Lay Summary

We aimed to identify factors specific to individuals with a history of depression/anxiety and no sickness absence during follow-up. Individuals with previous experiences of depression/anxiety, but no sickness absence during follow-up, were more likely to be male, have higher education, better self-rated health, and fewer life adversities along with lower use of antidepressant and outpatient healthcare, as compared to individuals with sickness absence during follow-up. Identification of key characteristics among those with a history of mental health problems may potentially be used to improve sickness absence prevention strategies.

Background

The continuity of mental health problems from early life years into adulthood is well acknowledged as well as the impact on the long-term outcomes including work incapacity. However, knowledge is scarce on individuals who are experiencing mental health problems but who have low or no sickness absence (SA). Identification of factors specific to these individuals may potentially help to improve SA prevention strategies. The aim of this study was to identify individual-level characteristics, including sociodemographic factors, morbidity, and lifestyle, among privately employed individuals with a history depression and anxiety but no SA during follow-up.

Methods

This prospective cohort study included 750 twin individuals born in Sweden in 1959-1986, who had a history of depression/anxiety and were employed in the private sector. Depending on the birth year, the twins were invited to participate in two different health-screening surveys in 2005, when study participants were aged 19-20 or 20-30, respectively. Survey data were used to evaluate depression and anxiety, self-rated health, stressful life events, emotional neglect, level of physical activity, and alcohol use. Study participants were prospectively followed regarding SA occurrence between 2006 and 2018. Data on SA, sociodemographic factors, outpatient healthcare use, and use of prescribed antidepressants were obtained from the Swedish national registries. Descriptive statistics and regression analyses were applied.

Results

Preliminary results showed that despite previous depression or anxiety, 35% of women and 52% of men were not on SA during the follow-up period. Those who had no SA during follow-up were more likely to have completed higher education of at least 12 years (49%), experienced fewer stressful life events (43%) and emotional neglect (56%), had better self-rated health (95%), along with a lower use of antidepressants (11%) and outpatient healthcare (88%), as compared with those on SA (33%, 65%, 66%, 90%, 17%, and 98%, respectively). No significant differences between those with and without SA were observed regarding level of physical activity or alcohol use.

Conclusion

Higher education, being male, fewer life adversities, good self-rated health and low use of antidepressant and outpatient healthcare were individual-level factors of importance for those with previous depression or anxiety and no incident SA during follow-up.