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• W2215511892 abstract "Background: Sickness absence is a frequent recommendation in Swedish health care. Yet, research on future health outcomes of being sickness absent is sparse. Mental disorders are one of the most common diagnostic groups for sickness absence. Knowledge on psychiatric morbidity and suicidal behaviour following sickness absence is therefore of special interest. Exploring this should be done by using different sick-leave measures and by exploring differences over time, for instance, in relation to changes of social insurance regulations. The aim of this thesis was to investigate different aspects of the associations between sickness absence and subsequent morbidity, suicide attempt, and suicide. Methods: Four population-based longitudinal cohort studies were conducted, using nationwide Swedish register data. All individuals aged 16-64 years who lived in Sweden as on 31 December 2004 (n=4 923 404), and all individuals aged 20-64 years who lived in Sweden as on 31 December 2005 or 2008 (n=4 477 678; n=4 500 400), respectively, and who were not on old-age or disability pension were followed up for six years in Study I and for two years in Study IV. In Study II, all such individuals aged 16-64 years who lived in Sweden as on 31 December 2004 and had inor specialised outpatient care due to depressive disorders in 2005 were included (n=21 096). In Study III, 4209 individuals aged 22-65 years who committed suicide in 2007-2010 were included. In all the studies, information on sociodemographics, health care, medication, sickness absence, disability pension, and death was linked at individual level from registers held by the Social Insurance Agency, the National Board of Health and Welfare, and Statistics Sweden. Cox regression analyses were performed to estimate associations between sickness absence and inpatient care and suicidal behaviour (Study I, II, and IV). A group-based trajectory method was applied to identify sickness absence/disability pension trajectories in the five years before the suicide (Study III). Results: Individuals who had been sickness absent, measured as incidence all-cause and diagnosis-specific sickness absence and sick-leave duration, showed a higher risk of subsequent suicide attempt and suicide compared to those without sickness absence (Study I and IV). Higher risks of suicidal behaviour associated with all-cause and diagnoses-specific sick-leave incidence and sick-leave duration were also observed among patients with depressive disorders (Study II). Among patients with depressive disorders and not on disability pension, those who had one or more incident sick-leave spells or had been full-time sickness absent had higher hazard ratios of suicide attempt in the following five years than those with no sickness absence (Study II). Individuals on sickness absence due to common mental or musculoskeletal diagnoses or with long-term sickness absence (>180 days) in 2009 had higher hazard ratios of subsequent inpatient care due to somatic disorders compared to those on such sickness absence in 2006 (i.e. before the regulatory change in 2008) (Study IV). Among those who committed suicide, five different previous sickness absence/disability pension trajectories were identified (Study III). Almost half of the suicide victims had had constantly low levels of sickness absence/disability pension, while 30% had constantly high such levels in the five years before the suicide. The trajectories were characterised by differences in socio-demographic and health care factors. Conclusions: Sickness absence was a risk marker for suicidal behaviour, irrespective of sick-leave diagnoses, both for women and men in the general population and for patients with depressive disorders. In addition, incident mental or somatic sickness absence and longterm sickness absence after the regulatory change in 2008 might be associated with a higher medical severity than such sickness absence before the change. More knowledge is warranted on such associations as bases for preventive actions. Svensk sammanfattning Bakgrund: Sjukfranvaro ar en vanlig ordination inom svensk halsooch sjukvard. Trots detta ar den vetenskapliga kunskapen om samband mellan sjukfranvaro och framtida halsosituation synnerligen begransad. Da den vanligaste diagnosgruppen for langre sjukskrivning ar psykiska diagnoser, finns det anledning att sarskilt studera samband mellan sadan sjukskrivning och senare psykiska besvar och sjalvmordsbeteende. Studier om detta behovs dar olika aspekter, inklusive sjuklighet