Gjesdal Sturla, Ringdal Peder R, Haug Kjell, Maeland John Gunnar
Section for Social Medicine, Department of Public Health and Primary Health Care and Programme for Health Economics, University of Bergen, Norway.
Nord J Psychiatry. 2008;62(4):294-301. doi: 10.1080/08039480801984024.
Sickness absence certified with psychiatric diagnoses is increasing in many Western countries. A substantial proportion of the sickness absentees never return to work, but ends up with a permanent disability pension (DP). This study investigated the incidence of long-term sickness absence (LTSA) with different psychiatric diagnoses, and tested predictors of the transition to permanent DP. A special objective was to explore previously reported gender differences, using a population-based cohort study. The population at risk of LTSA was 106,674 occupational active men and 89,356 women in a Norwegian county in 1994; 314 women and 203 men with LTSA >8 weeks, certified with a psychiatric diagnosis, were followed to the end of 1999, with DP as the endpoint. Diagnoses on sickness certificates, age, gender and income were used as explanatory variables in Cox regression analysis. Annual incidence of LTSA with a psychiatric diagnosis was 7.0/1000/year for women and 3.8/1000 for men; 72% of the women and 50% of the men had a diagnosis indicating depression. During follow-up, 32% of the men and 25% of the women obtained DP. Increasing age, male gender, low income and a diagnosis of psychosis or "other" increased the DP risk. Separate analysis for men indicated a different effect of age and a larger role of serious mental illness. The study verified that women more often than men had LTSA with psychiatric diagnoses, especially with depression. Men were at higher risk of transition to DP, and the study suggested some possible explanations.
在许多西方国家，因精神疾病诊断而获批的病假正在增加。相当一部分请病假的人再也没有回到工作岗位，而是最终领取了永久性残疾抚恤金（DP）。本研究调查了不同精神疾病诊断导致的长期病假（LTSA）发生率，并测试了向永久性DP转变的预测因素。一个特殊目标是通过一项基于人群的队列研究来探索先前报道的性别差异。1994年，挪威一个郡有106,674名在职男性和89,356名女性面临LTSA风险；对314名女性和203名男性进行了跟踪，他们因精神疾病诊断获批LTSA超过8周，随访至1999年底，以DP作为终点。病假证明上的诊断、年龄、性别和收入被用作Cox回归分析中的解释变量。女性因精神疾病诊断导致的LTSA年发生率为7.0/1000/年，男性为3.8/1000；72%的女性和50%的男性诊断显示为抑郁症。在随访期间，32%的男性和25%的女性获得了DP。年龄增长、男性、低收入以及精神病或“其他”诊断增加了获得DP的风险。对男性的单独分析表明年龄有不同影响，严重精神疾病的作用更大。该研究证实，女性因精神疾病诊断出现LTSA的情况比男性更常见，尤其是抑郁症。男性转变为领取DP的风险更高，该研究提出了一些可能的解释。
