Mental health treatment of employed people varies according to demographic group

Finnish Institute of Occupational Health media release 10 August 2023

The aim of statutory rehabilitative psychotherapy services is to support work ability and capacity for studying and to prevent mental health-related work disability. The use of the services has multiplied in the 2010s.

The Finnish Institute of Occupational Health’s research project explored the development of the work disability of those who used psychotherapy services. The indicators for work disability comprised of the number of sickness absences due to mental health issues and retirements on disability pension. Differences between various demographic groups, i.e. the significance of age and place of residence, were studied. In addition, the link between the level of income and the use of rehabilitative psychotherapy and mood stabilizers was also explored.

Evidence of rehabilitative psychotherapy being associated with reduced mental health-related work disability issues had already been observed at the population level earlier.  According to the comparison in the recently released study, among the employed population, women with high income are more likely to use rehabilitative psychotherapy services than those with low income. A similar difference was not observed among men.

“In the early 2010s, the use of mood stabilizers was more common among people with high income in Finland. However, the trend changed and, in 2019, the use of mood stabilizers was a more popular method of treatment among those with low income,” says the Finnish Institute of Occupational Health’s Research Professor Ari Väänänen.

“The costs of psychotherapy and medication are at completely different levels: you can get medicine for a year for the price of one or two psychotherapy appointments. The results raise the question of what kind of help can individuals get for their symptoms,” says the Finnish Institute of Occupational Health’s Senior Specialist Sanna Selinheimo.

Effects of rehabilitative psychotherapy on work disability differ by demographic group

The register study monitored the development paths of work disability related to depression or anxiety for five years. The effects of psychotherapy on work disability varied.

The majority of those who began rehabilitative psychotherapy were not eligible for the Kela sickness allowance due to their disability (more than 10 days of sickness absence) prior to the psychotherapy and the situation remained unchanged during therapy.

About 10% of the subjects showed clear reduction of work disability after beginning psychotherapy.

However, less than 10% of the subjects had a high level of work disability prior to psychotherapy and the therapy did not improve the situation. Higher probability of belonging to the group of long-term work disability was associated with higher age, being female, manual labour and living in Eastern or Northern Finland. The prognosis for work ability was poorer in the case of multiple factors coexisting.

“The research results show that the benefits of psychotherapy are not realized equally in different professional positions and regions.  If a mental health challenge affects one’s ability to cope at work, the workplace needs to be flexible. Are the solutions that support work ability universally possible in all jobs? In some cases, the suitability of rehabilitative psychotherapy as a mode of treatment should be re-evaluated,” says Sanna Selinheimo.

“The distances in sparsely populated areas might make it more difficult for rehabilitative psychotherapy to be impactful. Older employees might have multiple diseases and the overall health status affects their chances of benefitting from mental health rehabilitation,” adds Selinheimo.

Study: Use of rehabilitative psychotherapy by demographic group and region in Finland

• The two research projects of the Finnish Institute of Occupational Health examine the use of rehabilitative psychotherapy by demographic group and region and the effectiveness of therapy in terms of employment, earned income and mental health in the working-age population. The projects are based on the The rise of mental vulnerability in work life register data. The research projects were funded by Kela and the Finnish Institute of Occupational Health.
• The subjects of the study on the development paths of work disability included 3,605 employed people who began rehabilitative psychotherapy between 2011 and 2014. These subjects were monitored one year before and four years after beginning therapy.
• The comparison on income brackets monitored the use of rehabilitative psychotherapy and mood stabilizers of a total of 736,613 employed people between 2011 and 2019. The population was divided into four income brackets for this study.
• The studies are based on a random sample of 33% of the working-age population (18–65-year-olds).

Learn more

• Psychotherapy and change in mental health-related work disability: a prospective Finnish population-level register-based study with a quasi-experimental design | Journal of Epidemiology & Community Health (bmj.com)
• Income gradient in psychotherapy use and psychotropic drug purchases: A longitudinal register study in Finnish employed population - ScienceDirect
• The association of sociodemographic characteristics with work disability trajectories during and following long-term psychotherapy: a longitudinal register study | SpringerLink

Further information

• Senior Specialist Sanna Selinheimo, Finnish Institute of Occupational Health, Sanna.Selinheimo@ttl.fi, tel. +358 (0)43 825 0397
• Research Professor Ari Väänänen, Finnish Institute of Occupational Health, Ari.Vaananen@ttl.fi, tel. +358 (0)50 511 0530