Invalidität und Tod bei Erwerbsfähigen mit Depressionen

Zusammenfassung

Anliegen Untersucht wurden Frühberentung und Frühversterben im Zusammenhang mit rein ambulant und auch stationär behandelten Depressionen. Methode Hierfür wurden 128 001 Verläufe mit bis zu 10 Jahren Beobachtungsdauer multivariat untersucht. Ergebnisse Ein erhöhtes relatives Risiko (RR) für Frühberentung besteht bei rein ambulanter und stärker bei stationärer Behandlung. Dies betrifft besonders junge depressive Männer. Erhöhtes Frühversterben ließ sich nicht nachweisen, bei jüngeren, ambulant behandelten Frauen fand sich eher eine leicht verringerte Sterblichkeit. Schlussfolgerungen Auch in ambulanter Behandlung muss auf die berufliche Wiedereingliederung geachtet werden, für Männer und Frauen auf unterschiedliche Weise.

Abstract

Objective It was the aim of this study to estimate effects of depression on permanent disability and death in a statutory health insurance population. Methods Data from 128 001 clients were used with a mean follow up of 6.4 years. Excess risks were calculated with Cox regression models adjusted for age, gender, education and job classification. Results Outpatient treatment for depression was associated with an elevated relative risk for permanent disability, but inpatient treatment even more so. Life table analysis suggests higher risks of early retirement for males who get ill early in life. Depression treated solely in an outpatient setting may be associated with lower mortality early in life, but this was only significant for women. Conclusions Outpatient treatment should include an emphasis on occupational functioning, but also a gender-specific approach is needed.

Schlüsselwörter

Depression - Behandlung - Invalidität - Mortalität - Berufsunfähigkeit

Keywords

depression - treatment - invalidity - mortality - occupational disability

Literatur

• 1 Murray C JL, Lopez A D. Global mortality, disability, and the contribution of risk factors: Global burden of disease study.  Lancet. 1997;  349 1436-1442
• 2 Wittchen H U, Pittrow D. Prevalence, recognition and management of depression in primary care in Germany: The Depression 2000 study.  Hum Psychopharmacol. 2002;  17 (S 01) S1-S11
• 3 Bebbington P, Dunn G, Jenkins R et al. The influence of age and sex on the prevalence of depressive conditions: Report from the National Survey of Psychiatric Morbidity.  Int Rev Psychiatry. 2003;  15 74-83
• 4 Sobocki P, Lekander I, Borgstrom F et al. The economic burden of depression in Sweden from 1997 to 2005.  Eur Psychiatry. 2007;  22 146-152
• 5 Wang P S, Simon G, Kessler R C. The economic burden of depression and the cost-effectiveness of treatment.  Int J Methods Psychiatr Res. 2003;  12 22-33
• 6 Mathers C D, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030.  PLoS Med. 2006;  3 2011-2030
• 7 Sobocki P, Jonsson B, Angst J et al. Cost of depression in Europe.  J Mental Health Policy Econ. 2006;  9 87-98
• 8 Wedegaertner F, Sittaro N A, Emrich H M et al. Disability caused by affective disorders – What do the federal German health report data teach us?.  Psychiat Prax. 2007;  34 (S 03) S252-S255
• 9 Statistisches Bundesamt, Robert Koch-Institut, Hrsg .Die Gesundheitsberichterstattung des Bundes.. Bonn, Berlin: Robert Koch-Institut; 2009
• 10 Rytsälä H J, Melartin T K, Leskelä U S et al. Predictors of long-term work disability in major depressive disorder: A prospective study.  Acta Psychiatr Scand. 2007;  115 206-213
• 11 Hannerz H, Borga P, Borritz M. Life expectancies for individuals with psychiatric diagnoses.  Public Health. 2001;  115 328-337
• 12 Hiroeh U, Appleby L, Mortensen P B et al. Death by homicide, suicide, and other unnatural causes in people with mental illness: A population-based study.  Lancet. 2001;  358 2110-2112
• 13 Hiroeh U, Kapur N, Webb R et al. Deaths from natural causes in people with mental illness: A cohort study.  J Psychosom Res. 2008;  64 275-283
• 14 Statistisches Bundesamt, Hrsg .Erwerbstätige – Wirtschaftliche und berufliche Gliederung, Berufsausbildung.. Wiesbaden, Bonn, Berlin: Selbstverlag; 2003
• 15 Emslie C, Ridge D, Ziebland S et al. Men's accounts of depression: Reconstructing or resisting hegemonic masculinity?.  Soc Sci Med. 2006;  62 2246-2257
• 16 Danielsson U, Johansson E E. Beyond weeping and crying: A gender analysis of expressions of depression.  Scand J Prim Health Care. 2005;  23 171-177
• 17 Barth J, Schumacher M, Herrmann-Lingen C. Depression as a risk factor for mortality in patients with coronary heart disease: A meta-analysis.  Psychosom Med. 2004;  66 802-813
• 18 Satin J R, Linden W, Phillips M J. Depression as a predictor of disease progression and mortality in cancer patients: A meta-analysis.  Cancer. 2009;  115 5349-5361
• 19 Kelly M AR, Sereika S M, Battista D R et al. The relationship between beliefs about depression and coping strategies: Gender differences.  Br J Clin Psychol. 2007;  46 315-332
• 20 Geyer S, Peter R. Occupational status and all-cause mortality: A study with health insurance data from Nordrhein-Westfalen, Germany.  Eur J Pub Health. 1999;  9 114-118
• 21 Bratberg E, Gjesdal S, Mµland J G. Sickness absence with psychiatric diagnoses: Individual and contextual predictors of permanent disability.  Health Place. 2009;  15 308-314
• 22 Schubert I, Ihle P, Köster I. Verwendung von GKV-Diagnosen in der Sekundärdatenforschung.. In: Swart E, Ihle P, Hrsg Routinedaten im Gesundheitswesen.. Bern: Verlag Hans Huber; 2005: 235-241
• 23 Stausberg J, Lehmann N, Kaczmarek D et al. Reliability of diagnoses coding with ICD-10.  Int J Med Informatics. 2008;  77 50-57
• 24 Karpansalo M, Kauhanen J, Lakka T A et al. Depression and early retirement: Prospective population based study in middle aged men.  J Epidemiol Community Health. 2005;  59 70-74
• 25 Wittchen H U, Möller N, Pfister H et al. German National Health Interview and Examination Survey – Mental health supplement GHS-MHS.  Gesundheitswesen. 1999;  61 (S 02)
• 26 Alonso J, Angermeyer M C, Bernert S et al. Prevalence of mental disorders in Europe: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.  Acta Psychiatr Scand. 2004;  109 (S 420) 21-27
• 27 Jacobi F, Häflerl M, Meister W et al. Prevalence, recognition, and prescription behaviour in depressive syndromes. A German study.  Nervenarzt. 2002;  73 651-658
• 28 Karpansalo M, Kauhanen J, Lakka T A et al. Depression and early retirement: Prospective population based study in middle aged men.  J Epidemiol Community Health. 2005;  59 70-74
• 29 Ellis C, Zhao Y, Egede L E. Depression and increased risk of death in adults with stroke.  J Psychosom Res. 2010;  68 545-551
• 30 Katon W. Depression and diabetes: Unhealthy bedfellows.  Depress Anxiety. 2010;  27 323-326
• 31 Sher Y, Lolak S, Maldonado J R. The Impact of Depression in Heart Disease.  Curr Psychiatr Rep. 2010;  12 255-264