Previous research has shown that people with disabilities are disproportionately vulnerable to symptoms of psychological distress after exposure to armed conflict. Past work has also shown that individuals displaced by conflict are at heightened risk of post-traumatic stress. Using a national online sample of Ukrainians in the early weeks of the 2022 Russian invasion, we aim to examine associations between functional disability and symptoms of post-traumatic stress.

We examined the association between levels of functional disability in the Ukrainian population and symptoms of post-traumatic stress during the 2022 Russian invasion of Ukraine. We analysed data from a national sample of 2000 participants from across this country, assessing disability using the 12-item World Health Organization Disability Assessment Schedule (WHODAS-12)(six domains of disability) and the International Trauma Questionnaire assessment of post-traumatic stress disorder (PTSD) symptomatology according to the Eleventh Edition of The International Classification of Diseases (ICD-11). Moderated regression examined the impact of displacement status on the disability–post-traumatic stress relationship.

Different domains of disability predicted post-traumatic stress symptoms (PTSSs) to varying extents, with overall disability score significantly associated with PTSSs. This relationship was not moderated by displacement status. Consistent with previous research, females reported higher levels of post-traumatic stress.

In a study of a general population during a time of armed conflict, individuals with more severe disabilities were at greater risk of PTSSs. Psychiatrists and related professionals should consider pre-existing disability as a risk factor for conflict-related post-traumatic stress.

We examine the association between high ambient temperature and acute mental health-related healthcare encounters in New York City for children, adolescents and young adults.

This case-crossover study included emergency department (ED) visits and hospital encounters with a primary diagnosis of any mental health disorder during warm-season months (June–August) in New York City from 2005 to 2011 from patients of three age groups (6–11, 12–17 and 18–25 years). Using a distributed lag non-linear model over 0–5 lag days, by fitting a conditional logistic regression for each age group, we calculated the cumulative odds ratios of mental health encounters associated with an elevated temperature. Analyses were stratified by race/ethnicity, payment source and mental health categories to elucidate vulnerable subpopulations.

In New York City, there were 82,982 mental health–related encounters for young people aged 6 to 25 years during our study period months. Elevated temperature days were associated with higher risk of mental health–related ED and hospital encounters for the 6- to 11-year-olds (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.13–1.46), for the 12- to 17-year-olds (OR: 1.17, 95% CI: 1.09–1.25) and for the 18- to 25-year-olds (OR: 1.09, 95% CI: 1.04–1.15). Children with reaction disorders, adolescents with anxiety and bipolar disorders, young adults with psychosis and reaction disorders and Black and non-Hispanic children and adolescents showed vulnerability to elevated temperature.

We found that elevated ambient temperatures were associated with acute mental health ED or hospital encounters across childhood, adolescence and young adulthood.

Previous epidemiological evidence identified a concerning increase in behavioural problems among young children from 1997 to 2008 in Brazil. However, it is unclear whether behavioural problems have continued to increase, if secular changes vary between sociodemographic groups and what might explain changes over time. We aimed to monitor changes in child behavioural problems over a 22-year period from 1997 to 2019, examine changing social inequalities and explore potential explanations for recent changes in behavioural problems between 2008 and 2019.

The Child Behaviour Checklist was used to compare parent-reported behavioural problems in 4-year-old children across three Brazilian birth cohorts assessed in 1997 (1993 cohort, n = 633), 2008 (2004 cohort, n = 3750) and 2019 (2015 cohort, n = 577). Response rates across all three population-based cohorts were over 90%. Moderation analyses tested if cross-cohort changes differed by social inequalities (demographic and socioeconomic position), while explanatory models explored whether changes in hypothesized risk and protective factors in prenatal development (e.g., smoking during pregnancy) and family life (e.g., maternal depression and harsh parenting) accounted for changes in child behavioural problems from 2008 to 2019.

