The association between burnout and physical illness in the general population--results from the Finnish Health 2000 Study

OBJECTIVE: The association between burnout and physical diseases has been studied very little. The purpose of this study was to examine the relationship between burnout and physical illness in a representative nationwide population health study. METHODS: As a part of the "Health 2000 Study" in Finland, 3368 employees aged 30-64 years were studied. Burnout was assessed with the Maslach Burnout Inventory-General Survey. Physical diseases were diagnosed in a comprehensive health examination by research physicians. RESULTS: Physical illness was more common among subjects with burnout than others (64% vs. 54%, P<.0001), and the prevalence of diseases increased with the severity of burnout (P<.0001). Burnout was an important correlate of cardiovascular diseases among men (OR=1.35; 95% CI, 1.13-1.61) and musculoskeletal disorders among women (OR=1.22, 95% CI, 1.07-1.38) when adjusted for age, marital status, education, socioeconomic status, physical strenuousness of work, smoking, physical activity, alcohol consumption, body mass index, and depressive symptoms. The prevalence of musculoskeletal disorders and cardiovascular diseases increased with the severity of all three dimensions of burnout, that is, exhaustion (P<.0001 and P<.001, respectively), cynicism (P=.0001 and P<.001, respectively), and lack of professional efficacy (P<.01 and P<.0001, respectively). CONCLUSIONS: Burnout is associated with musculoskeletal diseases among women and with cardiovascular diseases among men. These associations are not explained by sociodemographic factors, health behavior, or depression. Physical illnesses are associated with all three dimensions of burnout and not only with the exhaustion dimension. In the future, the causal relationships between burnout and physical diseases need to be investigated in prospective studies.     

The mental health effects of multiple work and family demands

Background Individuals who experience work stress or heavy family demands are at elevated risk of poor mental health. Yet, the cumulative effects of multiple work and family demands are not well known, particularly in men. Methods We studied the association between multiple work and family demands and sickness absence due to non-psychotic psychiatric disorders in a longitudinal study conducted among members of the French GAZEL cohort study (8,869 men, 2,671 women) over a period of 9 years (1995–2003). Work stress and family demands were measured by questionnaire. Medically certified psychiatric sickness absence data were obtained directly from the employer. Rate ratios (RRs) of sickness absence were calculated using Poisson regression models, adjusting for age, marital status, social support, stressful life events, alcohol consumption, body mass and depressive symptoms at baseline. Results Participants simultaneously exposed to high levels of work and family demands (≥2 work stress factors and ≥4 dependents) had significantly higher rates of sickness absence due to non-psychotic psychiatric disorders than participants with lower levels of demands (compared to participants exposed to 0–1 work stress factors and with 1–3 dependents, age-adjusted rate ratios were 2.37 (95% CI 1.02–5.52) in men and 6.36 (95% CI 3.38–11.94) in women. After adjusting for baseline socio-demographic, behavioral and health characteristics, these RRs were respectively reduced to 1.82 (95% CI 0.86–3.87) in men, 5.04 (95% CI 2.84–8.90) in women. The effect of multiple work and family demands was strongest for sickness absence due to depression: age-adjusted RRs among participants with the highest level of work and family demands were 4.70 (1.96–11.24) in men, 8.57 (4.26–17.22) in women; fully adjusted RRs: 3.55 (95% CI 1.62–7.77) in men, 6.58 (95%CI 3.46–12.50) in women. Conclusions Men and women simultaneously exposed to high levels of work stress and family demands are at high risk of experiencing mental health problems, particularly depression.     

Burnout among health service providers

Conditions believed to produce burnout are examined empirically with the Gillespie-Numerof Burnout Inventory (GNBI) in a sample of 154 health service professionals. The GNBI was administered in a 205-bed, religious-affiliated general hospital located in a major midwestern city. Findings indicate that burnout is inversely related to two job characteristics: degree of formalization and perceived adequacy of communication with supervisor; and burnout is related inversely to three provider characteristics: age, marital status, and years of experience in present position. Age of the provider and communication with supervisor are strongly related to burnout.     

