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Excess mortality after disability retirement due to mental disorders: variations by socio-demographic factors and causes of death

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Abstract

Purpose

Mental disorders are the key causes of disability retirement and are associated with a high risk of mortality. Social variations in excess mortality after disability retirement are nevertheless poorly understood. We examined socio-demographic differences in all-cause and cause-specific mortality after disability retirement due to depression and other mental disorders.

Methods

The data comprised a nationally representative sample of the Finnish population aged 25–64 in 1996 with no prior disability retirement due to mental disorders (N = 392,985). We used Cox regression analysis with disability retirement due to mental disorders as a time-varying covariate and mortality between 1997 and 2007 as the outcome variable.

Results

We found excess mortality after disability retirement due to mental disorders as compared to those with no such retirement in all specific causes of death, in particular alcohol-related causes, suicide, and other unnatural causes. Excess suicide mortality was particularly large after depression-based disability retirement. Younger age groups, non-manual classes, and those living with a partner and children had largest excess mortality, especially from unnatural and alcohol-related causes. However, the absolute number of excess deaths was not always largest in these socio-demographic groups.

Conclusions

In young adulthood, disability retirement due to depression signifies severe health and other social disadvantages that lead to particularly large excess mortality, especially due to unnatural causes. The protective effects of a high socioeconomic position and family ties against unnatural and alcohol-related deaths are limited among those who have already developed depression or other mental disorders that have led to disability retirement.

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Acknowledgement

We are grateful to Statistics Finland, the Finnish Centre for Pensions, and the Social Insurance Institution of Finland for making the data available to us. This study was supported by the Finnish Doctoral Program in Social Sciences, the Emil Aaltonen Foundation, and the Academy of Finland.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Population Research Unit, Department of Social Research, University of Helsinki, PO Box 59, 00014, Helsinki, Finland

    Taina Leinonen & Pekka Martikainen

  2. Finnish Centre for Pensions, Helsinki, Finland

    Mikko Laaksonen

  3. Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland

    Eero Lahelma

Authors
  1. Taina Leinonen
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  2. Pekka Martikainen
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  3. Mikko Laaksonen
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  4. Eero Lahelma
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Correspondence to Taina Leinonen.

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Leinonen, T., Martikainen, P., Laaksonen, M. et al. Excess mortality after disability retirement due to mental disorders: variations by socio-demographic factors and causes of death. Soc Psychiatry Psychiatr Epidemiol 49, 639–649 (2014). https://doi.org/10.1007/s00127-013-0747-2

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  • DOI: https://doi.org/10.1007/s00127-013-0747-2

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