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Labour market marginalisation in obsessive–compulsive disorder: a nationwide register-based sibling control study

Published online by Cambridge University Press:  28 June 2018

Ana Pérez-Vigil Open the ORCID record for Ana Pérez-Vigil [Opens in a new window] ,
Ellenor Mittendorfer-Rutz ,
Magnus Helgesson ,
Lorena Fernández de la Cruz  and
David Mataix-Cols
Ana Pérez-Vigil*
Affiliation:
Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden Department of Child and Adolescent Psychiatry and Psychology, Clínic Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
Ellenor Mittendorfer-Rutz
Affiliation:
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
Magnus Helgesson
Affiliation:
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
Lorena Fernández de la Cruz
Affiliation:
Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
David Mataix-Cols
Affiliation:
Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
*
*Author for correspondence: Ana Pérez-Vigil, E-mail: ana.perez.vigil@ki.se
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Abstract

Background

The impact of obsessive–compulsive disorder (OCD) on objective indicators of labour market marginalisation has not been quantified.

Methods

Linking various Swedish national registers, we estimated the risk of three labour market marginalisation outcomes (receipt of newly granted disability pension, long-term sickness absence and long-term unemployment) in individuals diagnosed with OCD between 2001 and 2013 who were between 16 and 64 years old at the date of the first OCD diagnosis (n = 16 267), compared with matched general population controls (n = 157 176). Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox regression models, adjusting for a number of covariates (e.g. somatic disorders) and stratifying by sex. To adjust for potential familial confounders, we further analysed data from 7905 families that included full siblings discordant for OCD.

Results

Patients were more likely to receive at least one outcome of interest [adjusted HR = 3.63 (95% CI 3.53–3.74)], including disability pension [adjusted HR = 16.36 (95% CI 15.34–17.45)], being on long-term sickness absence [adjusted HR = 3.07 (95% CI 2.95–3.19)] and being on long-term unemployment [adjusted HR = 1.72 (95% CI 1.63–1.82)]. Results remained similar in the adjusted sibling comparison models. Exclusion of comorbid psychiatric disorders had a minimal impact on the results.

Conclusions

Help-seeking individuals with OCD diagnosed in specialist care experience marked difficulties to participate in the labour market. The findings emphasise the need for cooperation between policy-makers, vocational rehabilitation and mental health services in order to design and implement specific strategies aimed at improving the patients’ participation in the labour market.

Keywords

Adjustmentdisability pensiondisabilityfunctioningimpairmentlabour market marginalisationobsessive–compulsive disordersickness absenceunemploymentwork
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 6 , April 2019 , pp. 1015 - 1024
Copyright
Copyright © Cambridge University Press 2018 

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