Burnout as a risk factor for antidepressant treatment – a repeated measures time-to-event analysis of 2936 Danish human service workers

Burnout is a state of emotional exhaustion, feelings of reduced personal accomplishment, and withdrawal from work thought to occur as a consequence of prolonged occupational stress. The condition is not included in the diagnostic classifications, but is considered likely to develop into depressive disorder in some cases. We examined the prospective association between burnout and antidepressant treatment, as an indicator of clinically significant mental disorder. We further investigated potential effect-modifiers of the association, to identify factors that may prevent this progression of burnout. We used questionnaire data from a three-wave study of Danish human service workers conducted during 1999–2005, linked with national register data on purchases of antidepressants (ATC: N06A). We included 4788 observations from 2936 individuals (81% women) and analysed data by Aalens additive hazards modeling, examining the risk of entering antidepressant treatment in relation to the level of work-related burnout measured by the Copenhagen Burnout inventory. As effect-modifiers we examined both sociodemographic factors and a range of psychosocial work environment factors. The level of burnout predicted antidepressant treatment. This association was modified by sex (p < 0.01). In men, high vs. intermediate burnout was associated with a 5% increased risk of antidepressant treatment per year of follow-up. This risk difference was 1% for women. Due to the sex specific patterns, we restricted effect modification analyses to women. We found no effect-modification by the examined work environment factors, though a sensitivity analysis indicated a possible stronger association in women of lower occupational position. In conclusion, burnout predicted antidepressant treatment, with a stronger association in men than women. We found no evidence of effect-modification by any of the examined psychosocial work environment factors.     

The role of individual,interpersonal, and organizational factors in mitigating burnout among elderly Chinese volunteers

OBJECTIVE: This study examined the role of individual, interpersonal, and organizational factors in mitigating burnout among elderly Chinese volunteers in Hong Kong. METHODS: A total of 295 elderly Chinese volunteers were individually interviewed on their demographic characteristics, voluntary service experience, physical health status, general self-efficacy, social support, satisfaction and perceived benefit from volunteer work, and burnout symptoms. Exploratory factor analysis was first performed to determine the underlying dimensions of burnout experience. Correlation analyses were then conducted to explore associations among major variables. Hierarchical regression analyses were also performed to unearth the relative contribution of various factors in predicting burnout among elderly volunteers. RESULTS: A two-factor structure of burnout, namely lack of personal accomplishment and emotional depletion, was found. Demographics, individual, interpersonal, and organizational factors were significant predictors of lack of personal accomplishment. In particular, personal accomplishment was best predicted by a long duration of voluntary work service and high levels of self-efficacy, work satisfaction, and perceived benefit. For emotional depletion, only demographics and individual factors were significant predictors. A low level of emotional depletion was best predicted by older age, a short duration of voluntary work experience, and good health. CONCLUSIONS: Burnout experience was evident among elderly Chinese volunteers. There were different predictors of affective and cognitive components of burnout. Findings have significant implications to attenuate burnout symptoms among elderly volunteers.     

