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A prospective cohort study of disability pension due to mental diagnoses: the importance of health factors and behaviors

Åsa Samuelsson1, Annina Ropponen23, Kristina Alexanderson1 and Pia Svedberg1*

Author Affiliations

1 Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm SE-171 77, Sweden

2 School of Medicine, University of Eastern Finland, Kuopio, Finland

3 Finnish Institute of Occupational Health, Helsinki, Finland

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BMC Public Health 2013, 13:621  doi:10.1186/1471-2458-13-621

Published: 2 July 2013



Previous studies have found associations between various health factors and behaviors and mental disorders. However, knowledge of such associations with disability pension (DP) due to mental diagnoses is scarce. Moreover, the influence of familial factors (genetics and family background) on the associations are mainly unknown. The aim of the study was to investigate associations between health factors and behaviors and future DP due to mental diagnoses in a twin cohort, accounting for familial confounding.


A prospective cohort study of Swedish twins (N=28 613), including survey data and national register data on DP and other background factors was conducted. Cox proportional hazards regression models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI) for the whole twin cohort, and for discordant twin pairs.


During follow-up 1998–2008 (median 10 years), 2.2% of the cohort was granted a DP with a mental diagnosis. In the fully adjusted analyses of the whole cohort, the associations of poor or moderate self-rated health (SRH), under- or overweight, former or current tobacco use, or being an abstainer from alcohol were significantly associated with risk of DP due to mental diagnoses. Analyses of discordant twin pairs confirmed all these associations, except for current tobacco use, being independent from familial confounding. Exclusion of individuals with current or previous depression or anxiety at baseline did not influence the associations found.


Poor or moderate SRH, under- or overweight, former tobacco use or being an abstainer from alcohol seem to be strong direct predictors of DP due to mental diagnoses, independently of several confounders of this study, including familial factors.

Sick leave; Disability pension; Mental disorders; Self-rated health; Life-style; Twins