Gender differences in healthcare management of depression: aspects of sick leave and treatment with psychoactive drugs in a Swedish setting.

Purpose: To investigate whether women and men diagnosed with depressive disorder were managed equally in terms of being sick-leave certified and being prescribed psychoactive drugs. Materials and methods: Data from all patients diagnosed with depression during 2010-2015 in Uppsala county, Sweden (n = 19 448) were used to investigate associations between gender and issued sick-leave certificate, prescriptions of anti-depressants, anxiolytics, hypnotics and sedatives, and cognitive behavioral psychotherapy referrals, at different time points up till 180 days after diagnosis. Results: At diagnosis date, 50.1% were prescribed antidepressants; 14.2% anxiolytics; 13.3% hypnotics or sedatives. Corresponding proportion regarding issue of sick-leave certificate among working aged (18-64 years) was 16.6%. Men had higher odds than women of being prescribed antidepressants (OR 1.16; 95% CI 1.09-1.24); anxiolytics (1.10; 95% CI 1.02-1.21), hypnotics and sedatives (OR 1.09; 95% CI 1.00-1.19) and lower odds (among those aged 18-64 years) of being sick-leave certified (OR 0.90; 95% CI 0.82-0.98) in adjusted regression models. There were subtle changes in ORs for outcomes at 3- and 6-month follow-up periods. Conclusions: Men had somewhat higher odds of being prescribed psychoactive drugs and slightly lower odds of being sick-leave certified as compared to women at date when diagnosed with depression. The absolute differences were, however, small and the overall conclusion is that women and men with current diagnosed depressive episode/recurrent depressive disorder are generally managed likewise regarding sick leave and psychoactive treatment.

Health-related and social factors predicting non-reemployment amongst newly unemployed.

BACKGROUND: Many researchers have examined the effect that mental health has on reemployment opportunities amongst the unemployed, but the results are inconclusive. Our aim in this study is to investigate the effects that different aspects of mental and physical health, as well as socio-demographic, social, and economic factors, have on reemployment. METHODS: A questionnaire was administered to 1,000 and answered by 502 newly registered unemployed Swedes, who were followed for one year using data from the Swedish National Labour Market Board. The differences between those reemployed and those not reemployed was analysed using stepwise logistic regression. RESULTS: General mental ill health amongst unemployed individuals measured by the General Health Questionnaire scale was associated with lower levels of reemployment after one year. This effect could not be explained by any of the scales measuring specific aspects of mental disease such as health-related level of function, rate of depression, burnout, or alcohol misuse. Instead being above 45, low control over one's financial situation, being an immigrant, and visiting a physician during the last three months were better predictors of failure to be reemployed. CONCLUSION: There are theoretical reasons to assume that psychological distress leads to a decreased reemployment rate amongst the unemployed. The results of this study partly endorse this hypothesis empirically, showing that general subjective mental distress decreases the rate of reemployment amongst newly unemployed individuals, although this effect was mediated by social and economic factors. Indicators of psychiatric disease had no significant effect on reemployment. The results of this study lead us to suggest the early introduction of financial counselling, psychological support, and other interventions for groups with lower reemployment rates.

Impact of increased patient choice of providers in Sweden: cataract surgery.

OBJECTIVES: Choice of provider was introduced in Sweden in 2001. Our aim was to describe the scope and character of patient flows and to analyze any differences between patients who chose to move outside of their home county (movers) and those who did not (non-movers) with regard to age, sex, waiting time and level of need. METHODS: Use of cataract operations between 2005 and 2008 based on data from the National Cataract Register. Data were analysed using descriptive statistics, odds ratios and multivariate regression analysis to compare movers and non-movers. Information on contracting between county councils and providers in other counties was obtained from a survey. RESULTS: Only 4% of cataract patients were treated by a provider outside their home county. Patient flows were mainly determined by contracts between county councils and providers, and only 1% were considered to be 'true' movers (i.e. patients who were not part of any special contracting agreement). Movers differed from non-movers in that they were on average younger, had less serious visual problems and had shorter waiting times. CONCLUSION: Though patient flows are minor in scope, the possibility of changing provider has probably been important in tackling long waits in some counties. However, the reform may threaten the equity of health care use.

Care or not care--that is the question: predictors of healthcare utilisation in relation to employment status.

BACKGROUND: International research shows that there is a higher use of care among the unemployed than among the employed, although the findings on the association between unemployment and healthcare use are not conclusive. PURPOSE: To examine the association between healthcare use and employment status and the factors influencing this relationship. METHOD: During 2002, a questionnaire was sent to 1,000 persons who had recently registered as unemployed (participation rate: n = 570) and to a sample of 1,000 persons representing the Swedish population (participation rate: n = 641). The study design was cross-sectional. Persons still unemployed or otherwise not employed (n = 416) were compared with the employed (n = 414) using logistic regression analyses. RESULTS: About half of those in the unemployed group had contacted a physician. The unemployed were also more likely to have needed but not sought care. Being in the unemployed group was a statistically significant risk factor for reporting unmet care needs, after adjusting for sociodemographic factors (OR = 1.53). The risk of abstaining from seeking care did not persist when considering economy and social network. Among those with unmet care needs, there was still a higher risk in the unemployed group of reporting: a small social network (OR = 2.73), economic hardship (OR = 2.87) and symptoms of depression (OR = 2.04). CONCLUSIONS: Unemployment is a risk factor for both contacting a physician and for unmet care needs. A low social network and economic hardship are more present among persons who abstain from seeking healthcare and seem to be more common among the unemployed. The healthcare system should also be aware of the fact that some unemployed people with symptoms of depression abstain from seeking care.