Suicide and Marital Status in Italy

Background  Completed suicide has been reported as being linked to marital status, with being unmarried associated with a higher suicide rate as compared with being married or living with a partner. Method  Data were obtained from the Italian Data Base on Mortality, collected by the Italian Census Bureau (ISTAT) and processed by the Italian National Institute of Health-Statistics Unit. The Italian population in the last Italian census (October 2001) was used to estimate age-standardized mortality rates from suicide by marital status (ICD-9 revision: E950–E959) and “natural” causes (ICD-9 revision: 0–280; 320–799). Rate ratios and 95% confidence intervals were calculated using married individuals as a reference. All analyses were conducted separately for men and women and for three different age groups (25–44 years, 45–64 years and 65 years and over) for 2000–2002, the most recent years with data available. Logistic regression analysis was used to compare differences by marital status for suicide versus death from natural causes. Results  Being married appears to be a protective factor for suicide, but the impact of being never-married, divorced/separated or widowed varies with age and gender. It is noteworthy that the differences between married and non-married women were less consistent than those among men, especially for elderly women. The results confirm that the protective impact of marriage is higher for suicide than for natural causes of death, and the comparison between the risks of suicide and natural causes of death reveals that the groups relatively more at risk for suicide are divorced/separated women, divorced/separated men (under the age of 64) and widowed men. Conclusions  Both among men and women, being unmarried, widowed or divorced/separated is associated with a higher suicide rate. This study, however, adds information on suicide mortality in specific age-groups compared to mortality from natural causes of death. Overall, these findings support the notion that marital status may dramatically influence the risk of suicide.     

Le syndrome d’épuisement professionnel et les facteurs de risques psychosociaux spécifiques au métier des personnels navigants commerciaux libanais,en comparaison avec un groupe témoin

ObjectiveThe aim of our study was to investigate the influence of demographic factors (gender and age), work related factors (the position and years of practice) and psychosocial risk factors (cognitive demands, demands to hide emotions, work–family conflict, offensive behaviors…) on the development of burnout among flight attendants, and the nature of psychosocial factors to which they are exposed.MethodsThe sample was divided into two groups: 67 flight attendants and 67 persons in various jobs. Our sampling units were informed and consented to fill in two questionnaires: the Copenhagen burnout inventory (CBI) and the Copenhagen Psychosocial Questionnaire (COPSOQ II).ResultsThe burnout syndrome affected both groups equally. It affected equally the women as well as men, whatever their age categories and their years of experience. The flight attendants occupying an intermediate position in the hierarchy had the highest score on the burnout syndrome. The psychosocial factors significantly found in flight attendants compared to the control group were: demands for hiding emotions, quantitative demands, emotional demands, temporal demands, lack of influence at work, of rewards, of possibility for development and variation of work, poor quality of leadership, exposure to sexual harassment, lack of social support from supervisors, colleagues, social community at work and work–family conflict. Four of them correlated positively with the development of burnout: quantitative demands, temporal demands, emotional demands and work–family conflict. Their expected work volume is very high (quantitative demands). They have to perform their tasks quickly in a limited time without forgetting the technical constraints (temporal demands). They have to work with an average of three hundred passengers besides colleagues and subordinates, which requires diligent control of the emotions promoted by the airline code of conduct based on repression of emotions (emotional demands). These demands affect the workers once they find themselves in their family environment and can have a negative effect on their private life (work–family conflict). However, the predictability seems to allow them to be aware of decisions and changes and protect them against burnout.ConclusionThe profession of flight attendants appears to be characterized by some psychosocial risk factors, some of which are positively correlated with burnout. Improved working conditions can prevent these risks and protect these employees from burnout.     

Observations on burnout in family medicine and psychiatry residents.

OBJECTIVE: To investigate the relationship between burnout, work environment, and a variety of personal variables, including age, gender, marital, parental and acculturation status within a population of family medicine and psychiatry resident physicians. METHODS: Between 2002 and 2005, 155 residents in family medicine and psychiatry at East Tennessee State University College of Medicine were surveyed at intervals using the Maslach Burnout Inventory and Work Environment Scale, form R, to assess their current state of emotional health and job satisfaction. RESULTS: Female residents had lower scores on the Depersonalization scale of the Maslach Burnout Inventory (t=3.37, p=0.001). Parenting was associated with lower Depersonalization (t=3.98, p<0.001) and Emotional Exhaustion (t=2.59, p=0.011). Residents from the United States culture reported higher Depersonalization and Emotional Exhaustion (t=-3.64, p<0.001; t=-3.85, p<0.001). On the Work Environment Scale, residents from United States culture reported less Task Orientation and Control but higher Work Pressure (t=2.89, p=0.005; t=2.24, p=0.027; t=-2.79, p=0.006). Psychiatry residents reported less burnout than family medicine residents on the Depersonalization and Emotional Exhaustion scales (t=2.49, p=0.014: t=2.05, p=0.042) and higher Physical Comfort on the Work Environment Scale (t=-2.60, p=0.011); while family medicine residents reported higher Peer Cohesion, Supervisor Support, and Autonomy (t=3.41, p=0.001; t=2.38, p=0.019; t=2.27, p=0.025). CONCLUSION: This study design, using well established, standard, and valid measures, identified important issues for further exploration: the relationship between acculturation to burnout, the potential role of parenting as a protective factor from burnout, and the recognition that women residents may not be as vulnerable to burnout as previously reported.     

