Onset age and 40-year employment outcomes in psychoses: findings from the Northern Finland Birth Cohort 1966

Abstract Purpose There is limited knowledge on how age at onset relates to long-term employment in psychosis, accounting for premorbid employment. We examined whether onset age is associated with employment over a 40-year follow-up, as well as employment status two years before psychosis onset, five years after onset, and at the end of follow-up (age 57). Methods We used national register data to identify participants of the Northern Finland Birth Cohort 1966 (NFBC1966) with psychosis ( n = 225) and categorized them into three onset age groups. We analyzed 40-year employment data (1983–2023) and compared the proportion of time in employment across the follow-up period between onset age groups using nonparametric tests. We used binary logistic regression to examine whether onset after age 21 was associated with employment at selected time points, adjusting for covariates including premorbid employment. Results Individuals with earlier onset spent a lower proportion of time in employment during the follow-up. Later onset was associated with being employed at the 5-year follow-up, but this association became nonsignificant after adjustment. Having children was associated with being employed at all time-points. Those with earlier onset were less often employed before psychosis onset. Being employed before psychosis onset increased the odds of being employed at follow-up. Conclusion Later onset is associated with a higher proportion of time in employment during a 40-year follow-up and being employed before psychosis onset. Being employed before psychosis onset emerged as a strong predictor of later employment outcomes.