The role of familial factors and neuroticism in the association between exposure to offensive behaviors at work and long-term sickness absence due to common mental disorders - a prospective twin study.

OBJECTIVES: The aim of this study was to investigate associations between exposure to work-related violence/threats and harassment, and future sickness absence (SA) due to common mental disorders (CMDs), taking familial factors (shared genetics and early-life environment) and neuroticism into account. METHODS: The study sample included 8795 twin individuals from the Swedish Twin Project of Disability Pension and Sickness Absence (STODS), including survey data from the Study of Twin Adults: Genes and Environment (STAGE). Self-reported work-related violence and/or threats as well as work-related harassment (including bullying) and national register data on SA due to CMDs were analyzed using standard logistic regression, and conditional logistic regression among complete twin pairs discordant on exposures. Individuals were followed for a maximum of 13 years. Interactions between neuroticism and exposures were assessed using both multiplicative and additive interaction analyses. RESULTS: Exposure to work-related violence/threats was associated with higher odds of SA due to CMDs when adjusting for age, sex, marital status, children, education, type of living area, work characteristics, and symptoms of depression and burnout (OR 2.11, 95% CI 1.52-2.95). Higher odds of SA due to CMDs were also found for exposure to harassment (OR 1.52, 95% CI 1.10-2.11) and a combined indicator of exposure to violence/threats and/or harassment (OR 1.98, 95% CI 1.52-2.59), compared with the unexposed. Analyses of twins discordant on exposure, using the unexposed co-twin as reference, showed reduced ORs. These ORs were still elevated but no longer statistically significant, potentially due to a lack of statistical power. No multiplicative interaction was found between neuroticism and exposure to work-related violence/threats, or harassment. However, a statistically significant additive interaction was found between neuroticism and exposure to violence/threats, indicating higher odds of SA due to CMDs in the group scoring lower on neuroticism. CONCLUSIONS: Exposure to work-related offensive behaviors was associated with SA due to CMDs. However, the results indicated that these associations may be partly confounded by familial factors. In addition, an interaction between exposure and neuroticism was suggested. Thus, when possible, future studies investigating associations and causality between offensive behaviors at work and mental health-related outcomes, should consider familial factors and neuroticism.

Changes in family situation and concurrent changes in working life: a 15-year longitudinal analysis.

OBJECTIVE: Currently, little is known regarding changes in family situation with concurrent changes in working life. This study aimed to examine whether changes in family situation (based on living with children and/or marrying/divorcing) were associated with changes in working life and whether the associations were influenced by sex, genetics and early life environment. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: Data from Swedish national registers of 16 410 twins were used. Fixed-effects logistic regression models assessing ORs with 95% CIs were applied to examine associations between changes in family situation and working life controlling for time-invariant effects and adjusted for covariates, and conditional models to account for confounding of genetics and early life environment. RESULTS: Changes in individuals life situation from being single and living without children to married and living with children were associated with transitioning from unsustainable (ie, having unemployment or sickness absence/disability pension) to sustainable working life (men: OR 2.40, 95% CI 2.26 to 2.56; women: OR 1.68, 95% CI 1.59 to 1.78). Changes from being married to single, in contrast, attenuated the likelihood of transitioning to a sustainable working life. Moreover, changes in men's working life seem to be more dependent on changes in family situation compared with women. Genetic factors and early life environment play a role in the associations. CONCLUSIONS: Family formation increases the likelihood of a more stable working life whereas divorce is a risk factor for work interruptions. Our study emphasises that family formation improves the work life situation and to a higher degree for men.

Regional differences in annual prevalence of sustainable working life in Swedish twin cohort.

The global rise in life expectancy transforms age structure consequently having impact to the sustainability of social protection systems and working life. This descriptive study aimed to illustrate the annual prevalence of sustainable working life across Swedish residential regions, and investigate differences between age groups, sex, or being identical or fraternal twin. The study sample included 81,231 twins with linkage to national register data on sickness absence, disability pension, unemployment, and residential regions. Regions were classified by Swedish municipalities into nine groups. Sustainable working life were then followed in 1998, 2003, 2008, and 2013. Annual prevalence and Generalized Estimating Equation (GEE) with log linear models for interaction test were used. Medium to large size municipalities (15-24%) had higher annual prevalence of sustainable working life than smaller municipalities (1-7%). Young adults in medium to large size municipalities had high annual prevalence of sustainable working life. We found no differences for sexes or being identical or fraternal twin. To conclude, annual prevalence of sustainable working life in 1998, 2003, 2008 and 2013 differed by region being highest in medium to large size municipalities which may have importance for targeting policies, regulations, and practices in a region-specific way. Further studies on residential regions and sustainable working life would be merited to confirm associations and other influential factors.

