Sammendrag
In Norway, almost 10% of the working age population receive a disability pension. Spouses tend to have similar health and lifestyle, and they also tend to coordinate their retirements. Spousal similarities can be explained by similarities existing before marriage, spousal influence and shared resources. Sickness is the social role related to disease and illness, sickness is therefore also a social construct. There are thus both medical and non-medical determinants of work related disability, and there might be temporal changes in the illness experienced by people who receive a disability pension.
The aims of this thesis were to assess disability pension receipt in Norway in the context of the married or cohabitating couple, and to consider how the health around time of receiving a disability pension might have changed over time.
We conducted three studies based on the second and third wave of the Nord-Trøndelag Health Study (HUNT2 1995-97 and HUNT3 2006-08), linked to data on households and families, retirements and education from national registries. In the first study, we assessed the clustering of disability pensions received within couples, as well as the hazard of receiving a disability pension dependent on the spouse’s disability status. We adjusted for baseline health, diseases, illness, health-related behaviours and education. In the second study, we examined the association of health, disease, illness, lifestyle and education in couples with disability pension receipt and mortality. We estimated association both within and between couples. In the third study, we examined the self-rated health, insomnia and mental symptoms of people who received a disability pension in the 1990s and 2000s and their spouses, depending on time before or after receiving a disability pension.
We found a substantial clustering of disability pensions within couples. Some of this could be attributed to pre-existing similarities between partners. Living with an ill spouse could have a negative impact on work related disability, but we did not find that it affected all-cause mortality. A negative impact on the spouse’s health could still not explain the higher risk of receiving a disability pension when the spouse after the spouse had received a disability pension. Other contributing mechanisms could include social influence on illness behaviour and self-efficacy.
Furthermore, our results indicate that the health and illness experience by individuals who receive a disability pension has not changed much from the 1990s to the 2000s. This suggests that the National Labour and Welfare Administration treated requests for disability pensions in similar manners in the two time periods. However, the stress related to the disability process seems to be lower in the 2000s compared to the 1990s. This could be due to faster case handling or fewer stigmas.
Our findings of possible associations between couple’s health and individual work related disability should be examined further. In the clinical setting, spouses could be included in the discussions about opportunities and limitations regarding return-to-work.
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