Antidepressant medication before and after exiting paid work: a population-based study from Sweden

Abstract Background Exiting paid work can be linked to changes in mental health. However, antidepressant medication as an indicator of mental disorder has not been studied in a population that continues working longer. We aimed to explore trajectories of antidepressant medication before and after exiting paid work, among people in paid work at least until age 66. We then examined how sociodemographic factors and prior sickness absence and disability pension (SADP) were associated with such trajectories. Methods We included all people living in Sweden 2005-2020, aged 65-70 and in paid work 2010 based on income (N = 32,849, 39% women). All participants were in paid work at least 2005-2011, exited work during 2012-2015 and were not in paid work 2016-2020. We used register microdata for five years before and five years after exiting paid work and included a range of sociodemographic factors at the exit year as well as number of SADP days/year due to mental diagnosis (ICD-10) prior to work exit. We used group-based trajectory modelling to examine developmental patterns in antidepressant medication (ATC-code N06A) and average marginal effects to study factors that were associated with each trajectory. Results A majority, 89.5% did not have any antidepressant medication during the study period. Among those with such medication, two latent trajectories were identified: 94% had constant use and 6% increasing use. Having any SADP due to mental diagnoses before work exit was the most consistent determinant of belonging to the trajectories of increasing or of constant use of antidepressant medication, even after full adjustments. Older age at work exit was associated with a lower likelihood of belonging to increasing antidepressant medication trajectory. Conclusions Exit from paid work did not result in any major changes in the developmental patterns in antidepressant medication. Prior SADP was the most consistent determinant of antidepressant medication even after exit from paid work. Key messages • Most people working until aged 66 or older had no antidepressant use and among those who did, the use was stable. Only in a small group such medication increased, already before their work exit. • Sickness absence or disability pension days with mental diagnoses before work exit was associated with both increasing and constant antidepressant medication trajectories after the work exit.