Darlings and Disability - Perceived Health in Couples and Disability Pension Receipt

Abstract

Background In Norway, almost 10% of the working age population receive a disability pension. Spouses tend to have similar health and lifestyle, and they also tend to coordinate their retirements. Spousal similarities can be explained by similarities existing before marriage, spousal influence and shared resources. Sickness is the social role related to disease and illness, sickness is therefore also a social construct. There are thus both medical and non-medical determinants of work related disability, and there might be temporal changes in the illness experienced by people who receive a disability pension. Aims The aims of this thesis were to assess disability pension receipt in Norway in the context of the married or cohabitating couple, and to consider how the health around time of receiving a disability pension might have changed over time. Methods We conducted three studies based on the second and third wave of the Nord-Trøndelag Health Study (HUNT2 1995-97 and HUNT3 2006-08), linked to data on households and families, retirements and education from national registries. In the first study, we assessed the clustering of disability pensions received within couples, as well as the hazard of receiving a disability pension dependent on the spouse’s disability status. We adjusted for baseline health, diseases, illness, health-related behaviours and education. In the second study, we examined the associations of health, disease, illness, lifestyle and education in couples with disability pension receipt and mortality. We estimated association both within and between couples. In the third study, we examined the self-rated health, insomnia and mental symptoms of people who received a disability pension in the 1990s and 2000s and their spouses, depending on time before or after receiving a disability pension. Results In the first paper, we identified a substantial clustering of disability pensions in couples and an increased risk of receiving a disability pension for more than six years after the spouse’s disability pension for both men and women. The hazard of receiving disability pensions increased by about a third after the spouse had received a disability pension. In the second paper, we found indication of an association between the couple’s exposures and the individual’s risk of receiving a disability pension. This association appeared for poor self-rated health, illness and education, but not for somatic diseases. Such associations could indicate influence from the burden of a partner with poor health, but also shared confounding in the couple. We did not find corresponding association between poor health in the couple and the individual’s mortality. There were, however, associations between couple’s smoking and education and the individual’s mortality. In the third paper, we found a peak in prevalence of poor self-rated health around time of disability pension, and similar prevalence of poor self-rated health among those who received a disability pension in the 1990s and 2000s. Symptoms of depression peaked the year before a disability pension in the 1990s, while the prevalence was similar before and after receiving a disability pension in the 2000s. Estimated prevalence of insomnia increased between the 1990s and 2000s. On the other hand, the association between time before or after receiving a disability pension and insomnia was stronger in the 1990s compared to the 2000s. We did not find statistical evidence of associations between time before or after receiving a disability pension and the spouse’s health and illness. Conclusions We found a substantial clustering of disability pensions within couples. Some of this could be attributed to pre-existing similarities between partners. Living with an ill spouse could have a negative impact on work related disability, but we did not find that it affected all-cause mortality. A negative impact on the spouse’s health could still not explain the higher risk of receiving a disability pension when the spouse after the spouse had received a disability pension. Other contributing mechanisms could include social influence on illness behaviour and self-efficacy. Furthermore, our results indicate that the health and illness experienced by individuals who received a disability pension did not change much from the 1990s to the 2000s. This suggests that the National Labour and Welfare Administration treated requests for disability pensions in similar manners in the two time periods. However, the stress related to the disability process seemed to be lower in the 2000s compared to the 1990s. This could be due to faster case handling or fewer stigmas. Our findings of possible associations between couple’s health and individual work related disability should be examined further. In the clinical setting, spouses could be included in the discussions about opportunities and limitations regarding return-to-work.