A long-term follow-up study of labor market marginalization in psychiatric patients with and without personality disorder
Keywords:
Personality disorder, young adulthood, social functioning, labor market marginalization, vocational functioning
Abstract
Background: Personality disorders (PDs) in adulthood are considered stable over time and are likely to have lasting psychosocial impact on the affected individual, including in areas like vocational functioning. The aim of this study was to study labor market marginalization (LMM) and receipt of social welfare benefits during 13 years from age 18 to 25 years in a sample of former psychiatric patients with and without PD.
Methods: This study followed-up 186 former psychiatric patients who were thoroughly assessed in 2002–2004, including for PD, and compared them with controls. Participants were divided into three groups: former patients with PD, without PD, and a matched control group from the general population. Register data on employment, sick leave absence, disability pensioning, education, days of psychiatric care, income, and receipt of social welfare benefits in 2003–2016 were collected.
Results: Former patients had more days of unemployment, sick leave absence, and disability pensioning and received more social welfare benefits than controls during the study period. Differences between patients with and without PD were smaller than expected, but significant as regards receipt of social welfare benefits. PD also had an effect on income at age 30 years.
Conclusions: Early onset of psychiatric disorders impairs vocational functioning up to 13 years after diagnosis, and most in those with PD.
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References
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41. Gawda B, Czubak K. Prevalence of personality disorders in a general population among men and women. Psychol Rep. 2017;120:503–19. doi: 10.1177/0033294117692807
2. Skodol AE. Impact of personality pathology on psychosocial functioning. Curr Opin Psychol. 2018;21:33–8. doi: 10.1016/j.copsyc.2017.09.006
3. Helgesson M, Tinghög P, Niederkrotenthaler T, Saboonchi F, Mittendorfer-Rutz E. Labour-market marginalisation after mental disorders among young natives and immigrants living in Sweden. BMC Public Health. 2017;17:593. doi: 10.1186/s12889-017-4504-4
4. Mousteri V, Daly M, Delaney L, Tynelius P, Rasmussen F. Adolescent mental health and unemployment over the lifespan: population evidence from Sweden. Soc Sci Med. 2019;222:305–14. doi: 10.1016/j.socscimed.2018.12.030
5. Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR. Psychosocial functioning of borderline patients and axis II comparison subjects followed prospectively for six years. J Pers Disord. 2005;19:19–29. doi: 10.1521/pedi.19.1.19.62178
6. Helgesson M, Tinghög P, Wang M, Rahman S, Saboonchi F, Mittendorfer-Rutz E. Trajectories of work disability and unemployment among young adults with common mental disorders. BMC Public Health. 2018;18:1228.doi: 10.1186/s12889-018-6141-y
7. Galobardes B, Lynch J, Smith GD. Measuring socioeconomic position in health research. Br Med Bull. 2007;81–82:21–37. doi: 10.1093/bmb/ldm001
8. Marmot M. Social justice, epidemiology and health inequalities. Eur J Epidemiol. 2017;32:537–46. doi: 10.1007/s10654-017-0286-3
9. Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, et al. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358:2468–81. doi: 10.1056/NEJMsa0707519
10. Klungsoyr O, Antonsen B, Wilberg T. Contours of a causal feedback mechanism between adaptive personality and psychosocial function in patients with personality disorders: a secondary analysis from a randomized clinical trial. BMC Psychiatry. 2017;17:210. doi: 10.1186/s12888-017-1365-4
11. Gjerde LC, Roysamb E, Czajkowski N, Knudsen GP, Ostby K, Tambs K, et al. Personality disorders and long-term sick leave: a population-based study of young adult Norwegian twins. Twin Res Hum Genet. 2014;17:1–9. doi: 10.1017/thg.2013.90
12. Ostby KA, Czajkowski N, Knudsen GP, Ystrom E, Gjerde LC, Kendler KS, et al. Personality disorders are important risk factors for disability pensioning. Soc Psychiatry Psychiatr Epidemiol. 2014;49:2003–11. doi: 10.1007/s00127-014-0878-0
13. Knudsen AK, Skogen JC, Harvey SB, Stewart R, Hotopf M, Moran P. Personality disorders, common mental disorders and receipt of disability benefits: evidence from the British National Survey of Psychiatric Morbidity. Psychol Med. 2012;42:2631–40. doi: 10.1017/S0033291712000906
14. Korkeila J, Oksanen T, Virtanen M, Salo P, Nabi H, Pentti J, et al. Early retirement from work among employees with a diagnosis of personality disorder compared to anxiety and depressive disorders. Eur Psychiatry. 2011;26:18–22. doi: 10.1016/j.eurpsy.2009.12.022
15. Ettner SL, Maclean JC, French MT. Does having a dysfunctional personality hurt your career? Axis II personality disorders and labour market outcomes. Ind Relat (Berkeley). 2011;50:149–73. doi: 10.1111/j.1468-232X.2010.00629.x
16. Moran P, Romaniuk H, Coffey C, Chanen A, Degenhardt L, Borschmann R, et al. The influence of personality disorder on the future mental health and social adjustment of young adults: a population-based, longitudinal cohort study. Lancet Psychiatry. 2016;3:636–45. doi: 10.1016/S2215-0366(16)30029-3
17. Spitzer RL. Psychiatric diagnosis: are clinicians still necessary? Compr Psychiatry. 1983;24:399–411. doi: 10.1016/0010-440X(83)90032-9
18. Bech P, Timmerby N, Martiny K, Lunde M, Soendergaard S. Psychometric evaluation of the Major Depression Inventory (MDI) as depression severity scale using the LEAD (Longitudinal Expert Assessment of All Data) as index of validity. BMC Psychiatry. 2015;15:190. doi: 10.1186/s12888-015-0529-3
19. Kranzler HR, Tennen H, Babor TF, Kadden RM, Rounsaville BJ. Validity of the longitudinal, expert, all data procedure for psychiatric diagnosis in patients with psychoactive substance use disorders. Drug Alcohol Depend. 1997;45:93–104. doi: 10.1016/S0376-8716(97)01349-5
20. Pilkonis PA, Heape CL, Ruddy J, Serrao P. Validity in the diagnosis of personality disorders: the use of the LEAD standard. Psychol Assess. 1991;3:46–54. doi: 10.1037/1040-3590.3.1.46
21. Statens beredning för medicinsk utvärdering. Diagnostik och uppföljning av förstämningssyndrom – en systematisk litteraturöversikt. SBU, Stockholm. 2012.
