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Labour market marginalisation in obsessive–compulsive disorder: a nationwide register-based sibling control study

  • Ana Pérez-Vigil (a1) (a2), Ellenor Mittendorfer-Rutz (a3), Magnus Helgesson (a3), Lorena Fernández de la Cruz (a1) and David Mataix-Cols (a1) (a4)...

Abstract

Background

The impact of obsessive–compulsive disorder (OCD) on objective indicators of labour market marginalisation has not been quantified.

Methods

Linking various Swedish national registers, we estimated the risk of three labour market marginalisation outcomes (receipt of newly granted disability pension, long-term sickness absence and long-term unemployment) in individuals diagnosed with OCD between 2001 and 2013 who were between 16 and 64 years old at the date of the first OCD diagnosis (n = 16 267), compared with matched general population controls (n = 157 176). Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox regression models, adjusting for a number of covariates (e.g. somatic disorders) and stratifying by sex. To adjust for potential familial confounders, we further analysed data from 7905 families that included full siblings discordant for OCD.

Results

Patients were more likely to receive at least one outcome of interest [adjusted HR = 3.63 (95% CI 3.53–3.74)], including disability pension [adjusted HR = 16.36 (95% CI 15.34–17.45)], being on long-term sickness absence [adjusted HR = 3.07 (95% CI 2.95–3.19)] and being on long-term unemployment [adjusted HR = 1.72 (95% CI 1.63–1.82)]. Results remained similar in the adjusted sibling comparison models. Exclusion of comorbid psychiatric disorders had a minimal impact on the results.

Conclusions

Help-seeking individuals with OCD diagnosed in specialist care experience marked difficulties to participate in the labour market. The findings emphasise the need for cooperation between policy-makers, vocational rehabilitation and mental health services in order to design and implement specific strategies aimed at improving the patients’ participation in the labour market.

