Alcohol, sickness absence and disability pension : a study in the field of disease, ill health, psychosocial factors, and medicalisation

In Sweden 1998 there were 34 487 newly granted DPs (disability pensions) irrespective of diagnosis and 466 (1.4 %) with a main diagnosis of alcohol dependence or abuse. Other studies have shown that alcohol diagnoses are underestimated on certificates for disability pension. The general aim of this thesis is to contribute to the knowledge of the association between on the one hand alcohol habits and psychosocial factors, and on the other high levels of sickness absence (HSA) respectively DPs.

Three sources of data are used: a population-based health study from Stockholm County, a sample of women from Göteborg, a nationwide conscription survey in 1969-1970.

Information on alcohol habits and psychosocial factors was linked to information on DP and high levels of sick leave (HSA), obtained from registers during follow-up periods of 7-22 years. In addition, information on socio-economic classification in 1975, on drink driving and other criminality during follow-up was linked to the conscription data. The risk associated with hazardous alcohol use, psychosocial factors, drink driving and criminality and DP/HSA was analysed mainly with logistic regression analyses.

All studies showed a positive association between indicators of hazardous alcohol use and increased risk of DP and/or HSA, as well as a positive association for several psychosocial factors. Among both men and women unfavourable conditions during childhood and adolescence, school difficulties and early deviant behaviours predicted DP/HSA in adulthood.

The majority of the conscripts who were granted an early DP (before the age of 43) had a psychiatric diagnosis. DPs with an alcohol- or drug-related diagnosis had strong associations with extrovert deviant behaviour. Convictions for drink driving and other criminal acts during follow-up were risk factors for receipt of an early DP as well as of HSA. Large differences in the distribution of risk indicators across the social strata were found. The increased risk for DPs among lower socio-economic groups decreased considerably after controlling for a large number of factors on conditions during childhood and late adolescence. However, a 50 % increased risk was still observed for unskilled manual workers.

A disability pension granted in younger ages is likely to have a different aetiology compared to that in older ages. Conditions during childhood and hazardous alcohol use are suggested to predict an unfavourable life career, including HSA/DP. The results suggest that hazardous alcohol use and psychosocial conditions are underreported causal factors for HSA and DP. The results also raise the issue of medicalisation, a process whereby more and more life areas are becoming the object of medical decisions.