Initial increases in child behavioural problems from 1997 to 2008 were followed by declines in conduct problems (mean change = −2.75; 95% confidence interval [CI]: −3.56, −1.94; P < 0.001), aggression (mean change = −1.84; 95% CI: −2.51, −1.17; P < 0.001) and rule-breaking behaviour (mean change = −0.91; 95% CI: −1.13, −0.69 P < 0.001) from 2008 to 2019. Sex differences in rule-breaking behaviour diminished during this 22-year period, whereas socioeconomic inequalities in behavioural problems emerged in 2008 and then remained relatively stable. Consequently, children from poorer and less educated families had higher behavioural problems, compared to more socially advantaged children, in the two more recent cohorts. Changes in measured risk and protective factors partly explained the reduction in behavioural problems from 2008 to 2019.

Following a rise in child behavioural problems, there was a subsequent reduction in behavioural problems from 2008 to 2019. However, social inequalities increased and remained high. Continued monitoring of behavioural problems by subgroups is critical for closing the gap between socially advantaged and disadvantaged children and achieving health equity for the next generation.

Suicidal ideation constitutes a central element of most theories of suicide and is the defining facet separating suicide from other causes of death such as accidents. However, despite a high worldwide prevalence, most research has focused on suicidal behaviours, such as completed suicide and suicide attempts, while the greater proportion who experienced ideation, which frequently precedes suicidal behaviour, have received much less attention. This study aims to examine the characteristics of those presenting to EDs with suicidal ideation and quantify the associated risk of suicide and other causes of death.

Retrospective cohort study was performed based on population-wide health administration data linked to data from the Northern Ireland Registry of Self-Harm and centrally held mortality records from April 2012 to December 2019. Mortality data, coded as suicide, all-external causes and all-cause mortality were analysed using Cox proportional hazards. Additional cause-specific analyses included accidental deaths, deaths from natural causes and drug and alcohol-related causes.

There were 1,662,118 individuals aged over 10 years, of whom 15,267 presented to the ED with ideation during the study period. Individuals with ideation had a 10-fold increased risk of death from suicide (hazard ratio [HRadj] = 10.84, 95% confidence interval [CI] 9.18, 12.80) and from all-external causes (HRadj = 10.65, 95% CI 9.66, 11.74) and a threefold risk of death from all-causes (HRadj = 3.01, 95% CI 2.84, 3.20). Further cause-specific analyses indicated that risk of accidental death (HRadj = 8.24, 95% CI 6.29, 10.81), drug-related (HRadj = 15.17, 95% CI 11.36, 20.26) and alcohol-related (HRadj = 10.57, 95% CI 9.07, 12.31) has also significantly increased. There were few socio-demographic and economic characteristics that would identify which of these patients are most at risk of suicide or other causes of death.

Identifying people with suicidal ideation is recognized to be both important but difficult in practice; this study shows that presentations to EDs with self-harm or suicide ideation represent an important potential intervention point for this hard-to-reach vulnerable population. However, and unlike individuals presenting with self-harm, clinical guidelines for the management and recommended best practice and care of these individuals are lacking. Whilst suicide prevention may be the primary focus of interventions aimed at those experiencing self-harm and suicide ideation, death from other preventable causes, especially substance misuse, should also be a cause of concern.

Intimate partner violence (IPV) is a major global public health problem. Although IPV is known to be frequent and perpetration and victimisation often co-occur, large representative samples assessing both, male and female IPV perpetration and victimisation and overlaps are missing to date. Thus, we aimed to assess victimisation and perpetration and its overlap in physical, sexual, psychological and economic IPV in a representative sample of the German population.

We conducted a cross-sectional, observational study in Germany from July to October 2021. Using different sampling steps including a random route procedure, a probability sample of the German population was generated. The final sample consisted of 2503 persons (50.2% female, mean age: 49.5 years). Participants were asked about socio-demographic information in a face-to-face interview and experience of physical, psychological, sexual and economic IPV using a questionnaire.

