(20) Treatment‑Resistant Depression and Labor Market Affiliation in The Danish Welfare Society: A Register‑Based Study

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1065

Presenting Author(s)

Frederikke H. Gronemann
– Center for clinical research and prevention, Center for Clinical Research and Prevention, Frederiksberg, Hovedstaden, Denmark

Co-Author(s)

Thomas Lund
– Senior researcher, Unit of Social medicine, Bispebjerg and Frederiksberg Hospitals, Denmark
Louise Lindholdt
– Postdoc, Department of Public Health, Aarhus University, Denmark
Kathrine Bang Madsen
– Postdoc, National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Denmark
Martin Balslev Jørgensen
– Psychiatric Centre Copenhagen, Department O, Rigshospitalet, Denmark
Merete Nordentoft
– iPSYCH, the Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark, Denmark
Merete Osler
– Senior physician, clinical professor, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Hovedstaden, Denmark

Background: Treatment-resistant depression (TRD) has been suggested to contribute excessively to the burden of disability due to depression. These patients might experience a more substantial impact on social conditions and workability. However, few studies have addressed labor market affiliation among these patients

Objectives: To explore if patients with TRD go through different states of labor market affiliation during their course of illness before they return to work or obtain early retirement compared with patients with non-TRD

Methods: All adults between 18 and 58 years with a first-time in- or outpatient contact with major depression at a Danish hospital between 1 January 2000 and 31 December 2014, using the (ICD-10) codes F32 and F33 and no prior hospitalization with bipolar affective disorder, other affective mood disorders, persistent mood disorder, or schizophrenia spectrum disorder (N=106,090). To construct the final study population, we identified all patients meeting the criteria for incident TRD. These (n=16,253) were matched to patients with non-TRD in a 1:2 ratio according to time of first hospital contact with depression, sex, and age.

Exposure: TRD - TRD was defined as at least three distinct consecutive treatment trials for depression assessed during a time span of 12 months before and after first hospital contact with depression.

Outcome: Labor market affiliation: employment, sickness absence, social transfer payments (employment-ready), passive social transfer payments, and disability pension. Further, labor market indicators based on the patients’ different labor market affiliations was calculated

Statistical analysis: Sequence analysis and unconditional logistic regression analysis presented with odds ratios (OR) and 95% confidence intervals (CI).

Results: At the index week, 14.1% of patients with TRD were in employment compared with 26.4% among non-TRD patients. Over time, the proportion of patients in employment increased slightly. The proportion of TRD patients with sickness absence at the index week was 47.0% and 26.2% for non-TRD patients. The adjusted odds of a below mean volatility of labor market transitions, characterized by more episodes in passive social transfer payments and disability pension, were higher among patients with TRD compared with non-TRD patients (OR 1.63, 95% CI [1.56-1.69]). Similarly, the adjusted odds of a below mean integration into employment were 1.63 higher among TRD patients compared with non-TRD patients (95% CI [1.56-1.70]).

Conclusions: Patients with TRD have higher levels of sickness absence and lower levels of reintegration into the labor market after meeting the criteria for TRD compared with patients without TRD.

Abstract reused by permission from Springer Nature; Springer; Journal of Social Psychiatry and Psychiatric Epidemiology, Treatment-resistant depression and labor market affiliation in the Danish welfare society: a register-based study, Gronemann et al., 2022, https://doi.org/10.1007/s00127-022-02243-9.