Does Absence Due to Psychiatric Disorder Predict Cause-specific Mortality?
Does Absence Due to Psychiatric Disorder Predict Cause-specific Mortality?
Mental disorders are a frequent cause of morbidity and sickness absence in working populations; however, the status of psychiatric sickness absence as a predictor of mortality is not established. The authors tested the hypothesis that psychiatric sickness absence predicts mortality from leading medical causes. Data were derived from the French GAZEL cohort study (n = 19,962). Physician-certified sickness absence records were extracted from administrative files (1990–1992) and were linked to mortality data from France's national registry of mortality (1993–2008, mean follow-up: 15.5 years). Analyses were conducted by using Cox regression models. Compared with workers with no sickness absence, those absent due to psychiatric disorder were at increased risk of cause-specific mortality (hazard ratios (HRs) adjusted for age, gender, occupational grade, other sickness absence—suicide: 6.01, 95% confidence interval (CI): 3.07, 11.75; cardiovascular disease: 1.84, 95% CI: 1.10, 3.08; and smoking-related cancer: 1.65, 95% CI: 1.07, 2.53). After full adjustment, the excess risk of suicide remained significant (HR = 5.13, 95% CI: 2.60, 10.13) but failed to reach statistical significance for fatal cardiovascular disease (HR = 1.59, 95% CI: 0.95, 2.66) and smoking-related cancer (HR = 1.31, 95% CI: 0.85, 2.03). Psychiatric sickness absence records could help identify individuals at risk of premature mortality and serve to monitor workers' health.
In industrialized nations, mental disorders affect 30%–50% of individuals during their lifetime and are one of the leading causes of morbidity. These disorders are especially frequent in adults of working age, and, in addition to being a source of great suffering for those affected and those close to them, they often lead to impaired functioning, lost productivity, and premature death.
Research from population studies has shown that only a minority of individuals with mental disorders seek medical care or are absent from work. Among the employed, psychiatric sickness absence indicates the presence of severe mental health difficulties and predicts future risk of poor health (10), disability pension due to mental disorders, and mortality. However, to our knowledge, the association between psychiatric sickness absence and specific causes of death has been examined in only a single investigation based on the British Whitehall II study. The authors reported an association between psychiatric sickness absence and mortality due to cardiovascular causes and all cancers; however, because of low statistical power, they were not able to examine other frequent causes of death such as specific cancer types and suicide. Thus, current knowledge regarding the relation between sickness absence due to psychiatric disorder and patterns of mortality is incomplete. Thorough documentation of patterns of cause-specific mortality associated with psychiatric sickness absence can help improve understanding of the population impact of mental disorders and establish psychiatric sickness absence as an indicator of later health outcomes.
In the present study, we examined the association between psychiatric sickness absence and mortality over a follow-up period of 16 years among public-sector employees in France who participated in the GAZEL cohort study. A previous study based on this cohort showed that psychiatric sickness absence predicts the risk of all-cause mortality. In the present investigation, our aim was to extend that prior finding by testing associations between psychiatric sickness absence and specific causes of death.
Abstract and Introduction
Abstract
Mental disorders are a frequent cause of morbidity and sickness absence in working populations; however, the status of psychiatric sickness absence as a predictor of mortality is not established. The authors tested the hypothesis that psychiatric sickness absence predicts mortality from leading medical causes. Data were derived from the French GAZEL cohort study (n = 19,962). Physician-certified sickness absence records were extracted from administrative files (1990–1992) and were linked to mortality data from France's national registry of mortality (1993–2008, mean follow-up: 15.5 years). Analyses were conducted by using Cox regression models. Compared with workers with no sickness absence, those absent due to psychiatric disorder were at increased risk of cause-specific mortality (hazard ratios (HRs) adjusted for age, gender, occupational grade, other sickness absence—suicide: 6.01, 95% confidence interval (CI): 3.07, 11.75; cardiovascular disease: 1.84, 95% CI: 1.10, 3.08; and smoking-related cancer: 1.65, 95% CI: 1.07, 2.53). After full adjustment, the excess risk of suicide remained significant (HR = 5.13, 95% CI: 2.60, 10.13) but failed to reach statistical significance for fatal cardiovascular disease (HR = 1.59, 95% CI: 0.95, 2.66) and smoking-related cancer (HR = 1.31, 95% CI: 0.85, 2.03). Psychiatric sickness absence records could help identify individuals at risk of premature mortality and serve to monitor workers' health.
Introduction
In industrialized nations, mental disorders affect 30%–50% of individuals during their lifetime and are one of the leading causes of morbidity. These disorders are especially frequent in adults of working age, and, in addition to being a source of great suffering for those affected and those close to them, they often lead to impaired functioning, lost productivity, and premature death.
Research from population studies has shown that only a minority of individuals with mental disorders seek medical care or are absent from work. Among the employed, psychiatric sickness absence indicates the presence of severe mental health difficulties and predicts future risk of poor health (10), disability pension due to mental disorders, and mortality. However, to our knowledge, the association between psychiatric sickness absence and specific causes of death has been examined in only a single investigation based on the British Whitehall II study. The authors reported an association between psychiatric sickness absence and mortality due to cardiovascular causes and all cancers; however, because of low statistical power, they were not able to examine other frequent causes of death such as specific cancer types and suicide. Thus, current knowledge regarding the relation between sickness absence due to psychiatric disorder and patterns of mortality is incomplete. Thorough documentation of patterns of cause-specific mortality associated with psychiatric sickness absence can help improve understanding of the population impact of mental disorders and establish psychiatric sickness absence as an indicator of later health outcomes.
In the present study, we examined the association between psychiatric sickness absence and mortality over a follow-up period of 16 years among public-sector employees in France who participated in the GAZEL cohort study. A previous study based on this cohort showed that psychiatric sickness absence predicts the risk of all-cause mortality. In the present investigation, our aim was to extend that prior finding by testing associations between psychiatric sickness absence and specific causes of death.