A significant proportion of persons in Germany reporting IPV are both perpetrator and victim for each IPV form. The biggest overlap between perpetration and victimisation was seen for psychological IPV. Major risk factors for IPV perpetration only were male gender and adverse childhood experiences (ACEs) while major risk factors for IPV victimisation only comprised of female gender, low household income and ACEs. In the perpetration and victimisation group, gender differences were less significant; older age and lower household income did increase the likelihood of combined perpetration and victimisation.

We have identified a significant overlap of perpetration and victimisation of IPV in the German population for men and women. However, men are at much higher risk to perpetrate IPV without being a victim. Further research and the development of adapted approaches for contexts of overlapping IPV are necessary.

Intimate partner violence (IPV) is a public health challenge negatively affecting victims’ health. Telomere length (TL), a marker for biological ageing, might be reflective of the mechanisms through which IPV leads to adverse health outcomes. The objective of the current study was to explore the association between IPV and leucocyte TL.

We conducted an analysis using a subset of the UK Biobank (N = 144 049). Physical, sexual and emotional IPV were reported by the participants. DNA was extracted from peripheral blood leukocytes. TL was assayed by quantitative polymerase chain reaction. We used multivariable linear regressions to test the associations between IPV and TL adjusted for age, sex, ethnicity, deprivation, education, as well as symptoms of depression and post-traumatic stress disorder in a sensitivity analysis.

After adjusting for sociodemographic factors, any IPV was associated with 0.02-s.d. shorter TL (β = −0.02, 95% CI −0.04 to −0.01). Of the three types of IPV, physical violence had a marginally stronger association (β = −0.05, 95% CI −0.07 to −0.02) than the other two types. The associations of numbers of IPV and TL showed a dose–response pattern whereby those who experienced all three types of IPV types had the shortest TL (β = −0.07, 95% CI −0.12 to −0.03), followed by those who experienced two types (β = −0.04, 95% CI −0.07 to −0.01). Following additional adjustment for symptoms of depression and PTSD, the associations were slightly attenuated but the general trend by number of IPVs remained.

Victims of IPV, particularly those exposed to multiple types of IPVs, had shorter TL indicative of accelerated biological ageing. Given that all three types of IPV are linked to TL, clinical practitioners need to comprehensively identify all types of IPV and those who received multiple types. Further studies should explore the association of violence with changes in TL over time, as well as to which extent biological ageing is a mechanistic factor.

We aimed to assess the cost-effectiveness of psychiatric advance directives (PAD) facilitated by peer workers (PW-PAD) in the management of patients with mental disorders in France.

In a prospective multicentre randomized controlled trial, we randomly assigned adults with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition diagnosis of schizophrenia, bipolar I disorder or schizoaffective disorders, who were compulsorily hospitalized in the past 12 months, to either fill out a PAD form and meet a peer worker for facilitation or receive usual care. We assessed differences in societal costs in euros (€) and quality-adjusted life-years (QALYs) over a year-long follow-up to estimate the incremental cost-effectiveness ratio of the PW-PAD strategy. We conducted multiple sensitivity analyses to assess the robustness of our results.

Among the 394 randomized participants, 196 were assigned to the PW-PAD group and 198 to the control group. Psychiatric inpatient costs were lower in the PW-PAD group than the control group (relative risk, −0.22; 95% confidence interval, [−0.33 to −0.11]; P < 0.001), and 1-year cumulative savings were obtained for the PW-PAD group (mean difference, −€4,286 [−4,711 to −4,020]). Twelve months after PW-PAD implementation, we observed improved health utilities (difference, 0.040 [0.003–0.077]; P = 0.032). Three deaths occurred. QALYs were higher in the PW-PAD group (difference, 0.045 [0.040–0.046]). In all sensitivity analyses, taking into account sampling uncertainty and unit variable variation, PW-PAD was likely to remain a cost-effective use of resources.

PW-PAD was strictly dominant, that is, less expensive and more effective compared with usual care for people living with mental illness.