Longitudinal trajectories of sickness absence among young adults with a history of depression and anxiety symptoms in Sweden.

BACKGROUND: Depression and anxiety are associated with increased risk of sickness absence (SA), yet the developmental patterns of SA remain unclear. We aimed to identify trajectories of SA in young adults with depression and/or anxiety, accounting for sociodemographic and occupational factors. METHODS: Longitudinal study of 1445 twin individuals with elevated depressive/anxiety symptoms in late adolescence or young adulthood (age range: 19-30), assessed in Swedish surveys completed in 2005. Through linkage to nationwide registries, individuals were prospectively followed from 2006 to 2018. The outcome included consecutive annual days of SA, which were analyzed using group-based trajectory modeling. Multinomial logistic regression estimating odds ratios (OR) with 95 % confidence intervals (CI) was used to examine associations of age, sex, and educational level with the resulting SA trajectories. RESULTS: Four distinct SA trajectories were identified in the total sample: 'high-increasing' (6 %), 'low-increasing' (12 %), 'high-decreasing' (13 %), and 'low-constant' (69 %). Increasing age was associated with higher odds of belonging to the low-increasing trajectory (OR = 1.07, 95 % CI = 1.02-1.12). Women had higher odds of belonging to the low-increasing trajectory (OR = 1.67, 95 % CI = 1.10-2.53), compared with men. Higher education was associated with lower odds of belonging to high-increasing (OR = 0.34, 95 % CI = 0.22-0.54) and high-decreasing (OR = 0.59, 95 % CI = 0.43-0.81) trajectories, compared with lower education. Few differences were observed in analyses stratified by occupational sector. LIMITATIONS: Information on potential confounders (e.g., psychiatric comorbidity, work-environment factors) was not available. CONCLUSIONS: Among young adults with prior depression/anxiety, close to every fifth showed rising SA trajectories over time. This calls for targeted strategies to improve public mental health already at young ages.

Genetic and environmental contributions to individual differences in sustainable working life-A Swedish twin cohort study.

Although genetics is known to have a role in sickness absences (SA), disability pensions (DP) and in their mutual associations, the empirical knowledge is scarce on not having these interruptions, i.e., sustainable working life. Hence, we aimed to investigate how genetic and environmental factors affect individual variation in sustainable working life in short-term (two consecutive years) and in long-term (22 years of follow-up) using the classical twin modeling based on different genetic relatedness of mono- and dizygotic twins. The final sample (n = 51 071) included Swedish same-sex twins with known zygosity born between 1930 and 1990 (53% women) with complete national register data of employment, SA, DP, unemployment, old-age pension, emigration, and death. For the short-term sustainable working life, genetic factors explained 36% (95% confidence intervals (CI) 31-41%), environmental factors shared by co-twins such as family background 8% (95% CI 5-14%) and environmental factors unique to each twin individual 56% (95% CI 56-56%) on the individual differences. For the long-term sustainable working life, the largest proportions on individual differences were explained by environmental factors shared by co-twins (46%, 95% CI 44-48%) and unique to each twin individual (37% 95% CI 36-38%) whereas a small proportion was explained by genetic factors (18%, 95%CI 14-22%). To conclude, short-term sustainable working life was explained to a large extent by unique environment and to lesser extent by genetic factors whereas long-term (22 years) sustainable working life had both moderate unique and common environmental effect, and to lower extent genetic effects contributing to individual differences. These findings suggest that sustainable working life have different short- and long-term predictors.

Sickness absence transitions among Swedish twins with back, neck or shoulder pain and common mental disorders applying a multi-state approach.

