Zusammenfassung
Der Anteil psychischer Erkrankungen in den Verfahren zur Berentung aufgrund verminderter Erwerbsfähigkeit ist seit Jahren steigend. Modernere Behandlungsmaßnahmen scheinen diesen Trend nicht zu beeinflussen. Es gibt relativ umfangreiches wissenschaftliches Material über Risikofaktoren für die Entstehung einer Depression. Wenig Informationen existieren allerdings darüber, welche depressiv erkrankten Menschen so schwer und chronisch erkranken, dass eine Invalidität eintritt und ob diese gemeinsame Eigenschaften aufweisen, deren Kenntnis einen Ansatz zu einer gezielteren und damit potenziell besseren Behandlung ergibt.
Abstract
Objective To bring the data from the Federal German Health report about work disability and pensioning into context with current knowledge about the course and etiology of depression. Methods The report data about first-time recipients of a disability pension were analysed by year, illness and gender. Resulting data were interpreted and were compared with international publications. Results The percentage of applications for disability pensions due to psychiatric illnesses have been rising steadily for two decades. Among these, depression (31 %) and neurotic disorders (23 %) are most frequently responsible, while most other causes of disability have been declining. Current treatment of depressive disorders does not seem to have had any effect in terms of reducing the number of disabled persons per year. Conclusions Although the risk factors associated with developing a depressive disorder have been extensively studied, data explaining the progression into disability is scarce but essential. More research in the psychodynamics of depression and work participation might be helpful.
Schlüsselwörter
affektive Erkrankungen - Invalidität - Berentung
Key words
affective disorders - occupational disability - pensioning
Literatur
1
Bland R C.
International health and psychiatry.
Can J Psychiatry.
1996;
41
11-15
2
Mathers C D, Loncar D.
Projections of Global Mortality and Burden of Disease from 2002 to 2030.
PLoS Med.
2006;
3 (11)
442
3 Zechmeister I. Financing mental health systems. - Austria. London; Mental Health Economics European Network 2004
4 Wynne R, MacAnaney D. Employment and disability (128): Back to work strategies. Dublin; European Foundation for Work and Living Conditions 2004
5
Brugha T, Bebbington P E, MacCarthy B, Potter J, Sturt E, Wykes T.
Social networks, social support and the type of depressive illness.
Acta Psychiatr Scand.
1987;
76
664-673
6 Goldberg D P, Huxley P. Common Mental Disorders: A Biosocial Model. London; Routledge 1996
7
Beaudet M P.
Depression.
Health Reports.
1996;
7
11-24
8
Bijl R V, Ravelli A, van Zerssen G.
Prevalence of psychiatric disorder in the general population: results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS).
Soc Psychiatry Psychiatr Epidemiol.
1998;
33 (12)
587-595
9
Bebbington P, Dunn G, Jenkins R, Lewis G, Brugha T, Farrell M, Meltzer H.
The influence of age and sex on the prevalence of depressive conditions: report from the National Survey of Psychiatric Morbidity.
Int Rev Psychiatry.
2003;
15
74-83
10
Lorant V, Deliege D, Eaton W, Robert A, Philippot P, Ansseau M.
Socioeconomic inequalities in depression: a meta-analysis.
Am J Epidemiology.
2003;
157
98-112
11 Melzer D, Fryers T, Jenkins R. Social Inequalities and the Distribution of the Common Mental Disorders. Hove and New York; Psychology Press Ltd 2004
12
Villamil E, Huppert F A, Melzer D.
Low prevalence of depression and anxiety is linked to statutory retirement ages rather than personal work exit: a national survey.
Psychol Med.
2006;
36 (7)
999-1009
13 Statistisches Bundesamt, Robert Koch-Institut (Hrsg) .Die Gesundheitsberichterstattung des Bundes. Bonn, Berlin; 2007
14
Paykel E S, Brugha T, Fryers T.
Size and burden of depressive disorders in Europe.
Eur Neuropsychopharmacol.