Cardiovascular diseases (CVDs) are the leading cause of deaths globally. Mortality and incidence of CVDs are significantly higher in people with mood disorders. About 81.1% of CVD patients were reported with comorbidities in 2019, where the second most common comorbidity was due to major depressive disorder (MDD). This study, therefore, aimed to evaluate the genetic correlation between CVDs and mood disorders by using data from the UK Biobank towards understanding the influence of genetic factors on the comorbidity due to CVDs and mood disorders.

The UK Biobank database provides genetic and health information from half a million adults, aged 40–69 years, recruited between 2006 and 2010. A total of 117,925 participants and 6,128,294 variants were included for analysis after applying exclusion criteria and quality control steps. This study focused on two CVD phenotypes, two mood disorders and 12 cardiometabolic-related traits to conduct association studies.

The results indicated a significant positive genetic correlation between CVDs and overall mood disorders and MDD specifically, showing substantial genetic overlap. Genetic correlation between CVDs and bipolar disorder was not significant. Furthermore, significant genetic correlation between mood disorders and cardiometabolic traits was also reported.

The results of this study can be used to understand that CVDs and mood disorders share a great deal of genetic liability in individuals of European ancestry.

Previous observational studies have reported potential associations among attention-deficit/hyperactivity disorder (ADHD), obesity, and diabetes (including type 1 and type 2 diabetes mellitus [T1DM/T2DM]). However, whether the association between ADHD and diabetes is mediated by obesity is unknown.

With two-sample Mendelian randomization, we analysed the causal effect of ADHD on T1DM and T2DM and six obesity-related traits [including body mass index, waist circumference (WC), hip circumference, waist-to-hip ratio (WHR), body fat percentage and basal metabolic rate] and the causal effect of these obesity-related traits on T1DM/T2DM. Finally, with multivariable Mendelian randomization, we explored and quantified the possible mediation effects of obesity-related traits on the causal effect of ADHD on T1DM/T2DM.

Our results showed that ADHD increased the risk of T2DM by 14% [odds ratio (OR) = 1.140, 95% confidence interval (CI) = 1.005–1.293] but with no evidence of an effect on T1DM (OR = 0.916, 95% CI = 0.735–1.141, P = 0.433.). In addition, ADHD had a 6.1% increased causal effect on high WC (OR = 1.061, 95% CI = 1.024–1.099, P = 0.001) and an 8.2% increased causal effect on high WHR (OR = 1.082, 95% CI = 1.035–1.131, P = 0.001). In addition, a causal effect of genetically predicted high WC (OR = 1.870, 95% CI = 1.594–2.192, P < 0.001) on a higher risk of T2DM was found. In further analysis, WC mediated approximately 26.75% (95% CI = 24.20%–29.30%) of the causal association between ADHD and T2DM.

WC mediates a substantial proportion of the causal effect of ADHD on the risk of T2DM, which indicated that the risk of T2DM induced by ADHD could be indirectly reduced by controlling WC as a main risk factor.

Children of incarcerated mothers are at increased risk of experiencing multiple adversity such as poverty, mental illness and contact with child protection services (CPS), including being taken into out of home care (OOHC). However, little is known about whether these children are at increased risk of suicide or self-harm compared to children not exposed to maternal incarceration or about the factors that may contribute to this. We aimed to investigate differences in the risk of suicide and self-harm between children exposed to maternal incarceration and those not exposed and examine how socio-demographic factors, maternal mental illness and CPS contact (with or without OOHC) may affect these outcomes.

We used a retrospective matched cohort study design, comparing 7674 children exposed to maternal incarceration with 7674 non-exposed children. We used multivariable Cox proportional hazards regression to compare the risk of suicide and self-harm between exposed and non-exposed groups, controlling for geographical remoteness, CPS contact and maternal mental illness.