We aimed to investigate transitions to and from sickness absence, or disability pension among individuals with back, neck, or shoulder pain and/or with common mental disorders (CMDs), and the role of familial (genetics and shared environment) influences on the transitions. Swedish twins born 1935-1985 who responded to pain and CMDs survey items (N = 41,516) were followed on average 8.7 years for sickness absence states in national registers. Multi-state Cox regression models were applied for three exposure groups: pain, CMDs, and presence of both, compared to unexposed. Exposure discordant twin pairs, stratified by zygosity, were analysed to assess the role of familial factors. Hazard Ratios (HR) with 95% confidence intervals and transition intensities were calculated. HRs were similar for transitions between states among those with pain or CMDs. The highest HRs were for transitions from entry to sickness absence and sickness absence to disability pension among those with both pain and CMDs (HRs: 1.61 and 1.43, respectively). Higher HRs for dizygotic compared to monozygotic twins for the first transition to sickness absence and for altering back to not being sickness absent indicate familial confounding. Back, neck, or shoulder pain and/or CMDs indicate a higher risk to become sickness absent and for repeated sickness absence episodes over time compared to unaffected.

Associations of Internalizing and Externalizing Problems in Childhood and Adolescence With Adult Labor Market Marginalization.

Importance: Mental health problems in early life are associated with labor market marginalization, especially in youths with persistent internalizing and externalizing problems. However, previous research has not adjusted for familial (genetic and shared environmental) factors. Objective: To examine associations of early-life internalizing and externalizing problems with adulthood unemployment and work disability, adjusting for familial factors. Design, Setting, and Participants: This population-based prospective cohort study included Swedish twins who were born in 1985-1986 and surveyed at 4 consecutive waves across childhood and adolescence until 2005. Through linkage to nationwide registries, participants were followed up from 2006 to 2018. Data analyses were conducted between September 2022 and April 2023. Exposures: Internalizing and externalizing problems, assessed with the Child Behavior Checklist. Participants were differentiated regarding duration of internalizing and externalizing problems (persistent, episodic, and noncases). Main Outcomes and Measures: Unemployment (180 days or more of being unemployed) and work disability (60 days or more of being sickness absent or disability pensioned) during follow-up. Cox proportional hazards regression models were calculated to obtain cause-specific hazard ratios (HRs) with 95% CIs in the whole cohort and exposure-discordant twin pairs. Results: Of 2845 participants, 1464 (51.5%) were female. Incident unemployment was experienced by 944 (33.2%) and incident work disability by 522 (18.3%) participants. Compared with noncases, persistent internalizing problems were associated with unemployment (HR, 1.56; 95% CI, 1.27-1.92) and work disability (HR, 2.32; 95% CI, 1.80-2.99). Similarly, compared with noncases, persistent externalizing problems were associated with unemployment (HR, 1.87; 95% CI, 1.55-2.26) and work disability (HR, 2.38; 95% CI, 1.87-3.03). Persistent cases had overall higher risks of adverse outcomes than episodic cases. After adjustment for familial factors, associations with unemployment were no longer statistically significant, whereas associations with work disability remained or were only slightly reduced. Conclusions and Relevance: In this cohort study of young Swedish twins, familial factors explained the associations between early-life persistent internalizing and externalizing problems and unemployment; such factors were comparatively less important for the association with work disability. This suggests nonshared environmental factors may be important for the risk of future work disability among young individuals with persistent internalizing and externalizing problems.

Trajectories of sustainable working life in nine Swedish residential regions: A longitudinal twin cohort study.

OBJECTIVE: To investigate trajectories of sustainable working life (SWL, ie, no interruptions or transitions in working life due to sickness absence (SA), disability pension (DP), or unemployment) in Swedish residential regions using a population-based twin cohort, while assessing sociodemographics and twin pair similarity. METHODS: Sample of 60 998 twins born in 1925-1958. SWL was assessed through main labor market status in each year in 1998-2016 based on > 180 days with SA/DP, > 180 days with unemployment, or >half of yearly income from old-age pension for not in SWL, and employment (in paid work and did not fulfill the criteria SA/DP, unemployment, or old-age pension) for SWL. Residential regions were classified into nine groups based on Swedish municipalities. Group-based trajectory models and multinomial logistic regression were applied separately for all regions. RESULTS: In all regions, the largest trajectory group was sustainable working life. Three to four trajectory groups developed toward unsustainable working life with different exit points from sustainable working life. A small proportion were grouped with partial stable or increase in sustainable working life. Increased age, being a woman, <12 years of education, and history of unstable working life increased, and being married and twin pair similarity decreased the likelihood of belonging to trajectories toward unsustainable working life. CONCLUSIONS: In all regions, most of the individuals followed a sustainable working life trajectory. A reasonable proportion of individuals followed trajectories developing toward unsustainable working life. The influence of sociodemographic and familial factors on trajectory groups was similar in all regions.

