From unemployment to disability? Relationship between unemployment rate and new disability pensions in Iceland 1992-2007.

BACKGROUND: The study was carried out in order to examine the effect of unemployment on the incidence of disability pension in Iceland by examining changes in this relationship from 1992 to 2007. METHODS: The annual incidence of disability pension for the period 1992-2007 was calculated. Correlations and significance tests for the relationship between unemployment rates and disability pension incidence rates were calculated. The relationship was examined for different disease groups. RESULTS: Two big fluctuations occurred in the unemployment rate during the study period with an upswing in unemployment from 1993 to 1995 and in 2002 and 2003. In both cases, there were corresponding increases in the incidence of disability pension. The incidence of disability pension declined again when the level of unemployment went down, even though not to the same extent. CONCLUSIONS: Health and mental and physical capability determine the overall incidence of disability pension, but marginal fluctuations over time seem to be related to environmental conditions in the labour market, especially the unemployment rate. The observed disability pension incidence pattern in the two unemployment cycles of the study period indicates mainly that people with impaired health are forced out of the labour market in times of increasing unemployment rather than pointing towards a negative effect of unemployment on health. Our findings indicate that there is a need to strengthen the vocational rehabilitation system in Iceland as well as the support system for employment and social participation.

Increased incidence of disability due to mental and behavioural disorders in Iceland 1990-2007.

AIMS: To explore longitudinal changes in the importance of mental and behavioural disorders and their subgroups among people receiving disability pension in Iceland in the period 1990 to 2007. METHOD: Estimation of the incidence of disability pension was based on national demographic data and information from the national disability register which includes the main diagnoses causing disability. RESULTS: The share of mental and behavioural disorders among new recipients of disability pension increased from 14 to 30% for women and 20 to 35% men. There was a marked increase in the incidence of disability due to disorders related to the use of alcohol and other psychoactive substances, mood disorders, disorders of psychological development and behavioural and emotional disorders with onset usually occurring in childhood and adolescence. The proportion of mental and behavioural disorders as the primary diagnosis among new recipients of disability pension increased. CONCLUSION: The most likely explanation for the changes we observe is alteration in social conditions leading to a lower threshold for seeking disability pension for mental disorders.

[Fluctuations in unemployment and disability in Iceland 1992-2006]. / Sveiflur í atvinnuleysi og örorku á Islandi 1992-2006.

OBJECTIVE: To examine and explain the effect of unemployment on the number of disability pensioners in Iceland by examining changes in this relationship from 1992 to 2006. MATERIAL AND METHODS: Information on gender and place of residence of new recipients of disability pension in Iceland and corresponding information on unemployment for each year in the period 1992 to 2006. The variables were correlated and disaggregated by gender and regions within Iceland. RESULTS: Two big fluctuations occurred in the rate of new disability pension receivers during the study period, with significant increases in disability from 1993 to 1995 and again from 2003 onwards. Both of these fluctuations are associated with considerable increases in the unemployment rate. The extent of new disability pensioners declined again when the level of unemployment went down, even though not to the same relative extent. In the upswing from 2003 a delay of about a year in the increase of disability pensioners' numbers, following the rise in unemployment rate, became more prominent and the overall rate of new disability pensioners reached new highs. The relationship applies equally to the capital area as well as the provincial areas as a whole. There is though a small deviation in three of the seven provincial areas, with less decline of the disability rate on the downswing. CONCLUSION: Health and capability condition determine the overall disability rate, but fluctuations over time are related to environmental conditions in the labour market, especially the unemployment rate. The features of the welfare system, especially the benefit and rehabilitation system, as well as the extent and character of activation measures in the labour market also influence the number of disability pensioners. A new method of disability assessment from late 1999 may have had some influence on the relationship during the latter part of the period and increasing applications from people with mental and psychiatric deficiencies seems to have had a significant influence on the growing disability rate during the last few years.

[The duration of disability pensions in Iceland]. / Hve lengi eru menn öryrkjar á Islandi?