There was no significant difference in the rate of suicide (rate ratio [RR] = 1.49; 95% confidence interval [CI]: 0.78, 2.87) or risk of suicide (adjusted hazard ratio [aHR] = 0.92; 95% CI: 0.43, 1.96) between the two groups. However, the exposed group had a significantly higher rate of self-harm (RR = 2.83; 95% CI: 2.50, 3.21) and a significantly higher risk of self-harm (aHR = 1.74; 95% CI: 1.45, 2.09) compared to those non-exposed. CPS contact with or without OOHC was independently associated with an increased risk of self-harm for both groups.

Children exposed to maternal incarceration are at an increased risk of self-harm and should be prioritized to receive targeted, multimodal support that continues after the mother’s release from prison. The association between CPS contact and self-harm warrants further research.

Depression is among the main contributors to older adults’ mental health burden. Retirement, one of the major life transitions, has been claimed to influence mental health substantially. Following up on a previous meta-analysis, the study aims to assess from a longitudinal perspective short- and long-term impacts of transitioning to retirement on depression risk and suicidality in older adults across Europe.

We conducted a longitudinal study using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), collected between 2004 and 2020 in 27 European countries plus Israel. To estimate relative risks (RR) and 95% confidence intervals (95% CIs) for depression and suicidality at seven time intervals before and after retirement, we fitted adjusted generalized estimating equation models for repeated measures.

We included 8,998 individuals employed at baseline and retired at follow-up (median follow-up time: 9 years; maximum: 16 years). Compared to the year of retirement, the risk of depression was 11% lower in the following year (RR 0.89; 95% CI 0.81–0.99), 9% lower after 2 years (RR 0.91; 95% CI 0.82–1.00) and after 3 years (RR 0.91; 95% CI 0.81–1.01). Significant estimates remained among females, married individuals, those with an intermediate or higher level of education, former manual workers and those who retired at or before their country’s median retirement age. A significant increase in depressive symptoms emerged from the tenth year after retirement among former non-manual workers (RR 1.21; 95% CI 1.05–1.40) and late retirees (RR 1.37; 95% CI 1.16–1.63). No heterogeneity emerged among strata. As for suicidality, we reported an increase in risk only 5 years or more after retirement, namely +30% 5–9 years after retirement (RR 1.30; 95% CI 1.04–1.64) and +47% 10 or more years after retirement (RR 1.47; 95% CI 1.09–1.98). Sensitivity analyses excluding subjects who reported a diagnosis of depression over the study period and those retirees who declared to receive a disability pension confirmed the results obtained in the overall analysis.

Longitudinal adjusted data suggest an independent effect of retiring associated with a reduction in depression and suicidality risk in the short run, with its effect decreasing in the long run. Such trends are particularly evident among selected subgroups of elderly populations. If greater flexibility in pensionable age may help prevent depression late in life, the transition to retirement is to be accompanied by targeted health promotion interventions. In an ageing society, welfare policies should be evaluated, considering their long-term impact on mental health.

Children in contact with social services are at high risk for mental ill health, but it is not known what proportion of the child population has contact with social services or how risk varies within this group compared to unexposed peers. We aim to quantify the extent and nature of contact with social services within the child population in Northern Ireland (NI) and the association with mental ill health. We also examine which social care experiences identify those most at risk.

This is a population-based record-linkage study of 497,269 children (aged under 18 years) alive and resident in NI in 2015 using routinely collected health and social care data. Exposure was categorized as (1) no contact, (2) referred but assessed as not in need (NIN), (3) child in need (CIN) and (4) child in care (CIC). Multilevel logistic regression analyses estimated odds ratios (ORs) for mental ill health indicated by receipt of psychotropic medication (antidepressants, anxiolytics, antipsychotics and hypnotics), psychiatric hospital admission and hospital-presenting self-harm or ideation.

