LAUSR

Trajectories of psychotropic drug purchases around disability pension process have only been studies among awarded applicants. The aim was to follow and compare psychotropic drug purchases between awarded and rejected applicants before and after the application ruling, and to analyse whether such differences are affected by diagnostic group and sociodemographic background. A representative 70% sample of Finnish adults applying disability pension due to mental or behavioral disorder in 2009-2011 (N = 18,087) were followed for four eight years in three-month periods. Registers of purchased psychotropic drugs measured in defined daily doses (DDDs), gender, age, occupational class, unemployment history, and diagnostic group were used. The DDD levels and trends were analysed using growth curve models. The average purchased DDDs of psychotropic drugs increased before the application ruling and decreased gradually thereafter among both awarded and rejected applicants. Before the application ruling the DDD level was higher for the rejected applicants. However, the increase in DDDs was steeper for awarded applicants. The inversed U-curve of purchase amount was most prominent awarded applicants in diagnostic groups of bipolar disorders, depression, anxiety disorders and schizophrenia. The results partly varied between sociodemographic groups. The early high level of psychotropic drug purchases of rejected disability pension applicants signals long running ill-health, calling for earlier measures to uphold their functional ability. Respectively, for awarded applicants, the steep DDD increase before the ruling may reflect accurate identification of worsening condition but also access to precise treatment. Rejected disability pension applicants with mental disorders suffer from long-running mental ill-health, calling for earlier measures to uphold their mental health and prevent the pension process. Awarded disability pension applicants with mental disorders may have access to more precise treatment, but their worsening condition appear to be accurately identified by Finnish system.