Association of socioeconomic status with sleep disturbances in the Swiss population-based CoLaus study

ObjectiveTo examine the association of socioeconomic status (SES) with subjective and objective sleep disturbances and the role of socio-demographic, behavioural and psychological factors in explaining this association.MethodsAnalyses are based on 3391 participants (53% female, aged 40–81 years) of the follow-up of the CoLaus study (2009–2012), a population-based sample of the city of Lausanne, Switzerland. All participants completed a sleep questionnaire and a sub-sample (N = 1569) underwent polysomnography.ResultsCompared with men with a high SES, men with a low SES were more likely to suffer from poor sleep quality [prevalence ratio (PR) for occupational position = 1.68, 95% Confidence Interval (CI): 1.30–2.17], and to have long sleep latency (PR = 4.90, 95%CI: 2.14–11.17), insomnia (PR = 1.47, 95% CI: 1.12–1.93) and short sleep duration (PR = 3.03, 95% CI: 1.78–5.18). The same pattern was observed among women (PR = 1.29 for sleep quality, 2.34 for sleep latency, 2.01 for daytime sleepiness, 3.16 for sleep duration, 95%CIs ranging from 1.00 to 7.51). Use of sleep medications was not patterned by SES. SES differences in sleep disturbances were only marginally attenuated by adjustment for other socio-demographic, behavioural and psychological factors. Results from polysomnography confirmed poorer sleep patterns among participants with low SES (p <0.05 for sleep efficiency/stage shifts), but no SES differences were found for sleep duration.ConclusionsIn this population-based sample, low SES was strongly associated with sleep disturbances, independently of socio-demographic, behavioural, and psychological factors. Further research should establish the extent to which social differences in sleep contribute to socioeconomic differences in health outcomes.     

Occupational burnout and medically certified sickness absence: a population-based study of Finnish employees

OBJECTIVE: Occupational burnout is a common problem in working populations, but its association with sickness absence is poorly understood. The contribution of occupational burnout to medically certified sickness absence was examined in a population-based sample of employees. METHODS: A representative sample of 3151 Finnish employees aged 30-60 years participated in a comprehensive health study in 2000-2001, including an assessment of physician-diagnosed physical illnesses and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders based on the Composite International Diagnostic Interview. Burnout was measured with the Maslach Burnout Inventory-General Survey. Sickness absences longer than 9 days in 2000-2001 were extracted from a register of the Social Insurance Institution of Finland. RESULTS: The occurrence of medically certified sickness absence was more prevalent among employees with burnout than among those without burnout. After adjusting for sociodemographic factors and mental and physical disorders, the odds ratio of sickness absence for severe burnout was 6.9 [95% confidence interval (95% CI)=2.7-17.8] for men and 2.1 (95% CI=1.1-4.0) for women. Among employees with mental or physical disorders, severe burnout was associated with a 7.7-fold risk of sickness absence among men and with a 2.6-fold risk among women. The duration of absence was related to burnout among men with absences, for whom severe burnout accounted for 52 excess sickness absence days during the 2-year period after adjusting for sociodemographic factors, mental disorders, and physical illnesses. CONCLUSIONS: Severe burnout is associated with a substantial excess risk of medically certified sickness absence among both men and women. This association is independent of prevalent mental disorders and physical illnesses.     

