Skip to main content

Advertisement

SpringerLink
Log in

Prescribed psychiatric medication among multiple sclerosis patients before and after disability pension: a register study with matched controls

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Background

Many multiple sclerosis (MS) patients of working ages have psychiatric comorbidity, and 60 % are on disability pension (DP). It is unknown how DP is associated with MS patients’ mental health. The objective of this study was to investigate the association between prescriptions of psychiatric medication and time before and after receiving full-time DP in MS patients compared with matched controls.

Methods

Nationwide Swedish registers were used to identify 3836 MS patients who were granted DP in 2000–2012 and 19,180 DP controls matched on socio-demographic variables by propensity scores. Patients and controls were organized in groups by year granted DP. Adjusted odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated for being prescribed selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, or sleeping agents in 2006.

Results

Both patients and controls, who were not yet on DP in the study year of 2006, had lower OR compared with those who were granted DP in the same year. The OR increased when being closer to DP. MS patients, who had been granted DP 5–6 years earlier, had a higher risk for prescription of benzodiazepines (OR 1.72; 95 % CI 1.16–2.57) than controls (OR 1.14; 95 % CI 1.14–1.18). These patients also had a higher risk for SSRI prescription when compared directly with controls (OR 1.76; 95 % CI 1.44–2.15).

Conclusions

MS patients have substantially higher odds ratios for being prescribed psychiatric drugs after DP than other disability pensioners. Further research on the association of DP with the mental health of MS patients is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Multiple Sclerosis International Federation (2013) Atlas of MS 2013: Mapping multiple sclerosis around the world. Multiple Sclerosis International Federation, London

    Google Scholar 

  2. Trojano M, Paolicelli D, Bellacosa A, Cataldo S (2003) The transition from relapsing-remitting MS to irreversible disability: clinical evaluation. Neurol Sci 24(Suppl 5):S268–S270. doi:10.1007/s10072-003-0171-6

    Article  PubMed  Google Scholar 

  3. Koch M, Kingwell E, Rieckmann P, Tremlett H (2010) The natural history of secondary progressive multiple sclerosis. J Neurol Neurosurg Psychiatry 81(9):1039–1043. doi:10.1136/jnnp.2010.208173

    Article  PubMed  Google Scholar 

  4. Andersson PB, Waubant E, Gee L, Goodkin DE (1999) Multiple sclerosis that is progressive from the time of onset: clinical characteristics and progression of disability. Arch Neurol 56(9):1138–1142

    Article  CAS  PubMed  Google Scholar 

  5. Tinghog P, Hillert J, Kjeldgard L, Wiberg M, Glaser A, Alexanderson K (2013) High prevalence of sickness absence and disability pension among multiple sclerosis patients: a nationwide population-based study. Mult Scler (Houndmills, Basingstoke, Engl) 19(14):1923–1930. doi:10.1177/1352458513488234

    Article  Google Scholar 

  6. Swedish Social Insurance Agency (2014) Social insurance in figures. Swedish Social Insurance Agency, Stockholm

    Google Scholar 

  7. Patti F, Pozzilli C, Montanari E, Pappalardo A, Piazza L, Levi A, Onesti E, Pesci I, Italian Study Group On Quality Of Life In M (2007) Effects of education level and employment status on HRQoL in early relapsing-remitting multiple sclerosis. Mult Scler (Houndmills, Basingstoke, Engl) 13(6):783–791. doi:10.1177/1352458506073511

    Article  CAS  Google Scholar 

  8. Jones KH, Ford DV, Jones PA, John A, Middleton RM, Lockhart-Jones H, Peng J, Osborne LA, Noble JG (2013) How people with multiple sclerosis rate their quality of life: an EQ-5D survey via the UK MS register. PLoS One 8(6):e65640. doi:10.1371/journal.pone.0065640

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Tinghog P, Bjorkenstam C, Carstensen J, Jansson C, Glaser A, Hillert J, Alexanderson K (2014) Co-morbidities increase the risk of disability pension among MS patients: a population-based nationwide cohort study. BMC Neurol 14(1):117. doi:10.1186/1471-2377-14-117

    Article  PubMed  PubMed Central  Google Scholar 

  10. Johansson V, Lundholm C, Hillert J, Masterman T, Lichtenstein P, Landen M, Hultman CM (2014) Multiple sclerosis and psychiatric disorders: comorbidity and sibling risk in a nationwide Swedish cohort. Mult Scler (Houndmills, Basingstoke, Engl). doi:10.1177/1352458514540970

    Google Scholar 

  11. Brenner P, Alexanderson K, Bjorkenstam C, Hillert J, Jokinen J, Mittendorfer-Rutz E, Tinghog P (2014) Psychiatric diagnoses, medication and risk for disability pension in multiple sclerosis patients; a population-based register study. PLoS One 9(8):e104165. doi:10.1371/journal.pone.0104165

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lunde HM, Bjorvatn B, Myhr KM, Bo L (2013) Clinical assessment and management of sleep disorders in multiple sclerosis: a literature review. Acta Neurol Scand Suppl(196):24–30. doi:10.1111/ane.12046

