Educational attainment, labour market position and mental ill health as pathways from adversities in adolescence to disability pension in early adulthood: A Finnish cohort study using register data.

BACKGROUND: We investigated whether social adversities (parents' receipt of income support and care placement) in adolescence were associated with the receipt of work disability pension (DP) in early adulthood. A further aim was to examine whether and to what extent individual educational attainment, labour market position and mental disorders during the period of transition to adulthood operate as underlying mechanisms in this relationship. METHODS: This was a nationwide cohort study of a 60% representative sample of Finnish young adults born between 1983 and 1985 with no prior DP at entry to the study ( N=116,788). Data from several nationwide registers were used with a follow-up time from 2004 to 2010. The age range of the cohort was 19-21 years at the beginning of the follow-up period. Hazards ratios (HRs) with 95% confidence intervals (CIs) were calculated using a Cox regression. Mediation analyses for educational attainment, labour market position and purchases of psychotropic drugs were performed. RESULTS: A total of 1597 (1.37%) people were granted a DP during the follow-up period of 687,429 years at risk. After adjustment for mediators, the HR (95% CI) of DP for those whose parents had received income support was 1.36 (1.21-1.53) for men and 1.21 (1.07-1.36) for women. The corresponding figures for those with a history of care placement were 1.23 (1.00-1.51) and 1.58 (1.29-1.92), respectively. CONCLUSIONS: Social adversities in adolescence increase the risk of DP in early adulthood. The intergenerational social determination of disability could be addressed through interventions promoting mental health and improving educational and employment opportunities for young people.