Petter Tinghög

Work-related functional impairment in terms of sickness absence and disability pension (SA/DP) has been reported to be associated with subsequent suicide. However, there is only limited knowledge on SA/DP patterns prior to suicide. The aim was to identify trajectories of work-related functional impairment prior to suicide and to describe associations of socio-demographic and medical factors with such trajectories. This is a population-based retrospective cohort study of the 4 209 individuals aged 22-65 years who committed suicide during 2007-2010 in Sweden. Work-related functional impairment was measured as mean annual number of months of SA/DP. We analyzed trajectories of SA/DP during five years prior to suicide (i.e., 2002-2009) by a group-based trajectory method. Associations between socio-demographic and medical factors with different groups of trajectories were estimated by chi2-test and multinomial logistic regression. Five different functional impairment trajectory groups were identified prior to suicide. One group had constant low levels of SA/DP (46%), while 30% had constant high levels of SA/DP. Two groups (16%) showed increasing number of SA/DP months. The remaining 7% showed decreasing number of SA/DP months before the suicide. Sex, age, educational level, family situation, and diagnosis-specific healthcare were significantly associated with different trajectory groups (Likelihood ratio X2 tests <0.05). A larger proportion of higher educated and younger men with a lower proportion of previous suicide attempts were found in the group with constant low levels. Opposite characteristics were displayed in the group with constant high levels. This study identified five different groups of work-related functional impairment trajectories before suicide. These differences might be partly explained by the variations in socio-demographic profiles and health care consumptions five years before suicide.

We evaluated the risk of work disability (sick leave and disability pension) before and after diabetes diagnosis relative to individuals without diabetes during the same time period, as well as the trajectory of work disability around the diagnosis. This Swedish population-based cohort study with register data included 14 428 individuals with incident diabetes in 2006 and 39 702 individuals without diabetes during 2003 to 2009. Work disability was substantially higher among people with diabetes (overall mean = 95 days per year over the 7 years, SD = 143) than among those without diabetes (mean = 35 days, SD = 95). The risk of work disability was slightly higher after diabetes diagnosis than before and compared with the risk of those without diabetes. The trajectory of work disability was already increasing before diagnosis, increased even more at the time of diagnosis, and leveled off after diagnosis. Individual sociodemographic characteristics and comorbid conditions contributed bo...

Psychiatric comorbidity is common among multiple sclerosis (MS) patients. The majority of MS patients of working ages are on disability pension. The aims of this study were to chart the prevalences of psychiatric diagnoses and medications among MS patients of working ages, and to investigate their association with the risk for future disability pension. This nationwide, population-based prospective cohort study includes 10,750 MS patients and 5,553,141 non-MS individuals who in 2005 were aged 17-64 years. Psychiatric diagnoses and medications were identified using nationwide registers. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated adjusting for socio-demographics. Furthermore, a survival analysis with five-year follow-up was performed among the 4,571 MS patients not on disability pension in 2005, with psychiatric diagnoses and medication as risk factors, and disability pension as the outcome. Among MS patients, 35% had been prescribed psychiatric medication compared to 10% of non-MS individuals, adjusted OR 3.72 (95% CI 3.57 to 3.88). Ten percent of MS patients had received a psychiatric diagnosis, compared to 5.7% of non-MS individuals, OR 1.82 (95% CI 1.71 to 1.94). Serotonin reuptake inhibitors (SSRIs), were the most commonly prescribed drugs (17%) among MS patients, while depression (4.8%) was the most common psychiatric diagnosis. In the survival analysis, MS patients with any psychiatric diagnosis had a hazard ratio (HR) of 1.83 (95% CI 1.53 to 2.18) for disability pension compared to other MS patients. MS patients with any psychiatric drug prescription had a HR for disability pension of 2.09 (95% CI 1.84 to 2.33). Psychiatric diagnoses and medications are common among MS patients and adversely affect risk for disability pension. This highlights the importance of correct diagnosis and management of psychiatric comorbidity, in a clinical as well as in a societal perspective.

Migration may result in exposure to factors that are both beneficial and harmful for good health. How the act of migration is associated with mortality, or whether the socio-economic condition of migrants prior to migration influences their mortality trajectory, is not well understood. In the present study, a cohort of 413 randomly selected individuals born in the rural community of Överkalix, Sweden, between 1890 and 1935 were followed from birth to either death or old age. Around 50% of the study-population moved away from Överkalix at one time or another. To adjust for a potential bias resulting from self-selection among the migrants, the father's occupational status was used together with parents' and grandparents' longevity. Overall, migration could not be shown to predict mortality when the backgrounds of the migrants were taken into account. Nonetheless, socio-economic background conditions appeared to moderate the association, decreasing the mortality rates for migrants with relatively good pre-migratory socio-economic conditions, while increasing it for migrants with poorer pre-migratory conditions. However, further scrutiny revealed that this effect modification mainly affected the female migrants' mortality. In conclusion, the study suggests that there is no general association between migration and mortality, but that migrants with better socio-economic resources are more likely to improve their mortality trajectories than migrants with poorer resources. Better pre-migratory conditions hence appear to be important for avoiding health-adverse circumstances and gaining access to health beneficial living conditions when moving to foreign environments - especially for women.

The aim of this study was to investigate whether the Hopkins Symptom Checklist (HSCL-25) and the WHO (ten) Wellbeing Index are cross-culturally equivalent by comparing Scandinavians with Middle Eastern immigrants in Sweden. The study population consisted of a stratified random sample of native-born Swedes and immigrants from Finland, Iraq and Iran. Both instruments loaded on a single factor in the respective populations. A few of the items did however not discriminate or predict equally well in the groups, nonetheless it was found to have marginally influenced the instruments' total scores in both groups. The analyses also revealed that the groups had similar intercept and slope when the exogenous factor traumatic episodes was used to predict the measurement scores, supporting scalar equivalency. In conclusion, the results support the use of these instruments in population-based surveys within multicultural Western societies.