Family-Related Life Events as Predictors of Labor Market Marginalization Trajectories: A Cohort Study of Swedish Twins.

OBJECTIVES: The aims of the study are to investigate trajectories of labor market marginalization (LMM) and to examine the associations between family-related life events and LMM trajectories while accounting for familial factors. METHODS: This is a prospective cohort study of 37,867 Swedish twins. Data were analyzed by group-based trajectory modeling. Associations of family-related life events with trajectory groups were estimated by multinomial logistic regression. RESULTS: Most participants had no or low levels of LMM. Individuals who stayed married over time or changed from single without children to married with children had a decreased risk of LMM. The risk of LMM over time was higher among individuals who changed from married to being single. CONCLUSIONS: Being or getting married as well as having children decreases the risk of LMM while divorce is a risk factor for LMM.

Concurrent trajectories of residential region in relation to a sustainable working life among Swedish twins.

BACKGROUND: Residential regions may impact the possibilities to achieve a sustainable working life (SWL, i.e. not having interruptions due to sickness absence, disability pension or unemployment) due to disparities in social security and labour market. We aimed to investigate concurrent trajectories of regions and SWL among Swedish twins. METHODS: National register data were used for the degree of SWL in each year, old-age pension, emigration, death and residential regions classified in three categories (cities; towns and suburbs; or rural areas) of Swedish twins in 1998-2016 (n = 80 398). Group-based multi-trajectory modelling and multinomial regression for relative risks with 95% confidence intervals were calculated. RESULTS: The six-group solution had the best fit to data with trajectories: stable living in towns and suburbs with SWL (33.8%); stable living in cities with SWL (22.1%); stable living in towns and suburbs with increasing SWL (13.9%); stable living in towns and suburbs with lack of SWL (13.2%); stable living towns and suburbs with decreasing SWL (8.8%); and stable living towns and suburbs with decreasing and ultimately lack of SWL (8.3%). Age and being woman increased and being married and higher education decreased the likelihood of belonging to groups 2-6 (vs. 1). CONCLUSIONS: The simultaneous assessment of trajectories of three residential regions and SWL indicated that most people in Sweden seem to live continuously over time in towns and suburbs, but the degree of SWL may vary. More fine-grained assessment of residential regions would be needed to clarify the associations with SWL.

Sexual-orientation differences in risk of health-related impaired ability to work and to remain in the paid workforce: a prospective population-based twin study.

BACKGROUND: Studies consistently show an increased risk of poor health among sexual minorities (i.e., those identifying as lesbian, gay, bisexual [LGB] or other non-heterosexuals individuals), as compared to those identifying as heterosexual. It is largely unknown whether the increased risk of mental and physical health problems among sexual minorities is also reflected in an increased risk of health-related impaired ability to work, in terms of sickness absence (SA) and disability pension (DP), or successfully remain in the paid workforce. This study made use of a large sample of Swedish twins with self-reported information about sexual behavior in young adulthood to examine sexual orientation difference in SA and DP during a 12-year follow-up period. METHOD: Data from the Swedish Twin project of Disability pension and Sickness absence (STODS), including Swedish twins born 1959-1985 was used (N = 17,539; n = 1,238 sexual minority). Self-report survey data on sexual behavior was linked to information about SA and DP benefits from the MicroData for Analysis of the Social Insurance database (MiDAS), the National Social Insurance Agency. Sexual orientation differences in SA and DP between 2006 and 2018 was analyzed, as well as, the influence of sociodemographic, social stress exposure (i.e., victimization, discrimination), mental health treatment, and family confounding on these differences. RESULTS: Compared to heterosexuals, sexual minorities were more likely to having experienced SA and having been granted DP. The odds were highest for DP, where sexual minorities were 58% more likely to having been granted DP compared to heterosexuals. The higher odds for SA due to any diagnosis could largely be explained by sociodemographic factors. The higher odds of SA due to mental diagnosis could partially be explained by increased risk of being exposed to discrimination and victimization, and partially by having received treatment with antidepressant medication. The higher odds of being granted DP could also partially be explain by increased risk of being exposed to social stress and treatment with antidepressant medication. CONCLUSION: To our knowledge, this is the first study to report on sexual orientation differences in risk of SA and DP in a population-based sample. We found higher period prevalence of both SA and DP among sexual minorities as compared to heterosexuals. The higher odds of SA and DP could partially or fully be explained by sexual orientation differences in sociodemographic factors, exposure to social stress, and antidepressant treatment for depression. Future studies can extend these findings by continuing to investigate risk factors for SA and DP among sexual minorities and how such factors can be reduced.

