# Socioeconomic status, antidepressant use, and return to work after disability due to common mental disorders

## TL;DR

This study examines how socioeconomic status and antidepressant use affect returning to work after mental health-related disability in Finland.

## Contribution

The study reveals that SES has a minor role in antidepressant adherence and that rehabilitation, not medication, is linked to returning to work.

## Key findings

- Antidepressant use increased before disability pension and decreased afterward, with 14.6% not using antidepressants or antipsychotics.
- Only income among SES factors was positively linked to antidepressant adherence, but adherence itself was not associated with returning to work.
- Rehabilitation, rather than antidepressant use, was associated with return to work after disability.

## Abstract

Common mental disorders (CMDs) are significant causes of work disability. Low socioeconomic status (SES) is a known risk factor for CMDs and work disability, one possible reason being poorer treatment adherence. We aimed to study the realization of pharmacological treatment and antidepressant adherence in patients with CMDs 3 years before and 3 years after being granted a disability pension (DP) and the role of SES in this. We also studied whether antidepressant adherence is associated with return to work (RTW) after a temporary DP.

Information on all persons granted a DP due to CMD between 2010 and 2012 in Finland (n = 12,388) was retrieved from national registers, which included medical, socioeconomic, and sociodemographic information of the subjects. We used the PRE2DUP method to estimate drug use periods and regression analyses to study associations between SES, taking medications, and RTW.

Prevalence of taking antidepressants increased towards the DP grant and decreased thereafter, but 14.6% of subjects did not take antidepressants or antipsychotics at all during the study period. Of SES factors, only income was positively associated with antidepressant adherence, lasting over a year. Antidepressant adherence was not associated with RTW.

An alarming result was the absence of recommended medication in fewer than every seventh patient estimated to be disabled due to pharmacologically treatable psychiatric disorders. Contrary to expectations, SES had only a minor predictive role in antidepressant adherence in this patient group. Contrary to taking antidepressants, rehabilitation was associated with RTW. The results adduced the importance of CMD treatment optimization regardless of SES.