Regional differences in disability pension and sickness absence with psychiatric diagnoses in Sweden and Norway 1980-2000. The influence of demography and access to psychiatric health care

Abstract: Abstract: Background: Psychiatric diagnoses in sickness absence (SA) and disability pensions (DP) among individuals under 35 years and the proportion of SA and DP with psychiatric disorders have increased in several countries. SA and DP with psychiatric disorders show regional differences, and imply social and economic consequences for individuals and a high cost to employers and society. Aim: The overall purpose of this thesis was to describe regional differences in the occurrence of SA and DP with psychiatric diagnoses and to analyse whether these regional differences were associated with age, sex or access to psychiatric health care. Method: The thesis was based on four cross-sectional studies. The study base in Sweden was the municipality of Göteborg and the county of Göteborg and Bohuslän (excluding the municipality of Göteborg). For Norway, the study included the municipality of Oslo and the counties Östfold, Telemark, Vestfold, Aust-Agder and Vest-Agder. Sweden and Norway as a whole were used as references, and the studied years in Sweden were 1980,1985,1990,1995, 1998 and in Norway 1988,1990,1995,2000. Aggregated data on individuals granted DP and SA were collected from the National Insurance Board in Sweden and the National Insurance Administration in Norway. Data on access to psychiatric health care (staff and beds per 10 000) were collected from the Norwegian Special Health Service. Population data were drawn from national statistics. Standardised mortality ratio (SMR), incidence rate ratio (IRR), cumulative incidence (95%confidence intervals) were used to analysed data. Results: There were regional differences in both DP and SA with psychiatric diagnoses in Sweden and Norway. These regional differences remained after controlling for age and sex. Both men and women in urban Göteborg in Sweden and men in urban Oslo showed increased risk ratios for DP with psychiatric diagnoses compared to national data. For both sexes in certain semi-rural regions in Norway, especially Aust-Agder and Vest-Agder, increased risks were also found. The regional differences in DP with psychiatric diagnoses were found in all age groups in four regions, except for the oldest age groups. Access to psychiatric health care was associated with DP with psychiatric diagnoses in certain regions but did not explain the regional differences. Physicians, psychologists and beds were positively associated with DP rates. The cumulative incidence of DP with psychiatric diagnoses increased in the youngest age groups during the period of study and the cumulative incidence of SA with psychiatric diagnoses was highest and also showed the highest increase among women in urban Oslo. Conclusion: The regional differences in SA and DP with psychiatric diagnoses could not be explained by differences in the age and sex composition of the populations in the different regions or by regional differences in access to psychiatric health care. Future studies need to focus on the distribution of access to psychiatric and vocational rehabilitation, to possible differences in treatment and the influence of local labour markets. There is also a need for more gender and diagnosis specific research on SA and DP. Pressrelease: Bohusländska kvinnor oftare förtidspensionerade för depression Allt fler kvinnor i Bohuslän blev under åren 1980-1998 förtidspensionerade för till exempel depression eller stress. I jämförelse med övriga landet var det 20 % fler av länets förtidspensionerade kvinnor som hade en psykiatrisk diagnos. Det visar en avhandling från Sahlgrenska akademin. Socionomen Lena Andersson har gått igenom de medicinska intyg som låg till grund för Försäkringskassans beslut om förtidspension i Göteborg och Bohuslän mellan åren 1980 och 1998. Studien visar att det bara var kvinnorna i Bohuslän som i större utsträckning var förtidspensionerade för depression, stress eller neurotiska sjukdomar. Männens statistik skiljer sig inte från landet i övrigt. – Det är svårt att förklara vad det var som gjorde att kvinnorna i Bohuslän i så hög utsträckning skiljde sig från övriga landet. Det kan bero på att landsbygdens invånare hade sämre tillgång till psykiatrisk vård och deras längre restider kan också ha spelat en roll, säger Lena Andersson.