Date Published: July 6, 2017
Publisher: Public Library of Science
Author(s): Stein Atle Lie, Torill H. Tveito, Silje E. Reme, Hege R. Eriksen, Andrea Martinuzzi.
Disability benefits and sick leave benefits represents huge costs in western countries. The pathways and prognostic factors for receiving these benefits seen in recent years are complex and manifold. We postulate that mental health and IQ, both alone and concurrent, influence subsequent employment status, disability benefits and mortality.
A cohort of 918 888 Norwegian men was followed for 16 years from the age of 20 to 55. Risk for health benefits, emigration, and mortality were studied. Indicators of mental health and IQ at military enrolment were used as potential risk factors. Multi-state models were used to analyze transitions between employment, sick leave, time limited benefits, disability benefits, emigration, and mortality.
During follow up, there were a total of 3 908 397 transitions between employment and different health benefits, plus 12 607 deaths. Men with low IQ (below 85), without any mental health problems at military enrolment, had an increased probability of receiving disability benefits before the age of 35 (HRR = 4.06, 95% CI: 3.88–4.26) compared to men with average IQ (85 to 115) and no mental health problems. For men with both low IQ and mental health problems, there was an excessive probability of receiving disability benefits before the age of 35 (HRR = 14.37, 95% CI: 13.59–15.19), as well as an increased probability for time limited benefits and death before the age of 35 compared to men with average IQ (85 to 115) and no mental health problems.
Low IQ and mental health problems are strong predictors of future disability benefits and early mortality for young men.
Disability and long-term sick leave benefits are major economic burdens in many western countries, and the increase in disability benefits has been attributed to mental health problems[2–4]. Mental health problems in early life have been found to increase the risk of long term sick leave and disability benefits later in life[6–9]. Additionally, sick leave, unemployment, and rehabilitation benefits themselves are risk factors for later permanent disability benefits and mortality[10–12].
This study included 918 888 Norwegian men born between 1950 and 1980. As part of the selection of personnel to the Norwegian military service, all meet one day before a draft board and a military physician for assessments of physical and mental health.
In order to examine the lifetime course of employment, sick leave, disability benefits, emigration, and mortality, a multi-state model was constructed [21–25] (Fig 1).
A total of 3 921 004 transitions between the different states during the observation period were observed (Table 3). The mean number of transitions was 4.2, while the median number was 1 (quartile range: 0–6, range: 0–235). The highest state probability, except for employment, at the age of 35, was observed for sick leave; 3.1% for the 806 277 men with average to high IQ (Fig 2A), 3.4% for the 576 414 men without mental health problems (Fig 2C), and 3.3% for the 518 852 men with average to high IQ with no mental health problem (Fig 2E).
Young men with average to high IQ without any mental health problems at military enrolment had a high probability of employment between the ages of 20 to 55. These men also had an increased chance of emigration and a low risk of disability benefits. Men with lower than average IQ or with mental health problems at the age of military enrolment, had an increased risk of long-term sick leave, time limited benefits, receiving disability benefits later in life, and early mortality. The IQ assessment was performed 1–2 years after the males had finished 9 year compulsory school. Adjustment of IQ for level of education is hence not relevant. Employment was substantially reduced for those who had both low IQ and mental health problems. Low IQ was a prominent predictor for receiving disability benefits later in life. The state occupation probabilities showed that men with mental health problems and/or low IQ had a high probability for early vocational rehabilitation before the disability benefit.