OBJECTIVE: To analyze the long-term outcome for recipients of disability pension in Iceland. MATERIAL AND METHODS: The study includes all those receiving disability pension for the first time in 1992 in Iceland. Their status in the disability register at the State Social Security Institute of Iceland November 30th 2004 was examined as to whether they were still receiving disability pension, had died, had reached the age of retirement or were not receiving disability pension any more for some other reasons. RESULTS: In 1992 there were 725 new recipients of disability pension in Iceland, 428 females and 297 males. Twelve years later 434 from this group were no longer receiving disability pension, 240 females and 194 males. In most cases this was because they had reached the age of retirement or died (on average 88% of the females and 91% of the males each year). Only 12% of the females and 9% of the males ceased to receive disability pension (and probably went back to work). CONCLUSION: In Iceland few people return to work once they have started receiving disability pension.

[Prevalence of disability in Iceland in December 2002.].

OBJECTIVE: To determine the size and main medical and social characteristics of the group of individuals receiving disability benefits in Iceland in December 2002 and compare the results with figures from 1996. MATERIAL AND METHODS: The study includes all those receiving disability benefits on December 1st 2002 and December 1st 1996 as ascertained by the disability register at the State Social Security Institute of Iceland. Information on age and gender distribution of the Icelandic population was obtained. Age-standardized risk ratio between the years 1996 and 2002 was calculated for both pension levels combined and for full disability pension alone. RESULTS: On December 1st 2002 there were 11,791 individuals receiving disability benefits, 7044 women (59.7%) and 4747 men (40.3%). Of these there were 10,960 individuals receiving full disability pension, 6500 women (59.3%) and 4460 men (40.7%). The prevalence of all disability pension was 6.2%; full disability pension 5.8% and partial disability pension 0.4%. The prevalence of disability was lower in the capital region compared with other regions of Iceland among women, but among men there was no significant difference in the prevalence of disability according to residence. The prevalence of disability increased with age. On the whole disability was more common among women than men, but in the age group 16-19 years it was more common among men than women. Mental and behavioural disorders and diseases of the musculoskeletal system and connective tissue were the most prevalent causes of disability. The standardized risk ratio showed a significantly increased risk for both pension levels combined and for full disability pension alone both for men and women in the year 2002 as compared with the year 1996. CONCLUSION: The increase in the prevalence of disability in Iceland between the years 1996 and 2002 is probably mainly due to the introduction of a new method of disability evaluation in 1999 and increased pressure from the labour market, with increasing unemployment and competition. Mental and behavioural disorders are the most common cause of disability in Iceland and there has been a marked increase in disability due to these disorders since 1996.

[Disability due to mental and behavioural disorders in Iceland.].

AIMS: To determine the prevalence of disability in Iceland on December 1st 2002 due to mental and behavioural disorders according to gender, place of residence and marital status and main subcategories. MATERIAL AND METHODS: The disability register of the State Social Security Institute was used to obtain information on the number, gender, age, place of residence, marital status and main diagnosis of recipients of disability pension. From Statistics Iceland the same information was obtained for the Icelandic population between the age of 16 and 66. RESULTS: The prevalence of disability due to mental and behavioural disorders was 2.32% for females and 1.98% for males. For males receiving disability pension the proportion having mental disorders as the main cause of disability was larger than for females. Among females the most common cause of disability was mood disorders whereas among males it was schizophrenia, schizotypal and delusional disorders. Most of those with schizophrenia, schizotypal and delusional disorders in Iceland receive full disability pension. The prevalence of disability due to mental and behavioural disorders was significantly higher in the capital region than in the rest of the country. Marriage and registered co-habitation was considerably less common among recipients of disability pension due to mental and behavioural disorders than among the nation in general. CONCLUSION: The prevalence of disability due to mental and behavioural disorders in the capital region is in excess of what is to be expected from the prevalence of these disorders and from disability in general in Iceland. The relatively high prevalence of disability due to mental and behavioural disorders among males is in line with epidemiological data. The prevalence of disability due to mental and behavioural disorders in Iceland has been rising. This needs to be addressed by improving vocational rehabilitation programs for those suffering from these disorders.

