Most available data about psychiatric mortality and invalidity concerns inpatients, although the majority of patients are treated as outpatients only.

It was the aim of this study to estimate the effect of anxiety disorders on early retirement and premature death in the working population with special emphasis on outpatients.

125.019 workes between age 16 and 58 were followed for an average of 6.4 years. Excess risks of death and permanent disability were calculated with multivariate Cox regression models.

Outpatient and inpatient treatment for anxiety disorders (OR 1.40 resp. OR 2.10) were associated with higher risks of early retirement. Males generally were more often affected by this bad outcome than females.

Further analysis showed decreased risks of premature death for outpatients with an anxiety disorder (OR 0.33). The effect tended to be most prominent during the middle decades of life and got smaller with older age, at which all-cause mortality approximated that of the control group. No significant effect on mortality could be shown for inpatients.

Patients with outpatient treatment for anxiety disorders have an elevated risk of permanent disability early in life, while all-cause mortality is lower. This beneficial effect can only be partly explained by different risk-taking behaviors. Different causes of death early in life and their connections with these disorders need to be discussed, too. Treatment should have a strong focus on preserving ability to work.