2005;
15 (4)
411-423
15
Wittchen H U, Pittrow D.
Prevalence, recognition and management of depression in primary care in Germany: the Depression 2000 study.
Hum Psychopharmacol.
2002;
17, Suppl 1
S1-11
16
Kessler R C, Berglund P, Demler O, Jin R, Koretz D, Merikangas K R, Rush A J, Walters E E, Wang P S.
The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R).
JAMA.
2003;
289 (23)
3095-3105
17
Nuyen J, Schellevis F G, Satariano W A, Spreeuwenberg P M, Birkner M D, van den Bos G A, Groenewegen P P.
Comorbidity was associated with neurologic and psychiatric diseases: a general practice-based controlled study.
J Clin Epidemiol.
2006;
59 (12)
1274-1284
18
Filipčić I, Popović-Grle S, Marčinko D, Bašić S, Hotujac L, Pavičić F, Hajnšek S, Aganović I.
Screening for depression disorders in patients with chronic somatic illness.
Collegium Antropologicum.
2007;
31 (1)
139-143
19
Han B.
Depressive symptoms and self-rated health in community-dwelling older adults: A longitudinal study.
J Am Geriatr Soc.
2002;
50 (9)
1549-1556
20
Kessler R C, Barber C, Birnbaum H G. et al .
Depression in the workplace: effects on short-term disability.
Health Aff (Millwood).
1999;
18
163-171
21
Lerner D, Adler D A, Chang H. et al .
Unemployment, job retention, and productivity loss among employees with depression.
Psychiatr Serv.
2004;
55
1371-1378
22
Spijker J, Graaf R, Bijl R V, Beekman A T, Ormel J, Nolen W A.
Functional disability and depression in the general population. Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS).
Acta Psychiatr Scand.
2004;
110
208-214
23
Rytsälä H J, Melartin T K, Leskelä U S, Sokero T P, Lestelä-Mielonen P S, Isometsä E T.
Predictors of long-term work disability in Major Depressive Disorder: a prospective study.
Acta Psychiatr Scand.
2007;
115
206-213
24
Rytsälä H J, Melartin T K, Leskelä U S, Sokero T P, Lestelä-Mielonen P S, Isometsä E T.
Functional and work disability in major depressive disorder.
J Nerv Ment Dis.
2005;
193
189-195
25
Rabkin J G, McElhiney M, Ferrando S J, Van Gorp W, Lin S H.
Predictors of employment of men with HIV/AIDS: a longitudinal study.
Psychosom Med.
2004;
66
72-78
26
Isometsä E T, Katila H, Aro T.
Disability pension for major depression in Finland.
Am J Psychiatry.
2000;
157
1869-1872
27
Sorvaniemi M, Helenius H, Salokangas R K.
Factors associated with being granted a pension among psychiatric outpatients with major depression.
J Affect Disord.
2003;
75
43-48
28 Simon H. Allg Wschr Psychiatr 87 (1927), 90 (1929).
29
Prokop H.
Erhaltung der Arbeitsfähigkeit oder Frühberentung von psychisch Kranken.
Lebensversicherungsmedizin.
1979;
2
49-52
30
Apfel T, Riecher-Rossler A.
Werden psychisch Kranke zu schnell in die Rente „abgeschoben”?.
Psychiat Prax.
2005;
32 (4)
172-176
31
Schomerus G, Spindler P, Broker F.
Psychiater als Türsteher vor den Töpfen des Sozialsstaats?.
Psychiat Prax.
2005;
32 (4)
161-162
32
Watzke S, Galvao A, Gawlik B, Huhne M, Brieger P.
Maßnahmenabbrecher in der beruflichen Rehabilitation psychisch kranker Menschen.
Psychiat Prax.
2006;
33 (3)
124-131
Dr. Felix Wedegärtner, MPH
Medizinische Hochschule Hannover, Abteilung Klinische Psychiatrie und Psychotherapie, OE 7117
Carl-Neuberg-Straße 1
30625 Hannover
eMail: wedegaertner.felix@mh-hannover.de