Copyright

Corresponding author

*Author for correspondence: Ana Pérez-Vigil, E-mail: ana.perez.vigil@ki.se

References

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Allison, PD (2009) Fixed Effects Regression Models. Thousand Oaks, CA: Sage Publications.
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th Edn. Washington, DC: American Psychiatric Association.
Dubow, EF, Huesmann, LR, Boxer, P, Pulkkinen, L and Kokko, K (2006) Middle childhood and adolescent contextual and personal predictors of adult educational and occupational outcomes: a mediational model in two countries. Developmental Psychology 42, 937949.
Eisen, JL, Mancebo, MA, Pinto, A, Coles, ME, Pagano, ME, Stout, R and Rasmussen, SA (2006) Impact of obsessive-compulsive disorder on quality of life. Comprehensive Psychiatry 47, 270275.
Ekbom, A (2011) The Swedish multi-generation register. Methods in Molecular Biology 675, 215220.
Falkum, E, Klungsoyr, O, Lysatd, JU, Bull, HC, Evensen, S, Martinsen, EW, Friis, S and Ueland, T (2017) Vocational rehabilitation for adults with psychotic disorders in a Scandinavian welfare society. BMC Psychiatry 17, 24.
Grabe, HJ, Meyer, C, Hapke, U, Rumph, HJ, Freyberger, HJ, Dilling, H and John, U (2000) Prevalence, quality of life and psychosocial function in obsessive-compulsive disorder and subclinical obsessive-compulsive disorder in northern Germany. European Archives of Psychiatry and Clinical Neuroscience 250, 262268.
Helgesson, M, Tinghog, P, Niederkrotenthaler, T, Saboonchi, F and Mittendorfer-Rutz, E (2017) Labour-market marginalisation after mental disorders among young natives and immigrants living in Sweden. BMC Public Health 17, 593.
Hollander, E, Kwon, JH, Stein, DJ, Broatch, J, Rowland, CT and Himelein, CA (1996) Obsessive-compulsive and spectrum disorders: overview and quality of life issues. Journal of Clinical Psychiatry 57(suppl. 8), 36.
Kivimaki, M, Forma, P, Wikstrom, J, Halmeenmaki, T, Pentti, J, Elovainio, M and Vahtera, J (2004) Sickness absence as a risk marker of future disability pension: the 10-town study. Journal of Epidemiology and Community Health 58, 710711.
Ludvigsson, JF, Almqvist, C, Bonamy, AK, Ljung, R, Michaelsson, K, Neovius, M, Stephansson, O and Ye, W (2016) Registers of the Swedish total population and their use in medical research. European Journal of Epidemiology 31, 125136.
Ludvigsson, JF, Andersson, E, Ekbom, A, Feychting, M, Kim, JL, Reuterwall, C, Heurgren, M and Olausson, PO (2011) External review and validation of the Swedish national inpatient register. BMC Public Health 11, 450.
Ludvigsson, JF, Otterblad-Olausson, P, Pettersson, BU and Ekbom, A (2009) The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. European Journal of Epidemiology 24, 659667.
Mancebo, MC, Greenberg, B, Grant, JE, Pinto, A, Eisen, JL, Dyck, I and Rasmussen, SA (2008) Correlates of occupational disability in a clinical sample of obsessive-compulsive disorder. Comprehensive Psychiatry 49, 4350.
Mittendorfer-Rutz, EKL, Runeson, B, Perski, A, Melchior, M, Head, J and Alexanderson, K (2012) Sickness absence due to specific mental diagnoses and all-cause and cause-specific mortality: a cohort study including 4.9 million inhabitants of Sweden. PLoS ONE 7, e45788.
National Board of Health and Welfare (2013) Cause of death: 2013. Available at http://www.socialstyrelsen.se/statistics/statisticaldatabase/help/causeofdeath (Accessed 9 November 2017).
National Board of Health and Welfare (2017) Konverteringstabeller till ICD. Available at http://www.socialstyrelsen.se/klassificeringochkoder/diagnoskodericd-10/konverteringstabeller (Accessed 9 November 2017).
Nyman, K, Palmer, E and Bergendorff, S (2002) Den Svenska Sjukan. Stockholm: ESO.
Organisation for Economic Cooperation and Development (2003) Transforming Disability Into Ability: Policies to Promote Work and Income Security for Disabled People. Paris: OECD.
Organisation for Economic Cooperation and Development (2016) ‘Indicator A6 What are the Earnings Advantages from Education?’, in Education at a Glance 2016: OECD Indicators. Available at http://www.keepeek.com/Digital-Asset-Management/oecd/education/education-at-a-glance-2016/indicator-a6-what-are-the-earnings-advantages-from-education_eag-2016-12-en#.WN5Tgjt96Uk#page12 (Accessed 9 November 2017).
Organisation for Economic Cooperation and Development (2017) Unemployment rates by education level (indicator). Available at https://data.oecd.org/unemp/unemployment-rates-by-education-level.htm (Accessed 9 November 2017).
Pérez-Vigil, A, Fernández de la Cruz, L, Brander, G, Isomura, K, Jangmo, A, Feldman, I, Hesselmark, E, Serlachius, E, Lázaro, L, Rück, C, Kuja-Halkola, R, D'onofrio, BM, Larsson, H and Mataix-Cols, D (2018) Association of obsessive-compulsive disorder with objective indicators of educational attainment: a nationwide register-based sibling control study. JAMA Psychiatry 75, 4755.
Rück, C, Larsson, KJ, Lind, K, Pérez-Vigil, A, Isomura, K, Sariaslan, A, Lichtenstein, P and Mataix-Cols, D (2015) Validity and reliability of chronic tic disorder and obsessive-compulsive disorder diagnoses in the Swedish National Patient Register. BMJ Open 5, e007520.
Ruscio, AM, Stein, DJ, Chiu, WT and Kessler, RC (2010) The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry 15, 5363.
Sorensen, CB, Kirkeby, L and Thomsen, PH (2004) Quality of life with OCD. A self-reported survey among members of the Danish OCD Association. Nordic Journal of Psychiatry 58, 231236.
Swedish Social Insurance Agency (2014) Social Insurance in Figures. Stockholm: Swedish Social Insurance Agency.
Swedish Social Insurance Agency (2016) Social Insurance in Figures. Stockholm: Swedish Social Insurance Agency.
Swedish Social Insurance Agency (2017) Aktuella belopp 2017. Available at https://www.forsakringskassan.se/wps/wcm/connect/f2b205ca-24fc-4cfe-acf3-8bfcf3f3141d/293-aktuella-belopp-2017-07.pdf?MOD=AJPERES&CVID= (Accessed 9 November 2017).
Waghorn, G and Chant, D (2005) Labour force activity by people with depression and anxiety disorders: a population-level second-order analysis. Acta Psychiatrica Scandinavica 112, 415424.

Keywords

Labour market marginalisation in obsessive–compulsive disorder: a nationwide register-based sibling control study

  • Ana Pérez-Vigil (a1) (a2), Ellenor Mittendorfer-Rutz (a3), Magnus Helgesson (a3), Lorena Fernández de la Cruz (a1) and David Mataix-Cols (a1) (a4)...

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