Psychosocial characteristics in young men as predictors of early disability pension with a psychiatric diagnosis

Background: There is little knowledge about disability pensions (DPs) in ps ychiatric diagnoses. The aim of this study was to analyse risk factors amon g men for receiving an early disability pension with a psychiatric diagnosi s. Methods: The study is based on data from a nationwide survey of 49 285 y oung Swedish men who were conscripted into military service in 1969/1970. P otential psychosocial and behavioural risk factors were linked to records f rom the Swedish Social Insurance Board up until 1993. Results: The majority (63.4%) of the men granted a DP during follow-up had a psychiatric diagnos is as the main and/or secondary diagnosis. Among those conscripts analysed (41 702), 599 had been granted a disability pension with a psychiatric diag nosis. Of these, 35.4% had a diagnosis of psychosis, 23.2% an alcohol- or d rug-related diagnosis, and 41.4% 'other' psychiatric diagnosis. Receiving a psychiatric diagnosis at conscription, showing low emotional control, unem ployment after graduation, and ranking low on an "IQ" test were strong pred ictors of all categories of DP with psychiatric diagnoses. In multivariate analysis controlling for the effect of all other risk indicators included i n the model, DP with non-alcohol- and non-drug-related psychiatric diagnose s was related to low social support at adolescence but not to signs of extr overt deviant behaviour (risky use of alcohol or contact with police and ch ild authorities). In contrast, DP with an alcohol- or drug-related diagnosi s had strong associations with signs of extrovert deviant behaviour. The ri sk pattern of DP without psychiatric diagnoses was similar to that of DP wi th a psychosis but also, though to a lesser extent, to that of DP with 'oth er' psychiatric diagnosis. These similarities could be interpreted as showi ng that the diagnoses on the records of disability pensions have a low sens itivity and/or specificity or, alternatively, that the risk factors found a re risk factors for life careers steering toward a disability pension rathe r than toward the specific health outcomes per se. Conclusions: The results illustrate the importance of psychosocial factors established in late adol escence in the complex pathway of a decision of an early DP.