The co-occurrence of depressive symptoms and cognitive impairment in a french community: Are there gender differences?

The cross-sectional data are reported for co-occurrence of depressive symptomatology and cognitive impairment from the first wave of a longitudinal study of normal and pathological aging in a representative sample of 2792 older adults (> or = 65) residing in the Aquitaine Region (Bordeaux) of Southwest France. The prevalence rate for co-occurrence was 4.2% for men and 6.2% for women. Co-occurrence was associated with age, no or little education, functional impairment and dissatisfaction with social support for both men and women, though men were at higher risk than women for the latter two factors, and women were at higher risk than men for no or little education. Women over the age of 85 years were at increased risk whereas men were not, and marital status was associated with co-occurrence for men but had no effect for women. These findings indicate that the risk of co-occurrence differs for men and women, and that, with the exception of social support, the correlates we examined play different roles according to gender.     

Parental education is related to C-reactive protein among female middle aged community volunteers

Growing evidence suggests that socioeconomic attributes of both childhood and adulthood confer risk for cardiovascular morbidity and mortality. In this study, we examine the association of both parental and individual educational attainment with C-reactive protein (CRP), an inflammatory mediator relevant to cardiovascular pathophysiology, in a mid-life community sample. Subjects were 811 men and women (394 men/417 women; 87% European-American/13% African-American), 30–54 years of age. Plasma concentrations of CRP were determined from blood samples obtained at a single session following an overnight fast. Regression analyses adjusting for age and race showed both parental education and individual education to be associated inversely with CRP in women, but not men. The relationship of parental education with CRP in women persisted on multivariable adjustment for both lifestyle risk factors (smoking, alcohol consumption, sleep, exercise, body mass index) and individual SES. Independent of reported personal educational attainment, mid-life adult women whose parents achieved fewer years of educational attainment exhibit higher levels of circulating CRP than women with higher parental education. This association may help explain the increased risk of atherosclerotic cardiovascular morbidity and mortality conferred by low childhood socioeconomic status.     

Prevalence and correlates of burnout in health professionals in Ecuador

BackgroundAlthough burnout is a widespread phenomenon among healthcare professionals, there are no studies about its prevalence in Ecuador. This study assesses the prevalence of burnout syndrome among Ecuadorian healthcare professionals and examine the relationship with their personal and organizational characteristics.MethodsA total of 2404 healthcare professionals (average age 40.0 years; 68.4% women) from the capitals of all 24 provinces in Ecuador participated in this study. Trained psychologists assessed the presence of burnout by applying the Maslach Burnout Inventory. Sociodemographic variables, emotional distress, social support and coping styles as well as organizational variables were also collected.ResultsOf all healthcare professionals surveyed, 2.6% presented burnout syndrome. By dimensions, 17.2% of the participants presented a high level of emotional exhaustion, 13.5% of depersonalization, and 18.2% had reduced personal accomplishment. Being non-mestizo, being classified as a probable case of mental disorder and using more passive coping were associated with a greater probability of presenting burnout; having > 10 years of experience was associated with a lower probability of burnout.ConclusionsA significant number of active health professionals suffer from burnout. It is necessary to develop effective psychotherapeutic interventions for those who have the syndrome and to evaluate potential prevention strategies in those who have not yet developed it.     

