Long-term work disability and absenteeism in anxiety and depressive disorders

Abstract

Background

This longitudinal study aims to compare long-term work disability and absenteeism between anxiety and depressive disorders focusing on the effects of different course trajectories (remission, recurrence and chronic course) and specific symptom dimensions (anxiety arousal, avoidance behaviour and depressive mood).

Methods

We included healthy controls, subjects with a history of – and current anxiety and/or depressive disorders with a paid job (n=1632). The Composite International Diagnostic Interview was used to diagnose anxiety and depressive disorders and to assess course trajectories at baseline, over 2 and 4 years. The World Health Organization Disability Assessment Schedule II and the Health and Labour Questionnaire Short Form were used to measure work disability and absenteeism. Symptom dimensions were measured using the Beck Anxiety Inventory, the Fear Questionnaire and the Inventory for Depressive Symptomatology.

Results

A history of – and current anxiety and/or depressive disorders were associated with increasing work disability and absenteeism over 4 years, compared to healthy controls. Long-term work disability and absenteeism were most prominent in comorbid anxiety–depressive disorder, followed by depressive disorders, and lowest in anxiety disorders. A chronic course, anxiety arousal and depressive mood were strong predictors for long-term work disability while baseline psychiatric status, a chronic course and depressive mood were strong predictors for long-term work absenteeism.

Limitations

Results cannot be generalized to other anxiety disorders, such as obsessive compulsive disorder, posttraumatic stress disorder and specific phobias. Self-reported measures of work disability and absenteeism were used.

Conclusions

Our results demonstrate that depressive syndromes and symptoms have more impact on future work disability and absenteeism than anxiety, implying that prevention of depression is of major importance.

Introduction

Anxiety and depressive disorders have a major impact on daily functioning (Alonso et al., 2004, Bijl and Ravelli, 2000a, Bijl and Ravelli, 2000b, Stein et al., 2005, Olfson et al., 1997, Mendlowicz and Stein, 2000, Hendriks et al., 2014, Iancu et al., 2014). Subjects with anxiety and depressive disorders experience more disability at work and more work loss days (absenteeism) (de Graaf et al., 2012, Stewart et al., 2003, Kessler and Frank, 1997, Adler et al., 2006). This loss of productivity is a burden for subjects themselves, for their families and social support system, and for the society at large, which includes increased use of health care services (Druss et al., 2000, Buist-Bouwman et al., 2005, de Graaf et al., 2012). The risk for enduring work incapacity demonstrates the urgency to further explore the relationship between anxiety and depressive disorders, and work disability and absenteeism (Ahola et al., 2011, Mykletun et al., 2006, Bültman et al., 2008).

To date, most knowledge about work disability and absenteeism is derived from cross-sectional and short-term treatment studies. Cross-sectional studies showed that depressive disorders have more impact on work disability and absenteeism than anxiety disorders (Plaisier et al., 2010, de Graaf et al., 2012, Alonso et al., 2004, Merikangas et al., 2007). However, it remains unclear whether these differences remain present over a longer period. Anxiety disorders are more chronic in nature than depressive disorders (Penninx et al., 2011, Merikangas et al., 2003). Consequently, it is likely that over a longer time subjects with anxiety disorders experience at least as much work disability and absenteeism as subjects with depressive disorders. Nevertheless, this does not make depression a less important target for intervention because research about this topic is lacking. Little is known about differences and commonalities in work disability and absenteeism between comorbid anxiety–depressive disorders and pure anxiety disorders and pure depressive disorders. Research indicated that subjects with a comorbid anxiety–depressive diagnosis have more severe symptoms, more disability, a longer duration of illness and are less likely to respond to treatment than subjects with a single anxiety or depression diagnosis (Vollrath and Angst, 1989, Bijl and Ravelli, 2000a, Bijl and Ravelli, 2000b, Hecht et al., 1990: Roy-Byrne et al., 2000, Bruce et al., 2005, Ormel et al., 1994). Anxiety disorders and depressive disorders are highly comorbid disorders (Kesler et al., 2005). According to DSM-IV-TR, diagnostic criteria overlap with regard to symptoms like irritability, trouble with concentration, sleeping problems, restlessness, and fatigue (APA, 1994). Furthermore, there is overlap in treatment, including use of antidepressants and psychological interventions. Anxiety and depressive disorders often arise sequentially within the same patient and the order is more likely to start with anxiety, depression commonly arising later (Merikangas et al., 1996, de Graaf et al., 2002).

Besides baseline psychiatric status, it remains unclear to what extent the course of anxiety and depressive disorders influences the outcome in terms of long-term work disability and absenteeism. To our knowledge, associations between anxiety and depressive course trajectories and long-term work disability and absenteeism have not yet been investigated. Previous investigations point out that a chronic course in anxiety and depressive disorders is associated with a poor outcome and more comorbidity (Fichter et al., 2010, Merikangas et al., 2003, Rherbergen et al., 2011, Hendriks et al., 2013). Therefore, we expect that a chronic course is associated with more long-term work disability and absenteeism.

Considering the baseline clinical situation, specific clinical features, such as symptom severity or the prominence of a specific dimension of symptoms (like anxiety arousal, avoidance behaviour and depressive mood) may also provide important information about the prognosis of work disability and absenteeism (Hendriks et al., 2013). In order to better understand underlying symptoms like anxiety arousal, avoidance behaviour and depressive mood driving work disability and absenteeism patterns, it is important to examine their role in a prospective longitudinal design. Knowledge about these factors may help identifying subjects at risk for long-term work disability and absenteeism and to design interventions (both at organizational level and individual level) to prevent them.

This longitudinal study among a large cohort of working subjects aims to investigate: 1) differences in subsequent long-term work disability and absenteeism between subjects with a history (lifetime but not 6-month recency) of anxiety and/or depressive disorder, and subjects with current anxiety disorders, depressive disorders and comorbid anxiety–depressive disorders at baseline and healthy controls; 2) differences in subsequent long-term work disability and absenteeism for different psychiatric course trajectories (remission, recurrence and a chronic course) for subjects with anxiety and/or depressive disorders; and 3) the role of specific symptom dimensions that are common across anxiety and depression, such as anxiety arousal, avoidance behaviour and depressive mood, in subsequent long-term work disability and absenteeism.