Over one in six children (17.2%, n = 85,792) were currently or previously in contact with social services, and almost one child in every 20 (4.8%, n = 23,975) had contact in 2015. Likelihood of any mental ill health outcome increased incrementally with the level of contact with social services relative to unexposed peers: NIN (OR 5.90 [95% confidence interval (CI) 5.10–6.83]), CIN (OR 5.99 [95% CI 5.50–6.53]) and CIC (OR 12.60 [95% CI 10.63–14.95]). All tiers of contact, number of referrals, number of care episodes and placement type were strongly associated with the likelihood of mental ill health.

Children who have contact with social services account for a large and disproportionate amount of mental ill health in the child population. Likelihood of poor mental health across indicators is highest in care experienced children but also extends to the much larger population of children in contact with social services but never in care. Findings suggest a need for targeted mental health screening and enhanced support for all children in contact with social services.

To estimate the association of catastrophic health expenditure (CHE) with the risk of depression in middle-aged and old people in China.

We used data of 2011, 2013, 2015 and 2018 from the China Health and Retirement Longitudinal Study, which covered 150 counties of 28 provinces in China. CHE was calculated as out-of-pocket health expenditure exceeding 40% of a household’s capacity to pay. Depression was measured by a 10-item Centre for Epidemiological Studies Depression Scale. We evaluated CHE prevalence and applied Cox proportional hazard models to estimate adjusted hazard ratios (aHRs) and 95% confident intervals (CIs) for the risk of depression among participants with CHE after controlling potential confounders, compared with those without CHE.

Among 5765 households included in this study, CHE prevalence at baseline was 19.24%. The depression incidence of participants with CHE (8.00 per 1000 person-month) was higher than that of those without CHE (6.81 per 1000 person-month). After controlling confounders, participants with CHE had a 13% higher risk (aHR = 1.13, 95% CI: 1.02–1.26) of depression than those without CHE. In subgroup analysis, the association of CHE with depression was significant in males and in people with chronic diseases, of younger age, living in rural areas and of lowest family economic level (all P < 0.05).

Nearly one of five middle-aged and old people in China incurred CHE, and CHE was associated with the risk of depression. Concerted efforts should be made to monitor CHE and related depression episode. Moreover, timely interventions about CHE and depression need to be implemented and strengthened among middle-aged and old people.

Suicidal acts may cluster in time and space and lead to community concerns about further imitative suicidal episodes. Although suicide clusters have been researched in previous studies, less is known about the clustering of non-fatal suicidal behaviour (self-harm). Furthermore, most previous studies used crude temporal and spatial information, e.g., numbers aggregated by month and residence area, for cluster detection analysis. This study aimed to (i) identify space–time clusters of self-harm and suicide using daily incidence data and exact address and (ii) investigate the characteristics of cluster-related suicidal acts.

Data on emergency department presentations for self-harm and suicide deaths in Taipei City and New Taipei City, Taiwan, were used in this study. In all-age and age-specific analyses, self-harm and suicide clusters were identified using space–time permutation scan statistics. A cut-off of 0.10 for the p value was used to identify possible clusters. Logistic regression was used to investigate the characteristics associated with cluster-related episodes.

A total of 5,291 self-harm episodes and 1,406 suicides in Taipei City (2004–2006) and 20,531 self-harm episodes and 2,329 suicides in New Taipei City (2012–2016) were included in the analysis. In the two cities, two self-harm clusters (n [number of self-harm episodes or suicide deaths in the cluster] = 4 and 8 in Taipei City), four suicide clusters (n = 3 in Taipei City and n = 4, 11 and 4 in New Taipei City) and two self-harm and suicide combined clusters (n = 4 in Taipei City and n = 8 in New Taipei City) were identified. Space–time clusters of self-harm, suicide, and self-harm and suicide combined accounted for 0.05%, 0.59%, and 0.08% of the respective groups of suicidal acts. Cluster-related episodes of self-harm and suicide were more likely to be male (adjusted odds ratio [aOR] = 2.22, 95% confidence interval [CI] 1.26, 3.89) and young people aged 10–29 years (aOR = 2.72, 95% CI 1.43, 5.21) than their cluster-unrelated counterparts.

