Psychosocial characteristics in young men as predictors of early disability pension with a psychiatric diagnosis

Background: There is little knowledge about disability pensions (DPs) in psychiatric diagnoses. The aim of this study was to analyse risk factors among men for receiving an early disability pension with a psychiatric diagnosis. Methods: The study is based on data from a nationwide survey of 49 285 young Swedish men who were conscripted into military service in 1969/1970. Potential psychosocial and behavioural risk factors were linked to records from the Swedish Social Insurance Board up until 1993. Results: The majority (63.4%) of the men granted a DP during follow-up had a psychiatric diagnosis as the main and/or secondary diagnosis. Among those conscripts analysed (41 702), 599 had been granted a disability pension with a psychiatric diagnosis. Of these, 35.4% had a diagnosis of psychosis, 23.2% an alcohol- or drug-related diagnosis, and 41.4% 'other' psychiatric diagnosis. Receiving a psychiatric diagnosis at conscription, showing low emotional control, unemployment after graduation, and ranking low on an "IQ" test were strong predictors of all categories of DP with psychiatric diagnoses. In multivariate analysis controlling for the effect of all other risk indicators included in the model, DP with non-alcohol- and non-drug-related psychiatric diagnoses was related to low social support at adolescence but not to signs of extrovert deviant behaviour (risky use of alcohol or contact with police and child authorities). In contrast, DP with an alcohol- or drug-related diagnosis had strong associations with signs of extrovert deviant behaviour. The risk pattern of DP without psychiatric diagnoses was similar to that of DP with a psychosis but also, though to a lesser extent, to that of DP with 'other' psychiatric diagnosis. These similarities could be interpreted as showing that the diagnoses on the records of disability pensions have a low sensitivity and/or specificity or, alternatively, that the risk factors found are risk factors for life careers steering toward a disability pension rather than toward the specific health outcomes per se. Conclusions: The results illustrate the importance of psychosocial factors established in late adolescence in the complex pathway of a decision of an early DP.