Individuals with mood and common mental disorders are more likely to receive disability services, according to results of a study done in Ontario, Canada and published in JAMA Network Open.
Although studies have shown mood disorders to be strongly associated with disability, large population-based analyses on the trajectory to disability after the initial diagnosis of a mood disorder have not yet been conducted.
To determine the time between an incident mood disorder diagnosis and the receipt of disability services, data from 1,902,792 individuals with either a mood disorder, common mental disorder, or neither were analyzed. Mood disorders included major depressive and bipolar disorders. Common mental disorders included anxiety. The 139,148 individuals with a mood disorder (56.6% women) were an average of 37.5±11.9 years of age. The 812,248 individuals with common mental disorder (57.4% women) were an average of 36.5±11.8 years of age.
Both groups were compared with control groups that matched for age and sex proportion. Disability outcomes were established by entry into the Ontario Disability Support Program (ODSP) or into a long-term care (LTC) residence.
Incidence of ODSP entry was more common among individuals with mood disorders than those without (adjusted hazard ratio [aHR], 2.03; 95% CI, 1.95-2.11; P <.001), as well as among individuals with common mental disorders than those without (aHR, 1.57; 95% CI, 1.55-1.60; P <.001). Individuals with bipolar disorders were more likely to enter ODSP than individuals with major depressive disorders. Incidence of LTC entry was more common among individuals with mood disorders than those without (aHR, 2.20; 95% CI, 1.80-2.69; P <.001), as well as among individuals with common mental disorders than those without (aHR, 1.21; 95% CI, 1.14-1.29; P <.001).
Limitations to this study include its use of healthcare administrative databases, which may not include individuals with mental disorders who were not in contact with the healthcare system. This could lead to underestimation of the effect size if individuals with mental disorders who were not in contact with the health care system were in the unexposed group. Also, the measurement of disability services as the entry to ODSP and LTC are very specific and do not capture other disability services patients may have received.
The results of this study showed that incident diagnosis of mood or common mental disorders were associated with higher rates of receipt of disability services than those without these diagnoses. Individuals with incident mood disorder diagnoses were more likely to receive disability services than individuals with common mental disorder diagnoses, possible because mood disorders tend to start during childhood and may therefore have a greater impact on future education and employment. Men were found to have a greater hazard ratio for receiving disability than women, which is consistent with previous studies on work disability.
Future research investigating the sex differences in the likelihood of receiving disability services are warranted. Additional studies including a greater range of individuals with mental disorders as well as a greater range of disability services are also warranted, as are investigations into the correlation of disorder severity and receipt of disability services.
Frey BN, Vigod S, de Azevedo Cardoso T, Librenza-Garcia D, et al. The early burden of disability in individuals with mood and other common mental disorders in Ontario, Canada. [published online October 26, 2020]. JAMA Netw Open. doi: 10.1001/jamanetworkopen.2020.20213