Mortality in relation to employment status during different levels of unemployment.

AIMS: The aim of this study was to estimate whether the risk for total and cause-specific mortality was related to employment status, and whether mortality in different non-employed groups differed during high and low levels of unemployment. METHODS: Structured interviews were used from the Swedish Survey of Living Conditions in 1984-89 and 1992-97, including women and men aged 18 to 64, classified as unemployed (n = 2,067), retired or on temporary disability pension (n = 2,674), economically inactive for other reasons (n = 1,373), and employed (n = 38,293). Data were linked to death certificates, as registered in the Cause of Death Register. Cox proportional hazards models were performed for the mortality risk up until eight and a half years following the interview. RESULTS: Being unemployed (OR = 1.43), retired, or on temporary disability pension (OR = 2.28) or being economically inactive for other reasons (OR = 1.63) was related to a risk for total mortality, after considering the level of unemployment, sociodemographic factors and longstanding illness. The risk of death due to external causes was excessive among the unemployed and among those retired or on temporary disability pension, and resulted to a large extent from suicide. The interaction between employment status and level of unemployment was not significant. CONCLUSIONS: The level of unemployment seems to have no major influence on the mortality risk. Future interventions for the non-employed groups should focus on preventing avoidable mortality, such as injury and suicide.

Health care utilization among persons who are unemployed or outside the labour force.

BACKGROUND: In Sweden, equity in health is a central aim of public health policy. To this end, the health care system is obligated to offer equal access to health care according to need. However, unemployment may hinder the fulfillment of this goal. The aim of the present study was to assess self-reported health care needs and service utilization with respect to employment status. METHODS: A questionnaire was sent to 4000 randomly chosen individuals 20-64 years of age living in different counties in Sweden (response rate 66.2%). Logistic regression analyses were carried out to estimate the influence of employment status, socio-demographic variables and health indicators on the need for and use of health care services. RESULTS: In total, 42.2% (n=35) among the unemployed, 37.4% (n=55) among persons who were on long-term sick leave (LTSD), and 22.3% (n=467) of the employed persons, abstained from consulting a physician despite reporting a perceived need to do so. The results persisted after adjusting for socio-demographic variables, social support and personal finances (unemployed: OR=1.91; LTSD: OR=1.62). The risk of foregoing care remained higher among the unemployed, but not the LTSD-group, after adjusting for long-standing illness (OR=1.94). The unemployed were more likely than the employed to perceive a need to seek care for psychological problems. The risk of abstaining from consulting a physician was related to symptoms of depression. CONCLUSIONS: Lack of employment may be related to unmet care needs, especially among unemployed who are experiencing psychological symptoms. To deal with the needs of the unemployed it may be useful to develop interventions within the health care system that focus more on psychological problems.

Self-rated health in relation to employment status during periods of high and of low levels of unemployment.

BACKGROUND: There is a need for more research on the health impact of changes in the national unemployment rate. Therefore, the present study was carried out to compare levels of self-rated health during periods of high and low levels of unemployment. METHODS: Data included cross-sectional interviews from the Swedish Survey of Living Conditions, which were based on random samples of inhabitants between 16 and 64 years of age living in Sweden. Data were collected for the period 1983-89, when unemployment levels were low (n = 35 562; 2.5%) and for the period 1992-97 when unemployment was high (n = 24 019; 7.1%). RESULTS: After adjusting for sociodemographic variables as well as long-term disease or handicap, the differences in self-rated health between the unemployed and employed were larger when unemployment levels were high in the 1990s, than when they were low in the 1980s. More groups of the unemployed were afflicted with poor health when unemployment was high, compared with when it was low. In 1992-97, being married, living in larger cities, or not having a long-term disease or handicap no longer buffered the negative effects on health among the unemployed. CONCLUSIONS: Poorer self-rated health among the unemployed seems to be an increasing public health problem during high levels of unemployment.

A large proportion of Swedish citizens refrain from seeking medical care--lack of confidence in the medical services a plausible explanation?

Equity in health and health care is and has been a long-standing goal in Swedish health care politics. This study aims to look into how different socio-demographic variables influence unmet needs i.e. why one would refrain from seeing a doctor, despite a perceived need for medical care. A nation-wide postal questionnaire was answered by 2648 (66%) randomly chosen individuals in the ages between 20 and 64 years. The questionnaire included questions on health and health care utilisation along with data on different socio-demographic variables. The proportion of citizens that refrain from visiting a physician despite a perceived need was higher (24%) than in any previous Swedish investigation. Women, those of a non-Swedish origin and those with a low level of education refrained from going to the physician to a higher extent than men, inborn citizens and those with a higher education. Stated reasons to why the respondents refrained from medical care were associated with confidence, primarily, finite availability and economy. It appears as the Swedish health care system is not fully adapted to provide for the so far unmet needs of a large proportion of the population and that this has equitable concerns.