Five-year follow-up study of disability pension rates in first-onset schizophrenia with special focus on regional differences and mortality ☆ Marjo Kiviniemi, M.H.S. a,b, ⁎ , Jaana Suvisaari, M.D., Ph.D c , Sami Pirkola, M.D., Ph.D d , Kristian Läksy, M.D., Ph.D e , Unto Häkkinen, Ph.D. c , Matti Isohanni, M.D, Ph.D. b,e , Helinä Hakko, Ph.D e a Social and Mental Health Services, City of Oulu, Finland b University of Oulu, Institute of Clinical Medicine, Psychiatry, Oulu, Finland c National Institute for Health and Welfare, Helsinki, Finland d Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland e Department of Psychiatry, Oulu University Hospital, Oulu, Finland Received 15 March 2011; accepted 27 May 2011 Abstract Objective: To evaluate the rate and regional determinants of disability pension in first-admission schizophrenia. In addition, we investigated whether patients with disability pension had increased mortality rates during follow-up. Method: A nationwide register-based 5-year follow-up study of all patients with onset of schizophrenia between 1998 and 2001 (n=3,875). Results: A total of 1944 (50.2%) first-onset schizophrenia patients retired on disability pension during the 5-year follow-up. Males retired on pension at an earlier age and more often than females. Regional disability pension rates and retirement times for schizophrenia varied between hospital districts. Patients on disability pension had lower overall and suicide mortality, and they had less physical illness, depression and more psychotropic medication use than patients without disability pension. In regions with a short median time from onset time to retirement, there was significantly higher regional overall mortality and suicide mortality. Disability pension rates were also higher in regions with high involuntary treatment rate. Conclusion: Half of the schizophrenia patients were pensioned off in 5 years. Lower mortality, especially suicide mortality among disability pensioners, suggests that the decision on a permanent disability pension, indicating for its part the activation of the service system, might be a relief to schizophrenic patients, helping them cope with illness. The retirement process has regional differences, which may be caused by the regional nature of treatment and resources. © 2011 Elsevier Inc. All rights reserved. Keywords: Schizophrenia; Disability pension; Regional differences; Mortality 1. Introduction Schizophrenia is a severe psychiatric disorder, which often leads to a progressive decline in cognitive and psychosocial functioning and consequent work disability [1]. Nearly 60% of schizophrenic patients in Finland are pensioned an average of 10 years after disease onset [2]. They are 4.5 times more likely to be disabled and to receive disability payments than persons without this disorder [3]. Negative symptoms, early onset and long duration of untreated psychosis are predictors of disability [4]. Also worth noting is the finding that the course and outcomes of schizophrenia vary between countries, as does the outcome of occupational status [5]. Generally, disability pension and unemployment status are associated with weakened social competence and decreased quality of life. Unemployment status also causes economical losses and increases patients' need for health services [3,6,7]. Reversely, being employed is associated with a better quality of life and self-esteem in schizophrenia Available online at www.sciencedirect.com General Hospital Psychiatry 33 (2011) 509 – 517 ☆ Conflict of interest: None declared. ⁎ Corresponding author. Social and Mental Health Services, P.O. Box 8, 90015 City of Oulu, Finland, USA. Tel.: +1 358 8 558 558 00; fax: +1 358 8 5584 6068. E-mail address: marjo.kiviniemi@oulu.fi (M. Kiviniemi). 0163-8343/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.genhosppsych.2011.05.017