[Comparison of the first medical assessment for rehabilitation benefits and disability pension in Iceland September 1st 1999 to November 30th 2003.].

AIMS: To evaluate the main characteristics which differentiate between those who are considered to benefit from rehabilitation and those for whom disability pension is thought more appropriate. MATERIAL AND METHODS: The study includes all those fulfilling the medical criteria for rehabilitation benefits or full disability pension in their first assessment at the State Social Security Institute of Iceland between September 1st 1999 and November 30th 2003. RESULTS: Rehabilitation benefits were mainly awarded in younger age groups; disability pension in older age groups. Mental and behavioural disorders were the most common medical reasons for granting rehabilitation benefits among both genders, followed by disorders of the musculoskeletal system and connective tissue, malignant neoplasms and injuries. Among females disorders of the musculoskeletal system and connective tissue were the most common medical reason for granting full disability pension, but this group of disorders was a less common reason for rehabilitation benefits. Those who fulfilled the medical criteria for rehabilitation benefits due to disorders of the musculoskeletal system and connective tissue were markedly older than those who fulfilled the medical criteria for rehabilitation benefits due to mental and behavioural disorders. CONCLUSION: In Iceland rehabilitation benefits are most likely to be awarded to relatively young claimants suffering from psychiatric disorders.

[Relationship between rate of unemployment and incidence of disability pension in Iceland 1992-2003.].

OBJECTIVE: To evaluate the effect of unemployment and the introduction of a new method of disability assessment on the number of recipients of disability pension in Iceland by examining changes in the incidence of disability pension and unemployment year by year from 1992 to 2003. MATERIAL AND METHODS: Information on gender, age and disability grade of new recipients of disability pension in Iceland and corresponding information on the Icelandic population for each year in the period 1992 to 2003 was used to calculate the incidence of disability pension. The results were compared with data on the rate of unemployment in Iceland. RESULTS: The incidence of disability pension was relatively high from 1992 to 1995, was lower from 1996 to 2002 and then increased markedly in 2003. There is a strong correlation between the incidence of disability pension and the rate of unemployment among both genders in Iceland during the period covered by the study. An increase from 1999 to 2000 in the incidence of disability pension among females coincided in time with the introduction of a new method of disability assessment in September 1999, but also with an increase in the rate of unemployment among females. CONCLUSION: It is not warranted to claim that the introduction of a new method of disability evaluation in September 1999 has resulted in a decisive increase in the incidence of disability pension in Iceland. The increase in the number of recipients of disability pension in Iceland recently has a strong statistical correlation with changes in the labour marked, especially with rising unemployment and increased pressure at work.

[Fibromyalgia and anxiety disorder.].

OBJECTIVE: The etiology of fibromyalgia is unclear. The diagnosis is based on widespread pain and muscular tenderness, but other symptoms often occur, such as sleep disturbance, excessive anxiety and fatigue and concentration difficulties. All these symptoms can occur in generalized anxiety disorder. The aim of this study was to assess whether fibromyalgia is associated with other diagnoses, particularly anxiety disorder. MATERIAL AND METHODS: The study includes all those receiving full disability pension on the 1st of December 2001 as ascertained by the disability register at the State Social Security Institute of Iceland. Information was obtained from the register on gender, age and diagnoses of the disability beneficiaries. Diagnoses were compared between two groups of disability beneficiaries - an index group with fibromyalgia and a comparison group without that diagnosis. There were 716 women in each group. We also compared diagnoses among the women who had fibromyalgia as primary diagnosis in the index group and among all women who had anxiety/depression as primary diagnosis. RESULTS: In the index group fibromyalgia was the single registered diagnosis in only 6.8% of cases, while 38.3% of the comparison group had a single registered diagnosis. There was a significant difference between the two groups in terms of the number of diagnoses by disease category (p<0.0001). Among individual categories of disease, the only category that showed a significant excess in the index group was mental disorders (p<0.0001). Women with fibromyalgia as a primary diagnosis were compared with women with a primary diagnosis of anxiety or depression in terms of distribution of the numbers of diagnoses per person. The distribution pattern was similar. CONCLUSIONS: The probability of having a mental disorder, especially an anxiety disorder, is significantly higher amongst women with fibromyalgia as compared to other women with full disability pension. This indicates an association between fibromyalgia and anxiety, an association which needs to be properly addressed in the treatment of this disorder.

