All-Cause and Cause-Specific Mortality after Long-Term Sickness Absence for Psychiatric Disorders: A Prospective Cohort Study

Objective: The aim was to examine if long-term psychiatric sickness absence was associated with all-cause and diagnosis-specific (cardiovascular disease (CVD), cancer and suicide) mortality for the period 1990-2007. An additional aim was to examine these associations for psychiatric sickness absence in 1990 and 2000, with follow-up on mortality during 19911997 and 2001-2007, separately. Methods: Employees within municipalities and county councils, 244,990 individuals in 1990 and 764,137 individuals in 2000, were followed up to 2007 through register linkages. Analyses were conducted with flexible parametric survival models comparing sickness absentees due to psychiatric diagnoses (>90 days) with those not receiving sick leave benefit. Results: Long-term sickness absence for psychiatric disorders was associated with an increased risk of mortality due to all causes; CVD; cancer (smoking and non-smoking related); and suicide during the period 1990-2007. After full adjustment for socio-demographic covariates and previous inpatient care due to somatic and psychiatric diagnoses, these associations remained significant for all-cause mortality (Hazard ratios (HR) and 95% confidence interval (CI)): HR 1.56, 95% CI 1.3-1.8; CVD: HR 1.35, 95% CI 1.0-1.9, and suicide: HR 3.84, 95% CI 2.4-6.1. For both cohorts 1990 and 2000 estimates point in the same direction. For the time-period 2000-2007, we found increased risks of mortality in the fully adjusted model due to all causes: HR 1.47, 95% CI 1.2-1.7; CVD: HR 1.83, 95% CI 1.2-2.7; overall cancer: HR 1.33, 95% CI 1.0-1.7; and suicide: HR 2.15, 95% CI 1.3-3.7. Conclusion: Long-term sickness absence for psychiatric disorders predicted premature mortality from all-causes, cardiovascular disease, cancer, and suicide.