Rehabilitation trends before depression-related pension application: a registry study from Finland

Abstract Background Major depressive disorder (MDD) is the leading cause of disability worldwide and the most common single diagnosis behind disability pension in Finland, with a rising trend. Earlier studies suggest inadequate rehabilitation prior to pension applications. In response, various initiatives have aimed to improve rehabilitation. We examined trends in rehabilitation among individuals applying for a disability pension due to depression from the Social Insurance Institution of Finland (Kela). Methods This retrospective register-based study included 30,105 applicants for disability pension due to depression, using data from the Kela. Rehabilitation use during the year preceding application from 2010 to 2019 was analysed using linear regression. Interactions between time trends and population groups based on age and sex were assessed with analysis of covariance. Results The proportion of applicants receiving any Kela-funded rehabilitation increased from 17.3% in 2010 to 24.4% in 2019, mainly due to increased psychotherapy use (from 6.1% to 13.5%). Vocational rehabilitation also rose modestly (5.4% to 8.4%), while other medical rehabilitation declined (7.2% to 5.5%). Annually, estimated average psychotherapy use increased by 0.90 percentage points and vocational rehabilitation by 0.31 percentage points, both statistically significant (p < 0.001). A significant interaction in psychotherapy trends by sex and age based groups was found (p = 0.012), but not for vocational rehabilitation (p = 0.16). Psychotherapy and vocational rehabilitation were most common among females under 40, while medical rehabilitation was highest among females aged 40 or over. Males aged 40 years or over had the lowest psychotherapy use. Conclusions Psychotherapy use among disability pension applicants due to depression has increased, particularly among younger females. However, a majority, especially older males, still receive no rehabilitation. Key messages • The share of disability pension applicants who received psychotherapy more than doubled in 2010–2019, yet the majority still received no rehabilitation during the year before applying. • Rehabilitation use varied by age and sex: females under 40 received most psychotherapy, while males aged 40 or over received the least.