22. Ramirez A. Young adults in general psychiatry [PhD thesis]. Uppsala: Acta Universitatis Upsaliensis: Universitetsbiblioteket: Uppsala University; 2011.
23. First MB, Spitzer R, Gibbon M, Williams J. Structured clinical interview for DSM-IV Axis I Disorders, Clinical version (SCID-I-CV). Washington, DC: American Psychiatric Press; 1996.
24. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth edition, DSM-IV. Washington, DC: American Psychiatric Association; 1994.
25. First MB, Spitzer R, Gibbon M, Williams J, Benjamin LS. Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). Washington, DC: American Psychiatric Press; 1997.
26. Ludvigsson JF, Svedberg P, Olen O, Bruze G, Neovius M. The longitudinal integrated database for health insurance and labour market studies (LISA) and its use in medical research. Eur J Epidemiol. 2019;34:423–37. doi: 10.1007/s10654-019-00511-8
27. Ludvigsson JF, Almqvist C, Bonamy AE, Ljung R, Michaëlsson K, Neovius M, et al. Registers of the Swedish total population and their use in medical research. Eur J Epidemiol. 2016;31:125–36. doi: 10.1007/s10654-016-0117-y
28. Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, et al. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450. doi: 10.1186/1471-2458-11-450
29. Socialstyrelsen. Ekonomiskt bistånd – för privatpersoner 2021. 2021. Available from https://www.socialstyrelsen.se/stod-i-arbetet/ekonomiskt-bistand/ekonomiskt-bistand-for-privatpersoner/ [cited 21 May 2021].
30. Jonsson U, Bohman H, Hjern A, von Knorring L, Olsson G, von Knorring AL. Subsequent higher education after adolescent depression: a 15-year follow-up register study. Eur Psychiatry. 2010;25:396–401. doi: 10.1016/j.eurpsy.2010.01.016
31. Statistiska Centralbyrån. 2021. Available from: https://www.scb.se/hitta-statistik/sverige-i-siffror/utbildning-jobb-och-pengar/utbildningsnivan-i-sverige/ [cited 13 March 2023].
32. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5 ed. Arlington, VA: American Psychiatric Association; 2013. doi: 10.1176/appi.books.9780890425596
33. Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;62:553–64. doi: 10.1016/j.biopsych.2006.09.019
34. Skodol AE. Personality disorders in DSM-5. Annu Rev Clin Psychol. 2012;8:317–44. doi: 10.1146/annurev-clinpsy-032511-143131
35. Burgard SA, Brand JE, House JS. Toward a better estimation of the effect of job loss on health. J Health Soc Behav. 2007;48:369–84. doi: 10.1177/002214650704800403
36. Bartelink VHM, Zay Ya K, Guldbrandsson K, Bremberg S. Unemployment among young people and mental health: a systematic review. Scand J Public Health. 2020;48:544–58. doi: 10.1177/1403494819852847
37. Neubert M, Süssenbach P, Rief W, Euteneuer F. Unemployment and mental health in the German population: the role of subjective social status. Psychol Res Behav Manag. 2019;12:557–64. doi: 10.2147/PRBM.S207971
38. Skodol AE, Bender DS, Morey LC, Clark LA, Oldham JM, Alarcon RD. Personality disorder types proposed for DSM-5. J Pers Disord. 2011;25:136–69. doi: 10.1521/pedi.2011.25.2.136
39. Alaie I, Philipson A, Ssegonja R, Copeland WE, Ramklint M, Bohman H, Jonsson U. Adolescent depression and adult labor market marginalization: a longitudinal cohort study. Eur Child Adolesc Psychiatry. 2022 Nov;31(11):1799–1813. doi: 10.1007/s00787-021-01825-3
40. Volkert J, Gablonski TC, Rabung S. Prevalence of personality disorders in the general adult population in Western countries: systematic review and meta-analysis. Br J Psychiatry. 2018;213:709–15. doi: 10.1192/bjp.2018.202
41. Gawda B, Czubak K. Prevalence of personality disorders in a general population among men and women. Psychol Rep. 2017;120:503–19. doi: 10.1177/0033294117692807
Published
2023-07-31
How to Cite
Spangenberg H., Ramklint M., & Ramirez A. (2023). A long-term follow-up study of labor market marginalization in psychiatric patients with and without personality disorder. Upsala Journal of Medical Sciences, 128(1). https://doi.org/10.48101/ujms.v128.9014
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