The prevalence of PSE-CATEGO disorders in a Finnish adult population cohort

Summary A normal Finnish population cohort, originally aged 15–64 years, has been followed psychiatrically for 16 years. In the 16-year follow-up, 742 of the original sample of 1000 persons could be contacted and personally examined i. a. by means of the full 140-item version of the PSE. The age-adjusted prevalence of mental disorders in the population aged 30–80 years was 9.9% (6.9% in men and 12.4% in women). The prevalence of psychotic conditions was exeptionally high in comparison to other studies, 2.7%. The occurrence of mental disorders was associated with marital status and social class in men but not in women. Other factors examined, namely age, education, occupational category and experience of unemployment during the follow-up period, were not associated with the occurrence of mental disorders. The results are compared with the results from other studies using the same case finding method.     

Relationship of socioeconomic markers to daily life ischemia and blood pressure reactivity in coronary artery disease patients

Background: Socioeconomic status (SES) is an important predictor of clinical outcomes in patients with coronary artery disease (CAD).Purpose: We hypothesized that a selected sample of low SES cardiac patients would display heightened cardiovascular stress responses in the laboratory and increased daily life ischemia compared to otherwise comparable higher SES patients.Methods: Eighty-two patients (M age=61.8±9.4 years; 71 men, 11 women) with a known history of CAD engaged in a stressful mental arithmetic task while blood pressure (BP) measures were collected. Myocardial ischemia was subsequently assessed via 48-hr ambulatory electrocardiographic monitoring in a subgroup of 51 patients. SES was defined by participants’ residential block groups, which were linked to Census Bureau data about their neighborhood, including per capita income, percentage of the population below poverty, educational level, as well as self-report of number of years of education.Results: Contrary to expectation, high SES participants in the study displayed higher diastolic BP (p<.01) and systolic BP (p<.001) responses to mental stress in the laboratory.Conclusions: Participants with daily life ischemia came from wealthier neighborhoods using indexes of poverty (p<.01), income (p<.02), and education (p<.04) compared to patients without ambulatory ischemia. This relationship was not accounted for by age, sex, race, body mass index, marital status, or measures of disease severity. Preparation of this article was assisted by grants from the National Institutes of Health (HL 47337) and Uniformed Services University of the Health Sciences (USUHS) grant RO7233. The opinions and assertions herein are ours and are not to be construed as reflecting the views of the USUHS or the U.S. Department of Defense.     

Socioeconomic differences in incident depression in older adults: the role of psychosocial factors, physical health status, and behavioral factors

OBJECTIVE: The objective of this study was to examine the association between socioeconomic status (SES) and the onset of depression in older adults and to determine the relative contribution of psychosocial factors, physical health status, and behavioral factors in explaining this link. METHODS: Data were from 2593 men and women, aged 55-85 years, participating in the Longitudinal Aging Study Amsterdam. Two indicators of SES were used: education and income. The onset of depression was measured over 9 years of follow-up. RESULTS: Adjusted hazard ratios of incident depression were significantly higher in those with low education and low income. Psychosocial factors explained on average 16% of the SES differences in incident depression, physical health status on average 7%, and behavioral factors less than 5%. CONCLUSION: In older adults, low SES predicted the incidence of depression. Part of this association was explained by psychosocial factors and physical health status.     

Burnout and job satisfaction in New Zealand psychiatrists: a national study

OBJECTIVES: To estimate the prevalence of burnout and the level of job satisfaction among New Zealand psychiatrists, and to ascertain relationships between socio-demographic variables, job satisfaction and burnout in the target population. METHOD: In phase one of the study a postal survey was mailed out to every practising psychiatrist on record as well as all doctors working in psychiatry without specialist qualifications (MOSS). Three questionnaires were used: a socio-demographic questionnaire, the Maslach Burnout Inventory (MBI) and a Job Diagnostic Survey (JSS). Regression analysis was performed on returned data sets using socio-demographic characteristics as explanatory variables and score components of the MBI and JDS as the outcome measures. RESULTS: The results showed that the prevalence of burnout in New Zealand psychiatrists is cause for concern. Two-thirds of all psychiatrists described moderate to severely high levels of emotional exhaustion, with a similar proportion describing low levels of personal accomplishment. Depersonalisation did not appear to be a major problem in the population. Job satisfaction remained relatively high despite the high prevalence of burnout, although there was a relationship between burnout and job satisfaction scores. CONCLUSIONS: This study has demonstrated a high prevalence of burnout and factors associated with it among New Zealand psychiatrists. Further research is needed to ascertain why job satisfaction remains high in the presence of burnout, and factors predisposing to, or protective of, burnout.     