och forandringar av socialforsakringen beaktas, baserade pa olika sjukfranvaromatt. Syftet med avhandlingen var att fa ytterligare kunskap om eventuella samband mellan att vara sjukskriven och framtida sjuklighet, sjalvmordsforsok och sjalvmord. Metod: Fyra populationsbaserade longitudinella kohortstudier genomfordes med hjalp av rikstackande svenska registerdata. Alla personer som var 16-64 ar gamla och som bodde i Sverige den 31/12 2004 (n=4 923 404) respektive alla personer som var 20-64 ar gamla och som bodde i Sverige den 31/12 2005 eller 2008 (n=4 477 678; n=4 500 400) och som inte hade alderspension eller sjukeller aktivitetsersattning foljdes upp i studie I och IV. I studie II inkluderades samtliga personer som var 16-64 ar gamla och bodde i Sverige 31/12 2004 och som haft sluteneller specialiserad oppenvard pa grund av depression under ar 2005 (n=21 096). I studie III inkluderades de 4209 personer, som nar de var 22-65 ar gamla begatt sjalvmord under 2007-2010 i Sverige. Information om sociodemografiska faktorer, halsooch sjukvard, medicinering, sjukfranvaro, sjukoch aktivitetsersattning och dod hamtades fran registerdata fran Forsakringskassan, Socialstyrelsen och Statistiska centralbyran. Cox regressionsanalyser utfordes for att berakna samband mellan sjukfranvaro och slutenvard och sjalvmordsbeteende (studie I, II, IV). I studie III anvandes en gruppbaserad analysmetod for att identifiera monster av tidigare sjukfranvaro/sjukoch aktivitetsersattning. Resultat: De som haft ett nytt sjukskrivningsfall, generellt respektive i specifika diagnoser samt haft langre sadana fall hade en hogre risk for senare sjalvmordsforsok respektive sjalvmord jamfort med dem som inte hade varit sjukskrivna (studie I och IV). Motsvarande hogre risk bland sjukskrivna fanns aven i studien dar endast patienter med depression inkluderades (studie II). Personer som varit sjukskrivna i psykiska eller muskuloskeletala diagnoser eller varit sjukskrivna >180 dagar under 2009 hade hogre hazard ratio av efterfoljande slutenvard pa grund av somatiska sjukdomar jamfort med dem som haft motsvarande sjukfranvaro under 2006 (dvs. fore inforandet av nya socialforsakringsregler ar 2008) (studie IV). Bland dem som begick sjalvmord identifierades fem olika monster av tidigare sjukfranvaro/sjukoch aktivitetsersattning (studie III). Nastan halften av dem som begatt sjalvmord hade konstant laga nivaer av sjukfranvaro/sjukoch aktivitetsersattning under de fem foregaende aren, medan 30 % hade haft konstant hoga sadana nivaer. De olika monstren karakteriserades av specifika sociodemografiska och sjukvardsfaktorer. Slutsatser: Sjukfranvaro var en riskmarkor for senare sjalvmordsbeteende, oberoende av sjukfranvarodiagnos, saval bland kvinnor som bland man. Detta gallde hela befolkningen och mer specifikt bland patienter med depression. Dessutom var incident sjukfranvaro i psykiska och somatiska diagnoser och lang sjukfranvaro efter inforandet av nya socialforsakringsregler associerade med senare sjukhusvistelse (och darmed ev. med mer allvarlig sjuklighet) an sjukfranvaro innan dess inforande. Mer kunskap om detta behovs for att kunna vidtaga forebyggande atgarder. LIST OF SCIENTIFIC PAPERS I. Wang M, Alexanderson K, Runeson B, Head J, Melchior M, Perski A, Mittendorfer-Rutz E. Are all-cause and diagnosis-specific sickness absence, and sick-leave duration risk indicators for suicidal behaviour? A nationwide register-based cohort study of 4.9 million inhabitants of Sweden. Occupational and Environmental Medicine. 2014 Jan;71(1):12-20. II. Wang M, Alexanderson K, Runeson B, Mittendorfer-Rutz E. Sick-leave measures, socio-demographic factors and health care as risk indicators for suicidal behavior in patients with depressive disorders a nationwide prospective cohort study in Sweden. Journal of Affective Disorders. 2015 Mar 1;173:201-10. III. Wang M, Bjorkenstam C, Alexanderson K, Runeson B, Tinghog P, Mittendorfer-Rutz E. Trajectories of work-related functional impairment prior to suicide. PloS One. 2015 Oct 7; 10 (10): e0139937. IV. Wang M, Alexanderson K, Runeson B, Mittendorfer-Rutz E. Morbidity and suicidal mortality following sick leave in relation to changes of national social insurance regulations in Sweden. Submitted." @default.
• W2215511892 created "2016-06-24" @default.
• W2215511892 creator A5030202879 @default.
• W2215511892 date "2015-11-20" @default.
• W2215511892 modified "2023-09-23" @default.
• W2215511892 title "SICKNESS ABSENCE - SUBSEQUENT PSYCHIATRIC MORBIDITY AND SUICIDAL BEHAVIOUR" @default.
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