Return to Work or Not: The Paths to Psychiatric Disability and Back

Objectives: Mental health-related work disability has increased in Europe, despite efforts to promote individuals´ work ability. We examined individuals´ occupational status before and after a psychiatric disability pension (DP). Methods: The study comprises individuals granted a DP for the first time between 2010 and 2012 in Finland (N = 18,373). We used modern methods to cluster the sequences of individuals´ occupational status before and after temporary (n = 8615) or permanent (n = 9758) psychiatric DP. We compared socioeconomic, illness and health care system-related factors between nine groups, formed by sequence analysis utilizing multinominal regression analysis. Results: The analysis identified typical groups of temporary pensioners: after steady working careers, periods of unemployment and from mixed states. Severity of health and mental health problems, socioeconomic and occupational status, pension system-related factors as well as treatment or rehabilitation varied between the groups. Individuals with temporary DPs (tDP) appeared mainly to either remain disabled (74% of the study tDP) or return to the same status they had before disability: to work (17%) or unemployment (8%). A steady working career, high education and received psychotherapy and rehabilitation all promoted returning to work. Among young adults, severity of the illness and lack of occupational education were risk factors for long-term disability. Conclusions: Among those with tDP, circles of disadvantage may exist. They relate to unemployment, poor mental and somatic heath, low education, poverty, and failure of rehabilitative efforts. Especially young adults with severe mental disorders require not only rehabilitation but also educational support.