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Mental disorders and suicidal behavior in refugees and Swedish-born individuals: is the association affected by work disability?

ABSTRACT: BACKGROUND:Among potential pathways to suicidal behavior in individuals with mental disorders (MD), work disability (WD) may play an important role. We examined the role of WD in the relationship between MD and suicidal behavior in Swedish-born individuals and refugees. METHODS:The study cohort consisted of 4,195,058 individuals aged 16-64, residing in Sweden in 2004-2005, whereof 163,160 refugees were followed during 2006-2013 with respect to suicidal behavior. Risk estimates were calculated as hazard ratios (HR) with 95% confidence intervals (CI). The reference groups comprised individuals with neither MD nor WD. WD factors (sickness absence (SA) and disability pension (DP)) were explored as potential modifiers and mediators. RESULTS:In both Swedish-born and refugees, SA and DP were associated with an elevated risk of suicide attempt regardless of MD. In refugees, HRs for suicide attempt in long-term SA ranged from 2.96 (95% CI: 2.14-4.09) (no MD) to 6.23 (95% CI: 3.21-12.08) (MD). Similar associations were observed in Swedish-born. Elevated suicide attempt risks were also observed in DP. In Swedish-born individuals, there was a synergy effect between MD, and SA and DP regarding suicidal behavior. Both SA and DP were found to mediate the studied associations in Swedish-born, but not in refugees. CONCLUSION:There is an effect modification and a mediating effect between mental disorders and WD for subsequent suicidal behavior in Swedish-born individuals. Also for refugees without MD, WD is a risk factor for subsequent suicidal behavior. Particularly for Swedish-born individuals with MD, information on WD is vital in a clinical suicide risk assessment.

SUBMITTER: Bjorkenstam E

PROVIDER: S-EPMC7395008 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Mental disorders and suicidal behavior in refugees and Swedish-born individuals: is the association affected by work disability?

Björkenstam Emma E Helgesson Magnus M Amin Ridwanul R Lange Theis T Mittendorfer-Rutz Ellenor E

Social psychiatry and psychiatric epidemiology 20200102 8

<h4>Background</h4>Among potential pathways to suicidal behavior in individuals with mental disorders (MD), work disability (WD) may play an important role. We examined the role of WD in the relationship between MD and suicidal behavior in Swedish-born individuals and refugees.<h4>Methods</h4>The study cohort consisted of 4,195,058 individuals aged 16-64, residing in Sweden in 2004-2005, whereof 163,160 refugees were followed during 2006-2013 with respect to suicidal behavior. Risk estimates wer ...[more]

PMID: 31897579

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Project description: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.

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Mental disorders and suicidal behavior in refugees and Swedish-born individuals: is the association affected by work disability?

Publications

Mental disorders and suicidal behavior in refugees and Swedish-born individuals: is the association affected by work disability?

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