Work incapacity and psychiatric patient care following attempted suicide - a cohort study of 65 097 Swedish twins.

BACKGROUND: Research is scarce on the role of familial factors and previous psychiatric care on the association between suicide attempt and future work incapacity as well as deterioration in mental health. We aimed to investigate the associations between suicide attempt and sickness absence, disability pension and psychiatric patient care and to study the influence of previous psychiatric care and familial factors (genetics and shared environment) on the associations. METHODS: The study included 65 097 twins living in Sweden on 31st of December 2006, aged 19-60 years. The twins were followed 2007-2013 regarding sickness absence, disability pension, inpatient care or specialized outpatient care for a mental diagnosis. Cox regression models were performed for the whole sample, and conditional models for discordant twin pairs. The analyses were also stratified by psychiatric care before 2007. RESULTS: We found that suicide attempt predicted sickness absence, disability pension, and future mental diagnosis among the whole sample. The discordant twin pair analyses showed that the association between suicide attempt and sickness absence or disability pension was influenced by familial factors. Stratified analyses of individuals with or without psychiatric care before 2007 showed that previous psychiatric care had some impact on the associations. CONCLUSIONS: A suicide attempt is a risk factor for work incapacity and psychiatric patient care. Familial factors and previous psychiatric care play a role in the associations between attempting suicide and work incapacity as well as psychiatric patient care. These factors are important when developing measures preventing work incapacity among those with a suicide attempt.

Sickness absence among young employees in private and public sectors with a history of depression and anxiety.

The aim was to investigate occurrence and duration of sickness absence (SA) among young employees with previous depression/anxiety in private and public sectors. This population-based prospective study included 11,519 Swedish twin individuals of age 19-29 years that were followed regarding SA during 2006-2016. Data on previous depression/anxiety came from two screening surveys in 2005. Data on SA and employment sector were received from national registries. Descriptive statistics and logistic regression were used, also controlling for familial factors. Proportion of employees with SA was significantly higher among those with, as compared to those without, previous depression/anxiety, regardless the employment sector. Individuals with previous depression/anxiety had increased risk for future SA, in both private (OR 2.25, 95% CI 1.90-2.66) and public sectors (OR 2.10, 95% CI 1.73-2.54). Familial factors played a role in the association among employees in the private sector. A higher proportion of long-term SA was observed among employees with previous depression/anxiety in the private as compared to the public sector. To conclude, previous depression/anxiety tends to increase risk for SA among young employees in both employment sectors, whereas long-term SA seemed to be more prevalent among those in the private as compared to the public sector.

Sustainable Working Life Patterns in a Swedish Twin Cohort: Age-Related Sequences of Sickness Absence, Disability Pension, Unemployment, and Premature Death during Working Life.

We aimed to investigate sustainable working life via age-related sequences of sickness absence (SA), disability pension (DP), unemployment (UE), premature death, and the influence of individual characteristics, accounting for familial confounding. The sample included monozygotic (MZ) and dizygotic (DZ) same-sexed twin pairs with register data (n = 47,450) that were followed for 10 years in four age cohorts: 26-35 (n = 9892), 36-45 (n = 10,620), 46-55 (n = 12,964) and 56-65 (n = 13,974). A sequence analysis was done in a 7-element state space: 1. "Sustainable working life": SA/DP 0-30 days and UE 0-90 days; 2. "Unemployment >90 days": SA/DP 0-30 days and UE > 90 days; 3. "Moderate SA/DP": SA/DP 30-180 days; 4. "Almost full year of SA/DP": SA/DP 180-365 days; 5. "Full year of SA/DP": SA/DP ≥ 365 days; 6. Death; 7. Old-age pension. The largest cluster had a sustainable working life and never experienced states 2-6 (34-59%). Higher education and being married predicted a lower likelihood of experiencing states 2-6. The MZ twin pairs (vs. DZ) were more often in the same cluster suggesting the role of genetic factors. To conclude, the sustainable working life was the largest cluster group. Few individuals had prolonged periods of interruptions of sustainable working life meriting actions, especially in early adulthood for interventions to support workability.

