Depression- and anxiety-related sick leave and the risk of permanent disability and mortality in the working population in Germany: a cohort study

BMC Public Health

William E Lee²  Siegfried Geyer³  Stefan Bleich¹  Nicola-Alexander Sittaro⁴  Sonja Arnhold-Kerri³  Felix Wedegaertner¹ 

[1] Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Centre for Mental Health, Carl-Neuberg-Str. 1, 30625, Hannover, Germany;Department of Psychological Medicine, King’s College London Institute of Psychiatry, 10 Cutcombe Rd, London, SE5 9RJ, UK;Hannover Medical School Medical Sociology, Carl-Neuberg-Str. 1, 30625, Hannover, Germany;Hannover Life Re, Karl-Wiechert-Allee 50, 30625, Hannover, Germany

关键词: Protection;    Occupational disability;    Mortality;    Invalidity;    Treatment;    Depression;    Anxiety;   

Others  :  1162534
DOI  :  10.1186/1471-2458-13-145

 received in 2012-04-12, accepted in 2013-02-12,  发布年份 2013

【 摘 要 】

Background

Anxiety and depression are the most common psychiatric disorders and are the cause of a large and increasing amount of sick-leave in most developed countries. They are also implicated as an increasing mortality risk in community surveys. In this study we addressed, whether sick leave due to anxiety, depression or comorbid anxiety and depression was associated with increased risk of retirement due to permanent disability and increased mortality in a cohort of German workers.

Methods

128,001 German workers with statutory health insurance were followed for a mean of 6.4 years. We examined the associations between 1) depression/anxiety-related sick leave managed on an outpatient basis and 2) anxiety/depression-related psychiatric inpatient treatment, and later permanent disability/mortality using Cox proportional hazard regression models (stratified by sex and disorder) adjusted for age, education and job code classification.

Results

Outpatient-managed depression/anxiety-related sick leave was significantly associated with higher permanent disability (hazard ratio (95% confidence interval)) 1.48 (1.30, 1.69) for depression, 1.25 (1.07, 1.45) for anxiety, 1.91 (1.56, 2.35) for both). Among outpatients, comorbidly ill men (2.59 (1.97,3.41)) were more likely to retire early than women (1.42 (1.04,1.93)). Retirement rates were higher for depressive and comorbidly ill patients who needed inpatient treatment (depression 3.13 (2,51, 3,92), both 3.54 (2.80, 4.48)). Inpatient-treated depression was also associated with elevated mortality (2.50 (1.80, 3.48)). Anxiety (0.53 (0.38, 0.73)) and female outpatients with depression (0.61 (0.38, 0.97)) had reduced mortality compared to controls.

Conclusions

Depression/anxiety diagnoses increase the risk of early retirement; comorbidity and severity further increase that risk, depression more strikingly than anxiety. Sickness-absence diagnoses of anxiety/depression identified a population at high risk of retiring early due to ill health, suggesting a target group for the development of interventions.

【 授权许可】

   
2013 Wedegaertner et al; licensee BioMed Central Ltd.

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