    Article  Google Scholar 

  13. Goldman Consensus Group (2005) The Goldman consensus statement on depression in multiple sclerosis. Mult Scler 11(3):328–337. doi:10.1191/1352458505ms1162oa

    Article  Google Scholar 

  14. Oksanen T, Vahtera J, Westerlund H, Pentti J, Sjosten N, Virtanen M, Kawachi I, Kivimaki M (2011) Is retirement beneficial for mental health?: antidepressant use before and after retirement. Epidemiology 22(4):553–559. doi:10.1097/EDE.0b013e31821c41bd

    Article  PubMed  PubMed Central  Google Scholar 

  15. Laaksonen M, Metsa-Simola N, Martikainen P, Pietilainen O, Rahkonen O, Gould R, Partonen T, Lahelma E (2012) Trajectories of mental health before and after old-age and disability retirement: a register-based study on purchases of psychotropic drugs. Scand J Work Environ Health 38(5):409–417. doi:10.5271/sjweh.3290

    Article  PubMed  Google Scholar 

  16. Leinonen T, Lahelma E, Martikainen P (2013) Trajectories of antidepressant medication before and after retirement: the contribution of socio-demographic factors. Eur J Epidemiol 28(5):417–426. doi:10.1007/s10654-013-9792-0

    Article  PubMed  Google Scholar 

  17. Mein G, Martikainen P, Hemingway H, Stansfeld S, Marmot M (2003) Is retirement good or bad for mental and physical health functioning? Whitehall II longitudinal study of civil servants. J Epidemiol Community Health 57(1):46–49

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Buxton JW, Singleton N, Melzer D (2005) The mental health of early retirees—national interview survey in Britain. Soc Psychiatry Psychiatr Epidemiol 40(2):99–105. doi:10.1007/s00127-005-0866-5

    Article  PubMed  Google Scholar 

  19. Butterworth P, Gill SC, Rodgers B, Anstey KJ, Villamil E, Melzer D (2006) Retirement and mental health: analysis of the Australian national survey of mental health and well-being. Soc Sci Med 62(5):1179–1191. doi:10.1016/j.socscimed.2005.07.013

    Article  PubMed  Google Scholar 

  20. van der Heide I, van Rijn RM, Robroek SJ, Burdorf A, Proper KI (2013) Is retirement good for your health? A systematic review of longitudinal studies. BMC Public Health 13:1180. doi:10.1186/1471-2458-13-1180

    Article  PubMed  PubMed Central  Google Scholar 

  21. World Health Organization (2004) International statistical classification of diseases and related health problems: ICD-10, vol. 1: tabular list, 2nd edn. World Health Organization, Geneva

    Google Scholar 

  22. Austin PC, Grootendorst P, Anderson GM (2007) A comparison of the ability of different propensity score models to balance measured variables between treated and untreated subjects: a Monte Carlo study. Stat Med 26(4):734–753. doi:10.1002/sim.2580

    Article  PubMed  Google Scholar 

  23. Austin PC (2009) Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research. Commun Stat-Simul Comput 38(6):1228–1234. doi:10.1080/03610910902859574

    Article  Google Scholar 

  24. WHO Collaborating Centre for Drug Statistics Methodology (2012) ATC classification index with DDDs, 2013. WHO Collaborating Centre for Drug Statistics Methodology, Oslo

  25. Hardin JW (2005) Generalized estimating equations (GEE). In: Everitt B, Howell DC (eds) Encyclopedia of statistics in behavioral science. Wiley, New Jersey, pp 721–729. doi:10.1002/0470013192.bsa250

  26. Feinstein A (2007) Neuropsychiatric syndromes associated with multiple sclerosis. J Neurol 254 Suppl 2:II73–II76. doi:10.1007/s00415-007-2017-2

    PubMed  Google Scholar 

  27. Gold R, Oreja-Guevara C (2013) Advances in the management of multiple sclerosis spasticity: multiple sclerosis spasticity guidelines. Expert Rev Neurother 13(12 Suppl):55–59. doi:10.1586/14737175.2013.865880

    Article  PubMed  Google Scholar 

  28. Flachenecker P, Henze T, Zettl UK (2014) Spasticity in patients with multiple sclerosis–clinical characteristics, treatment and quality of life. Acta Neurol Scand 129(3):154–162. doi:10.1111/ane.12202

    Article  CAS  PubMed  Google Scholar 

  29. Kroencke DC, Lynch SG, Denney DR (2000) Fatigue in multiple sclerosis: relationship to depression, disability, and disease pattern. Mult Scler (Houndmills, Basingstoke, Engl) 6(2):131–136

    Article  CAS  Google Scholar 

  30. Sundgren M, Maurex L, Wahlin A, Piehl F, Brismar T (2013) Cognitive impairment has a strong relation to nonsomatic symptoms of depression in relapsing-remitting multiple sclerosis. Arch Clin Neuropsychol: Off J Natl Acad Neuropsychol 28(2):144–155. doi:10.1093/arclin/acs113