Relationship between adverse childhood experiences and unemployment among adults from five US states

Purpose

Our study assesses the relationships between self-reported adverse childhood experiences (ACEs) (including sexual, physical, or verbal abuse, along with household dysfunction including parental separation or divorce, domestic violence, mental illness, substance abuse, or incarcerated household member) and unemployment status in five US states in 2009.

Methods

We examined these relationships using the 2009 Behavioral Risk Factor Surveillance System survey data from 17,469 respondents (aged 18–64 years) who resided in five states, completed the ACE Questionnaire, and provided socio-demographic and social support information. We also assessed the mediation of these relationships by respondents’ educational attainment, marital status, and social support.

Results

About two-third of respondents reported having had at least one ACEs, while 15.1 % of men and 19.3 % of women reported having had ≥4 ACEs. Among both men and women, the unemployment rate in 2009 was significantly higher among those who reported having had any ACE than among those who reported no ACEs (p < 0.05). Educational attainment, marital status, and social support mediated the relationship between ACEs and unemployment, particularly among women.

Conclusions

ACEs appear to be associated with increased risk for unemployment among men and women. Further studies may be needed to better understand how education, marital status, and social support mediate the association between multiple ACEs and unemployment.     

Obstetrical complications, parenting practices and risk of criminal behaviour among persons who develop major mental disorders

OBJECTIVE: The present study examined whether socio-economic status (SES) of the family of origin, inadequate parenting, and pre and perinatal factors are antecedents of criminality among men and women who develop a major mental disorder. METHOD: The sample included the 82 men and 79 women from the 1953 Stockholm birth cohort who developed a major mental disorder by age 30. Information was extracted from obstetric files, health, social and work records and official criminal records. RESULTS: Among males, neonatal complications increased the risk of offending two-fold, the risk of violent offending 2.5 times, and the risk of early start offending 3 times. Neither pregnancy or birth complications, inadequate parenting, or SES of the family of origin increased the risk for offending. Among females, none of the factors that were examined were associated with offending. CONCLUSION: Complications in the neonatal period are associated with offending among men who develop major mental disorders.     

Incidence of disability pension and associations with socio-demographic factors in a Swedish twin cohort

Purpose

The incidence of disability pension (DP), especially due to mental diagnoses, has increased in many countries, but knowledge of socio-demographic risk factors for DP is limited. Further, the influences of genetics and early-life factors (jointly called familial factors) on these associations remain to be studied. The aims were to study incidence of DP (due to all and mental diagnoses) and associations with socio-demographic factors, and also to establish whether associations differ with DP diagnosis and sex, and are influenced by familial factors.

Methods

A prospective cohort study of all twins born in 1928–1958 (n?=?52,609) in Sweden was conducted. The twins were followed from 1993 to 2008 regarding DP. Cox proportional hazard models were applied.

Results

The cumulative incidence of DP was 17?%. Of all the DP diagnoses 20?% were mental. Higher age (≥45?years), being a woman or unmarried, and/or living in a semi-urban area were risk factors for DP. Low education, being a blue-collar worker or being self-employed predicted either higher (all diagnoses) or lower (mental diagnoses) risk of DP. Rural areas were associated with DP due to mental diagnoses. The estimates varied for men and women. After adjustment for familial factors the associations of DP with education and marital status were attenuated and no longer significant. Similar results were apparent for DP due to mental diagnoses and socioeconomic status.

Conclusions

Familial factors may select individuals into some of the established risk environments for DP. Studies investigating the causes of DP need to take such confounding into account.