Sweden

Background In most OECD countries, there is a shift towards mental

diagnoses for disability pension (DP) claim.

Mental diagnoses were the primary cause of disability in

30% or more of all claims.

Common mental disorders (CMD) comprise one of the

main disability pension diagnoses. Brown J et al. 2009, Järvisalo J et al. 2005, OECD 2010

1 maj 2023Syed Rahman 2

Background People on DP seem to have a higher mortality.

Gjesdal et al. 2009, Karlsson et al., 2007, Wallman et al.,

2006

A significant association has been reported between DP and

suicidal behaviour.Qin et al., 2003, Leinonen 2013, Jonsson et at., 2013

Information on consequences of DP is sparse.


Aim

To examine the association between different socio-

demographic, health care factors and medication and

subsequent suicidal behaviour among individuals on

disability pension due to common mental disorders.


Methods Design: nationwide register based prospective cohort study.

Inclusion criteria: individuals aged 18-64 years, on DP due

to CMD during 2005, n = 48 803.

Exclusion criteria: schizophrenic spectrum and bipolar

disorders during 2001-05, old-age pensioners in 2005.

Final cohort: n = 46 745 individuals.


Methods

Follow-up (2006-10): Suicide attempt n=1 046,

Suicide n=210.

Censoring: for emigration, death (due to other causes in

case of suicide).

Statistical method: Hazard ratios and 95% CI were

estimated by Cox proportional hazard regression models.


Results- Suicide attempt Multivariate Hazard Ratios (HR), 95% Confidence Interval (CI)Characteristics Total n (%) HR (95 % CI)

Sex Female 736 (2.4) 1.15 (1.01-1.32)

Male 310 (2) 1

Age 18-24 years 61 (7.2) 2.11 (1.55–2.89)

25-34 years 161 (4.8) 2.06 (1.64–2.59)

35-44 years 342 (3.5) 2.06 (1.69–2.52)

45-54 years 306 (2.1) 1.52 (1.25–1.85)

55-64 years 176 (1) 1


Results- Suicide attempt Multivariate Hazard Ratios (HR), 95% Confidence Interval (CI) Characteristics Total n (%) HR (95 % CI)

Education(in years)

University/ higher (≥13) 152 (1.2) 1

High school (10-12) 540 (2.5) 1.38 (1.15–1.65)

Compulsory (0-9) 347 (2.9) 1.57 (1.29–1.91)

Family status

Married/cohab. with child 201 (1.9) 1

Married/cohab. no child 88 (0.9) 0.73 (0.56-0.95)

Single with child 558 (2.8) 1.23 (1.04-1.45)

Single no child 199 (3.1) 1.29 (1.06-1.57)


Results- Suicide attempt

Multivariate Hazard Ratios (HR), 95% Confidence Interval (CI)


Characteristics Total n (%) HR (95% CI)

Outpt. care in 2001-05

Mental diagnoses 571 (4.4) 1.30 (1.14-1.48)

Inpt. care in 2001-05

Somatic diagnoses 613 (3.9) 1.45 (1.26-1.67)

Mental diagnoses 507 (10) 2.88 (2.47-3.35)

Suicide attempt 314 (22) 3.89 (3.29-4.60)

Medication in 2005

Antidepr. only 299 (2.2) 1.82 (1.52-2.17)

Anxiolytics only 109 (3.2) 2.24 (1.77-2.82)

Both prescribed 423 (5.8) 3.35 (2.83-3.98)

Results- suicide Multivariate Hazard Ratios (HR), 95% Confidence Interval (CI)

Characteristics Total n (%) HR (95 % CI)Sex Female 102 (0.3) 1

Male 108 (0.7) 2.14 (1.61-2.85)

Family status

Married/cohab. with child 30 (0.3) 1

Married/cohab. no child 29 (0.3) 1.23 (0.72-2.10)

Single with child 25 (0.4) 1.48 (0.86-2.54)

Single no child 125 (0.6) 1.68 (1.11-2.53)


Results- suicide Multivariate Hazard Ratios (HR), 95% Confidence Intervals (CI)

Characteristics Total n (%) HR (95 % CI)Inpat. care in 2001-05

Mental diagnoses 90 (1.8) 2.71 (1.94-3.80)

Suicide attempt 46 (3.2) 3.00 (2.00-4.50)

Medication in 2005

Antidepr. only 47 (0.4) 1.32 (0.89-1.97)

Anxiolytics only 23 (0.7) 2.10 (1.28-3.44)

Both prescribed 86 (1.2) 3.30 (2.31-4.72)


ConclusionRisk factors for suicide attempt :

Socio-demographic factors: female sex, young age, low

education, living single.

Health care factors: outpatient care due to mental diagnosis,

inpatient care due to mental or somatic diagnoses and

suicide attempt.

Medication: antidepressant and anxiolytic alone or

combined.1 maj 2023Syed Rahman 12

Conclusion (continued)

Risk factors for suicide:

Socio-demographic factors: male sex, living single.

Health care factors: inpatient care due to mental diagnoses

and previous suicide attempt.

Medication: anxiolytic alone and combined antidepressant

with anxiolytic.


Thank you

Diagnoses & frequency of DP casesDiagnosis (ICD 10 code) Total number (%)

Depressive episode (F 32) 17 181 (36.8%)

Reaction to severe stress and adjustment disorder (F 43)

11 022 (23.6%)

Anxiety disorder (F 41) 9 799 (21.0%)

Recurrent depressive disorder (F 33) 4 950 (10.6%)

Phobic anxiety disorder (F 40) 2 783 (5.90%)

Obsessive-compulsive disorder (F 42) 1 010 (2.20%)


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