    Article  Google Scholar 

  31. Zabad RK, Patten SB, Metz LM (2005) The association of depression with disease course in multiple sclerosis. Neurology 64(2):359–360. doi:10.1212/01.WNL.0000149760.64921.AA

    Article  PubMed  Google Scholar 

  32. Patten SB, Metz LM (2002) Hopelessness ratings in relapsing-remitting and secondary progressive multiple sclerosis. Int J Psychiatry Med 32(2):155–165

    Article  PubMed  Google Scholar 

  33. Johnson KL, Yorkston KM, Klasner ER, Kuehn CM, Johnson E, Amtmann D (2004) The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis. Arch Phys Med Rehabil 85(2):201–209

    Article  PubMed  Google Scholar 

  34. Feinstein A, Kartsounis LD, Miller DH, Youl BD, Ron MA (1992) Clinically isolated lesions of the type seen in multiple sclerosis: a cognitive, psychiatric, and MRI follow up study. J Neurol Neurosurg Psychiatry 55(10):869–876

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Flensner G, Landtblom AM, Soderhamn O, Ek AC (2013) Work capacity and health-related quality of life among individuals with multiple sclerosis reduced by fatigue: a cross-sectional study. BMC Public Health 13:224. doi:10.1186/1471-2458-13-224

    Article  PubMed  PubMed Central  Google Scholar 

  36. Krokavcova M, Nagyova I, Rosenberger J, Gavelova M, Middel B, Gdovinova Z, Groothoff JW, van Dijk JP (2012) Employment status and perceived health status in younger and older people with multiple sclerosis. Int J Rehabil Res 35(1):40–47. doi:10.1097/MRR.0b013e32834e6520

    Article  PubMed  Google Scholar 

  37. Pfleger CC, Flachs EM, Koch-Henriksen N (2010) Social consequences of multiple sclerosis (1): early pension and temporary unemployment—a historical prospective cohort study. Mult Scler (Houndmills, Basingstoke, Engl) 16(1):121–126. doi:10.1177/1352458509352196

    Article  Google Scholar 

  38. Floderus B, Goransson S, Alexanderson K, Aronsson G (2005) Self-estimated life situation in patients on long-term sick leave. J Rehabil Med 37(5):291–299. doi:10.1080/16501970510034422

    Article  PubMed  Google Scholar 

  39. Qin P, Agerbo E, Mortensen PB (2003) Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981–1997. Am J Psychiatry 160(4):765–772

    Article  PubMed  Google Scholar 

  40. Taylor D, Paton C, Kapur S, Taylor D, London South, Trust Maudsley NHS (2012) The Maudsley prescribing guidelines in psychiatry, 11th edn. Wiley, Chichester

    Google Scholar 

Download references

Acknowledgments

This study was supported by the Swedish Research Council for Health, Working Life and Welfare (2007–1762), the Swedish Research Council (Project numbers: K2009-61P-21304-04-4; K2009-61X-21305-01-1; K2011-80P-21782-01-4), the regional agreement on medical training and clinical research (ALF, PPG) between Stockholm County Council and Karolinska Institutet, and by unrestricted grants from BiogenIdec. The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Clinical Neuroscience, Karolinska Institutet, Center for Psychiatry Research, Karolinska Universitetssjukhuset R5:00, 171 77, Stockholm, Sweden

    Philip Brenner & Jussi Jokinen

  2. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden

    Ellenor Mittendorfer-Rutz, Kristina Alexanderson & Petter Tinghög

  3. Department of Clinical Sciences, Umeå University, Umeå, Sweden

    Jussi Jokinen

  4. Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden

    Jan Hillert

  5. Red Cross University College, Stockholm, Sweden

    Petter Tinghög

Authors
  1. Philip Brenner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ellenor Mittendorfer-Rutz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jussi Jokinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kristina Alexanderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jan Hillert
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Petter Tinghög
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philip Brenner.

Ethics declarations

Conflict of interest

PB has received speaker’s fees from Novartis. PT was funded by an unrestricted research grant from BiogenIdec. KA has received unrestricted research grants from BiogenIdec. JH has over the years received honoraria for serving on advisory boards for BiogenIdec and Novartis and speaker’s fees from BiogenIdec, Merck-Serono, Bayer-Schering, Teva Novartis, and Sanofi-Aventis. He has served as P.I. for projects, or received unrestricted research support from, BiogenIdec, Merck-Serono, TEVA, Sanofi-Aventis, and Bayer-Schering and is in the process of negotiating a research grant from Novartis.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brenner, P., Mittendorfer-Rutz, E., Jokinen, J. et al. Prescribed psychiatric medication among multiple sclerosis patients before and after disability pension: a register study with matched controls. Soc Psychiatry Psychiatr Epidemiol 51, 1047–1054 (2016). https://doi.org/10.1007/s00127-016-1234-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-016-1234-3

Keywords

Search

Navigation