Night Work and Sustainable Working Life-A Prospective Trajectory Analysis of Swedish Twins.

The aim was to investigate the changes in sustainable working life over 10-13 years of follow-up and the effect of baseline night work. Data from the Swedish national registers were used to define sustainable working life. Survey data in the 1998-2003 "SALT" with 34,680 twins or in the 2004-2006 "STAGE" with 19,637 twins were utilized to assess night work at baseline. Group-based trajectory and multinomial regression models were applied. The results of the SALT cohort yielded five trajectory solutions: stable sustainable working life (40%), stable lack of sustainable working life (25%), later decreasingly sustainable working life (15%), increasingly sustainable working life (14%), and early decreasingly sustainable working life (7%). In the STAGE cohort, four trajectories were detected: stable sustainable working life (83%), decreasingly sustainable working life (7%), stable lack of sustainable working life (5%), and increasing sustainable working life (5%). Night work was associated with the decreasing or increasing sustainable working life in the trajectory groups. To conclude, the largest parts of both cohorts followed trajectories of stable sustainable working lives. Night work was associated with both the trajectories of decreasing and increasing sustainable working lives.

[Long term outcome of children diagnosed with resignation syndrome in the Stockholm Region 2005-2012]. / Långtidsuppföljning av barn med uppgivenhetssyndrom.

In the early 2000s, some children in asylum seeking families in Sweden showed severe reduction in function, including pervasive refusal to eat, drink, walk, talk or care for themselves. In 2014 this was to be named the resignation syndrome (ICD-10 F32.3A). The purpose of our study was to compare education and health-related outcomes over time between those with and without these symptoms, in a group of children from Central Asia who have been asylum seekers and received a residence permit in Sweden. We found that between the years 2005-2012, in the child and adolescent mental health services (CAMHS) in the Stockholm Region, 103 children showed symptoms of resignation, of whom 43 (43%) showed the most severe symptoms. Children with resignation syndrome assessed and cared for by CAMHS had similar need of outpatient care as other children of the same origin who had been treated by CAMHS for other conditions. They did not have an increased need for inpatient care compared with other children of the same origin, and they passed upper secondary school and past-secondary education to the same extent as other children of the same origin.

Psychosocial Working Conditions and Subsequent Sickness Absence-Effects of Pain and Common Mental Disorders in a Population-Based Swedish Twin Sample.

OBJECTIVE: To investigate pain and/or common mental disorders (CMDs) in the associations between psychosocial working conditions and sickness absence (SA) while controlling familial confounding. METHODS: Prospective Prospective twin cohort study included survey data for pain and CMD, register data for SA and psychosocial working conditions. The follow-up from 2005 to 2016 of 28,916 twin individuals for first incident SA spell measured as the main International Classification of Diseases version 10 (ICD-10) diagnosis groups (F00-F99, I00-I99, and M00-M99), or the duration. We used regression models to obtain odds ratio (OR), incidence rate ratio (IRR), or relative risk ratio (RRR) with 95% confidence intervals (CI). RESULTS: The covariate adjusted models of 9156 SA spells indicated almost no statistically significant associations between psychosocial working conditions and SA. CONCLUSIONS: Psychosocial working conditions were not associated with SA while familial confounding could not be ruled out.

Role of social benefits for future long-term sickness absence, disability pension and unemployment among individuals on sickness absence due to mental diagnoses: a competing risk approach.

