Sustainable working life trajectories among Swedish twins with and without common mental disorders

Abstract Background Research is scarce on factors influencing a sustainable working life with few or no interruptions from paid work due to unemployment, sick leave or disability pension among those with common mental disorders (CMDs). CMDs are prevalent in both Sweden and elsewhere and a large part of sick leave spells are currently due to CMDs. We aimed to identify patterns of sustainable working life among twin pairs discordant for CMDs and investigate the role of sociodemographic factors for the resulting patterns. Methods CMD-discordant twin pairs (n = 5529), aged 18-59 years at baseline in 1998 (50% women), were followed annually for work life status using Swedish national registers until 2020. Group-based trajectory modelling was applied to identify distinct trajectory groups among those with and without CMDs. Multinominal regression models were run with age, sex, marital status, education, occupational sector, and residential region for each trajectory group using the largest trajectory group as a reference to estimate Risk Ratios (RR) with 95% Confidence Intervals (CI). Results Three trajectories of working life were identified for those with CMDs, while their co-twins without CMDs followed two trajectories. Sustainable working life was the largest trajectory group in both, 71% of those with CMDs; 83% of those without CMDs. Among those with CMDs, 14.5% showed a decreasing sustainable working life trajectory. High education was associated with lower, while being single (with or without children) with higher, likelihood of belonging to trajectories with more interruptions in paid work. Conclusions A small group of individuals with CMDs tend to have a decreasing or no sustainable working life over time, in contrast to those without CMDs. Although a sustainable working life was prevalent regardless of CMDs, those with CMDs should be identified early for preventive actions and support to remain in paid work. Key messages • The study highlights the importance of early identification of individuals with CMDs to provide timely preventive actions and support to help maintain and reduce interruptions in working life. • Public health initiatives that focus on providing targeted support to high-risk groups, that is individuals with CMDs who are single or have low education, could enhance their work sustainability.