Space–time clusters of self-harm, suicide, and self-harm and suicide combined accounted for a relatively small proportion of suicidal acts and were associated with some sex/age characteristics. Focusing on suicide deaths alone may underestimate the size of some clusters and/or lead to some clusters being overlooked. Future research could consider combining self-harm and suicide data and use social connection information to investigate possible clusters of suicidal acts.

Research on the effect of oral contraceptive (OC) use on the risk of depression shows inconsistent findings, especially in adult OC users. One possible reason for this inconsistency is the omission of women who discontinue OCs due to adverse mood effects, leading to healthy user bias. To address this issue, we aim to estimate the risk of depression that is associated with the initiation of OCs as well as the effect of OC use on lifetime risk of depression.

This is a population-based cohort study based on data from 264,557 women from the UK Biobank. Incidence of depression was addressed via interviews, inpatient hospital or primary care data. The hazard ratio (HR) between OC use and incident depression was estimated by multivariable Cox regression with OC use as a time-varying exposure. To validate causality, we examined familial confounding in 7,354 sibling pairs.

We observed that the first 2 years of OC use were associated with a higher rate of depression compared to never users (HR = 1.71, 95% confidence interval [CI]: 1.55–1.88). Although the risk was not as pronounced beyond the first 2 years, ever OC use was still associated with an increased lifetime risk of depression (HR = 1.05, 95% CI: 1.01–1.09). Previous OC use were associated with a higher rate of depression compared to never users, with adolescent OC users driving the increased hazard (HR = 1.18, 95% CI: 1.12–1.25). No significant association were observed among adult OC users who had previously used OCs (HR = 1.00, 95% CI: 0.95–1.04). Notably, the sibling analysis provided further evidence for a causal effect of OC use on the risk of depression.

Our findings suggest that the use of OCs, particularly during the first 2 years, increases the risk of depression. Additionally, OC use during adolescence might increase the risk of depression later in life. Our results are consistent with a causal relationship between OC use and depression, as supported by the sibling analysis. This study highlights the importance of considering the healthy user bias as well as family-level confounding in studies of OC use and mental health outcomes. Physicians and patients should be aware of this potential risk when considering OCs, and individualized risk–benefit assessments should be conducted.

We explored long-term employment status and income before and after depression diagnosis among men and women and at different working ages in Taiwan.

Data from 2006 to 2019 were obtained from the National Health Insurance Research Database (NHIRD). Individuals with newly diagnosed depressive disorder aged 15 to 64 years during the study period were identified. An equal number of individuals without depression were matched for their demographic and clinical characteristics. Employment outcomes included employment status, which was categorized into employed or unemployed, and annual income. Based on the occupation categories and monthly insurance salary recorded in the Registry for Beneficiaries of the NHIRD, a subject was defined as unemployed if he or she differed from the income earner or the occupation category was unemployed. Monthly income was defined as zero for unemployed subjects and proxied as monthly insurance salary for others. Annual income was the sum of monthly income in each observation year.

A total of 420,935 individuals with depressive disorder were included in the study, and an equal number of individuals with not diagnosed depression served as controls. Employment rate and income were lower in the depression group than in the control group before the year of diagnosis, with a difference of 5.7% in employment rate and USD 1,173 in annual income. This gap increased considerably after the year of diagnosis (7.3% in employment rate and USD 1,573 in annual incomes) and further widened in the subsequent years (8.1% in employment rate and USD 2,006 in annual incomes in the 5th following year). The drops in the employment rate and income caused by depression were more evident in men and older age groups than in women and younger age groups, respectively. However, the reduction in employment rate and income in the following years after the diagnosis was more considerable among younger age groups.

The effect of depression on employment status and income was significant during the year of diagnosis and continued afterwards. The effect on employment outcomes varied between genders and across all age groups.