[Opinions of clients on vocational rehabilitation organized by the State Social Security Institute of Iceland.].

OBJECTIVES: Evaluation of opinions of those evaluated by a multidisciplinary team on the evaluation, vocational rehabilitation they participated in and on the effect of the process on their self-confidence and self-reliance. MATERIAL AND METHOD: The Institute of Social Sciences carried out a telephone survey in October 2001, where it was attempted to contact the 109 individuals evaluated for rehabilitation potential by a multidisciplinary team in the year 2000. The data was analysed using descriptive statistics. RESULTS: 83 (76.1%) replied. After the evaluation 40 individuals were referred to vocational rehabilitation for approximately 2 months in a rehabilitation clinic; 19 were referred to a 6 week personal computer training at a vocational rehabilitation centre and 15 to a longer (usually 18 months) rehabilitation program in the same centre. Approximately 80% were content with the vocational rehabilitation offered. 54% of those evaluated by the multidisciplinary team said that it had been useful for them to meet the members of the team and 59% said that the team had informed them on resources they had not been aware of. Approximately half of the participants said that their self-confidence and self-reliance had increased. CONCLUSION: Approximately 80% of the participants were content with the vocational rehabilitation offered and approximately 50% had gained more self-confidence and self-reliance.

[Fitness for work after vocational rehabilitation organized by the State Social Security Institute of Iceland.].

OBJECTIVE: The evaluation of a vocational rehabilitation programme initiated by the State Social Security Institute in Iceland (SSSI) in 1999 with the aim of reducing disability. MATERIAL AND METHODS: New disability claimants who had been unable to work because of illness for a few months at least were referred by SSSI physicians to a multidisciplinary team for assessment of rehabilitation potentials and an advice on the appropriate type of rehabilitation. The study group included all the 109 individuals who were referred to the team in the year 2000. Data on marital status, number of children and level of education was compared with information about the Icelandic population obtained in a national survey. The outcome of the rehabilitation was assessed in a telephone survey, carried out by the Social Science Research Institute, University of Iceland, 1-2 years after the assessment and by information obtained from the disability register at SSSI. The effectiveness of the rehabilitation programme was evaluated by comparing the study group with a comparable group that had started to receive rehabilitation pension before the SSSI could offer vocational rehabilitation. Their progress was assessed a year and half after they had contacted the SSSI, the same length of time as the study group had been in the in the rehabilitation programme. RESULTS: In the study group there were about twice as many women as men. The mean age was 35 years (range 18-57 years). The main medical reasons for referral to the team were musculosceletal and psychiatric disorders. Those evaluated were more likely to be unmarried or divorced, had more children and a lower educational level than the general Icelandic population. After evaluation 40 individuals were referred to vocational rehabilitation for approximately 2 months in a rehabilitation clinic; 19 were referred to a 6 week personal computer training at a vocational rehabilitation centre and 15 to a longer (usually 18 months) rehabilitation program in the same centre. In all, 46 individuals received other treatment or education. Almost three quarters (72%) of the participants in the telephone survey said that their fitness for work had increased after rehabilitation, but only 47% had returned to work. At the time of the reserach, 23% were students and it is likely that a part of them will return to work when their studies are completed. Between one and two years after the evaluation by the multidisciplinary team 44 out of 109 (40.4%) in the study group received disability pension and a equal number received no social insurance benefits at all. In the comparison group 97 out of 119 (81.5%) received disability pension and 21 (17.7%) received no social insurance benefits at all. CONCLUSIONS: This study shows that vocational rehabilitation organized by the SSSI is effective and can prevent disability. The results of this study are similar to the results of two Swedish studies on the same topic.