PURPOSE: To investigate associations between social benefits and disability pension (DP), long-term sickness absence (LTSA, ≥ 90 days), or unemployment among Swedish twins with sickness absence (SA) due to mental diagnoses. METHODS: This population-based prospective twin study included register data on first incident SA spell (< 90 days) due to mental diagnoses (ICD 10 codes F00-F99) during the follow-up 2005-2016. SA < 90 days due to other diagnoses than mental diagnoses or any other social insurance benefit was identified for the preceding year of the first incident SA spell due to mental diagnoses (coded yes/no). Comparing those with any previous social benefits vs without, cumulative incidence curve to compare time to an event, and Cox proportional hazards models for cause-specific hazard ratios (HR, 95% confidence intervals, CI) treating first incident DP, LTSA and unemployment as competing risks were modeled. RESULTS: During follow-up, 21 DP, 1619 LTSA, and 808 unemployment events took place. Compared to those without, those with at least one benefit had a higher risk for DP (HR 5.03; 95%CI 1.80, 14.01), LTSA (1.67; 1.50, 1.84) and unemployment (1.24; 1.03, 1.50). The cumulative incidence for DP was very low, < 1%, for LTSA 80% with any previous social benefits vs. 60% without, and for unemployment ≤ 5%. CONCLUSION: Social benefits received during the preceding year of SA due to mental diagnoses (< 90 days) predict DP, LTSA, and unemployment. Hence, previous social benefits may provide means for early identification of persons at risk for exit from labor market.

Effects of age on psychosocial working conditions and future labour market marginalisation: a cohort study of 56,867 Swedish twins.

PURPOSE: Previous studies have reported an elevated risk of sickness absence (SA) and disability pension (DP) due to adverse psychosocial working conditions, yet the influence of age and familial factors on the associations have not been examined. We aimed to investigate associations between psychosocial working conditions and labour market marginalisation (LMM) in terms of unemployment, SA and DP adjusting for familial confounding and possible differences in these associations with different age groups and different unemployment and sick leave days. METHODS: All twins living in Sweden in 2001, aged 16-64 years and not on old-age pension or DP were included (n = 56,867). The twins were followed from 2002 to 2016 regarding unemployment, SA and DP. Cox proportional hazards regression models were performed for the whole sample, and for discordant twin pairs, in five age groups. RESULTS: Each one-unit increase in job demands and job control was associated with a lower risk of unemployment, SA and DP in all age groups. Moreover, each one-unit increase in social support was associated with an increased risk of 1-30 days unemployment in individuals older than 45 years and SA and DP. Social support decreased the risk of unemployment longer than 365 days in age groups 16-25 and 36-45 years. In the discordant twin pair analyses, the estimates attenuated towards statistical non-significance. CONCLUSION: Even though familial factors seem to influence the associations between psychosocial working conditions and LMM, improving psychosocial working conditions by for example promoting high job control and social support at workplace may reduce the risk of future short- and long-term LMM in all age groups.

The role of familial confounding in the associations of physical activity, smoking and alcohol consumption with early exit from the labour market.

We investigated the associations between health behaviors and sustainable working life outcomes including all-cause disability pension, disability pensions due to musculoskeletal and mental diagnoses and unemployment. The role of familial factors behind these associations was studied by analysing discordant twin pairs. Our data included Swedish twins born in 1925-1986 (51891 twin individuals). Baseline data based on two independent surveys in 1998-2003 and 2005-2006 for health behaviors were linked to national registers on disability pension and unemployment until 2016. Cox proportional hazards models for hazard ratios (HR) with 95% confidence intervals (CI) were estimated for the whole sample adjusting for covariates. Analyses of health behavior discordant twin pairs (n = 5903 pairs) were conducted using conditional Cox models. In the whole cohort, the combination of healthy behaviors was associated with lower risk for all-cause disability pension, disability pension due to musculoskeletal diagnoses or mental diagnoses, and for unemployment (HRs 0.56-0.86, 95% CIs 0.51-0.92) as did being physically active (HRs 0.69-0.87, 95% CI 0.65-0.92). The discordant pair analyses confirmed the lower risk among those having healthy behaviors (HR 0.70-0.86) or being physically active (HR 0.86-0.87) for all-cause disability pension, disability pension due to musculoskeletal diagnoses, and for unemployment. To conclude, controlling the effects of covariates or familial confounding (i.e. discordant twin pair analyses) shows that being physically active or having several healthy behaviors predict better working life outcomes. This points towards independent association between healthy behavior and longer working life.