Section for Science of Complex Systems, CeDAS, Medical University of Vienna, Vienna, Austria.
Complexity Science Hub Vienna, Vienna, Austria.
Eur Child Adolesc Psychiatry. 2024 Mar;33(3):897-907. doi: 10.1007/s00787-023-02214-8. Epub 2023 Apr 28.
Little is known about the association between common mental disorders (CMD) and labor market integration among refugee and Swedish-born young adults. Socially disadvantaged patients such as refugees are more likely to discontinue their medication use prematurely. This study aimed to identify clusters of individuals with similar psychotropic medication patterns; and examine the relationship between cluster membership with labor market marginalization (LMM) in refugee and Swedish-born young adults with CMD. The study uses a longitudinal matched cohort aged 18-24 years with CMD diagnoses from Swedish registers covering 2006-2016. Dispensed psychotropic medications (antidepressants, antipsychotics, anxiolytics, sedative-hypnotics, mood stabilizers) were collected one year before and after CMD diagnosis. Clusters of patients with similar time courses of prescribed dosages were algorithmically identified. The association of cluster membership with subsequent LMM, (long-term sickness absence, SA, disability pension, DP, or long-term unemployment, UE) was assessed using Cox regression. Among 12,472 young adults with CMD, there were 13.9% with SA, 11.9% with DP, and 13.0% with UE during a mean follow-up of 4.1 years (SD 2.3 years). Six clusters of individuals were identified. A cluster with a sustained increase in all medication types yielded the highest hazard ratio (HR [95% CI]) 1.69 [1.34, 2.13] for SA and 2.63 [2.05, 3.38] for DP. The highest HRs of UE give a cluster with a concentrated peak in antidepressants at CMD diagnosis (HR 1.61[1.18, 2.18]). Refugees and Swedish-born showed similar associations between clusters and LMM. To prevent LMM, targeted support and early assessment of CMD treatment are needed for individuals with a sustained increase in psychotropic medication after CMD diagnosis and for refugees in high-risk clusters for UE characterized by a rapid lowering of treatment dosages, which could be an indicator for premature medication discontinuation.
关于常见精神障碍 (CMD) 与难民和瑞典出生的年轻成年人劳动力市场融合之间的关联，人们知之甚少。像难民这样处于社会劣势的患者更有可能过早停止使用药物。本研究旨在确定具有相似精神药物使用模式的个体集群；并研究在患有 CMD 的难民和瑞典出生的年轻成年人中，集群成员与劳动力市场边缘化 (LMM) 之间的关系。该研究使用了一项纵向匹配队列研究，年龄在 18-24 岁之间，患有 2006-2016 年瑞典登记处诊断的 CMD。在 CMD 诊断前一年和后一年收集了精神药物 (抗抑郁药、抗精神病药、抗焦虑药、镇静催眠药、心境稳定剂) 的处方剂量。使用算法确定了具有相似规定剂量时间过程的患者集群。使用 Cox 回归评估集群成员与随后的 LMM（长期病假、SA、残疾抚恤金、DP 或长期失业、UE）之间的关联。在 12472 名患有 CMD 的年轻成年人中，有 13.9%患有 SA，11.9%患有 DP，13.0%患有 UE，平均随访时间为 4.1 年（SD 2.3 年）。确定了六个个体集群。一个持续增加所有药物类型的集群产生了最高的风险比 (HR [95%CI])，SA 为 1.69 [1.34, 2.13]，DP 为 2.63 [2.05, 3.38]。UE 的最高 HR 为一个在 CMD 诊断时集中出现抗抑郁药峰值的集群（HR 1.61 [1.18, 2.18]）。难民和瑞典出生的人在集群与 LMM 之间表现出相似的关联。为了防止 LMM，需要针对 CMD 诊断后精神药物持续增加的个体以及 UE 风险较高的集群（以治疗剂量迅速降低为特征）的难民提供有针对性的支持和早期评估 CMD 治疗，这可能是过早停药的指标。
