Psychosocial work environment and the risk of disability pension among 1.2 million individuals with and without psychiatric diagnoses: a Danish nationwide register-based cohort study

PURPOSE: The purpose of this study was to investigate whether psychosocial working conditions contribute to the risk of disability pension (DP) before age 45, particularly among younger employees with psychiatric disorders, and to assess whether these associations differ by psychiatric diagnosis status. METHODS: We used data from the Danish Work Life Course Cohort, including 1,214,772 employees entering the labour market between 1995 and 2015. Psychosocial working conditions were assessed annually using job exposure matrices and included quantitative demands, influence at work, job strain, emotional demands, and work-related violence. Psychiatric diagnoses (ICD-10: F00-F99) and DP were identified from national registers. Cox proportional hazards models were applied using calendar time as the underlying time scale, adjusting for age and covariates. Analyses were stratified by psychiatric diagnostic status and sex, and interactions tested. RESULTS: DP incidence was higher among employees with hospital-registered psychiatric diagnoses (48.4 and 64.2 per 10,000 person-years among women and men) than among those without (5.6 and 5.0). Among employees with psychiatric diagnoses, psychosocial working conditions showed weaker or no associations with DP. In contrast, among those without psychiatric diagnoses, several working conditions were associated with DP, particularly low influence at work (hazard ratio 1.58 (95% CI 1.36-1.83) for women and 1.69 (1.43-2.00) for men). Interaction analyses consistently supported differences in these associations by psychiatric diagnostic status. CONCLUSIONS: Psychosocial working conditions were associated with DP before age 45, with more pronounced associations among individuals without psychiatric diagnoses and weaker or no associations among those with such diagnoses.