Unemployment and initiation of psychotropic medication: a case-crossover study of 2,348,552 Norwegian employees

David Gunnell, Silje Kaspersen, Kristine Pape, Solveig Ose, Johan Hakon Bjorngaard

Research output: Contribution to journalArticle (Academic Journal)peer-review

15 Citations (Scopus)
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Objectives: The study investigated initiation of psychotropic medication in relation to unemployment in the months before, during and after job loss to detect the period of greatest risk.

Methods: The Norwegian working population in 2004 (N=2 348 552) was observed from 2005 to 2010 through administrative registries linked to the Norwegian Prescription Database. A casecrossover design was used to analyse within-person relative risk of incident purchases of prescribed psychotropic drugs in relation to timing of unemployment. Control periods were defined 12, 24 and 36 months before the drug purchase. Supplementary analyses were performed on medication for cardiovascular disease, diabetes, obesity, thyroid disorder, pain and musculoskeletal conditions.

Results: Purchases of all psychotropic drugs increased 1-3 months before job loss. Antidepressants had the highest estimate in the month before job loss (odds ratio (OR) 2.68, 95% confidence intervals (CI) 2.39 to 3.01), followed by hypnotics/sedatives (OR 2.21, 95% CI 1.97 to 2.48), anxiolytics (OR 2.18, 95% CI 1.91 to 2.48) and antipsychotics (OR 2.09, 95% CI 1.76 to 2.48). Rises were greatest in males. Risk of starting psychotropic medication remained raised during a spell of unemployment, but returned to close to baseline levels following re-employment. Drugs used to treat somatic and pain conditions showed similar trends but with weaker associations.

Conclusions: Concerns about impending unemployment may influence mental health several months prior to job loss, especially around the time of notification. The clinical implications of this might be a strengthening of preventive health initiatives early in the unemployment process
Original languageEnglish
Article number726
Number of pages59
JournalOccupational and Environmental Medicine
Issue number11
Early online date14 Oct 2016
Publication statusPublished - 1 Nov 2016

Structured keywords

  • SASH


  • Depression
  • Mental Health
  • Job insecurity


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