Bryngelson Anna, Asberg Marie, Nygren Ake, Jensen Irene, Mittendorfer-Rutz Ellenor
Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden.
PLoS One. 2013 Jun 26;8(6):e67887. doi: 10.1371/journal.pone.0067887. Print 2013.
The aim was to examine if long-term psychiatric sickness absence was associated with all-cause and diagnosis-specific (cardiovascular disease (CVD), cancer and suicide) mortality for the period 1990-2007. An additional aim was to examine these associations for psychiatric sickness absence in 1990 and 2000, with follow-up on mortality during 1991-1997 and 2001-2007, separately.
Employees within municipalities and county councils, 244,990 individuals in 1990 and 764,137 individuals in 2000, were followed up to 2007 through register linkages. Analyses were conducted with flexible parametric survival models comparing sickness absentees due to psychiatric diagnoses (>90 days) with those not receiving sick leave benefit.
Long-term sickness absence for psychiatric disorders was associated with an increased risk of mortality due to all causes; CVD; cancer (smoking and non-smoking related); and suicide during the period 1990-2007. After full adjustment for socio-demographic covariates and previous inpatient care due to somatic and psychiatric diagnoses, these associations remained significant for all-cause mortality (Hazard ratios (HR) and 95% confidence interval (CI)): HR 1.56, 95% CI 1.3-1.8; CVD: HR 1.35, 95% CI 1.0-1.9, and suicide: HR 3.84, 95% CI 2.4-6.1. For both cohorts 1990 and 2000 estimates point in the same direction. For the time-period 2000-2007, we found increased risks of mortality in the fully adjusted model due to all causes: HR 1.47, 95% CI 1.2-1.7; CVD: HR 1.83, 95% CI 1.2-2.7; overall cancer: HR 1.33, 95% CI 1.0-1.7; and suicide: HR 2.15, 95% CI 1.3-3.7.
Long-term sickness absence for psychiatric disorders predicted premature mortality from all-causes, cardiovascular disease, cancer, and suicide.
本研究旨在探讨1990年至2007年期间，长期精神疾病病假是否与全因死亡率及特定诊断（心血管疾病（CVD）、癌症和自杀）死亡率相关。另一个目的是分别考察1990年和2000年精神疾病病假与死亡率之间的关联，并对1991年至1997年及2001年至2007年期间的死亡率进行随访。
通过登记链接对市和郡议会的雇员进行随访，1990年有244,990人，2000年有764,137人，直至2007年。采用灵活的参数生存模型进行分析，比较因精神疾病诊断而病假超过90天的人与未领取病假福利的人。
1990年至2007年期间，精神疾病的长期病假与全因、CVD、癌症（与吸烟和不吸烟相关）及自杀导致的死亡风险增加有关。在对社会人口统计学协变量以及因躯体和精神疾病诊断而先前住院治疗进行全面调整后，这些关联在全因死亡率方面仍然显著（风险比（HR）和95%置信区间（CI））：HR 1.56，95% CI 1.3 - 1.8；CVD：HR 1.35，95% CI 1.0 - 1.9，自杀：HR 3.84，95% CI 2.4 - 6.1。1990年和2000年这两个队列的估计结果指向相同方向。对于2000年至2007年期间，我们发现在完全调整模型中，全因死亡率风险增加：HR 1.47，95% CI 1.2 - 1.7；CVD：HR 1.83，95% CI 1.2 - 2.7；总体癌症：HR 1.33，95% CI 1.0 - 1.7；自杀：HR 2.15，95% CI 1.3 - 3.7。
精神疾病的长期病假预示着全因、心血管疾病、癌症和自杀导致的过早死亡。
