Katalin Gémes

Research problem and specific questionsAutism Spectrum Disorder (ASD) is a developmental disorder characterised by a range of deficits that affect communication, behaviour, and social interaction, which can contribute to challenges in entering and maintaining employment. In recent years, the number of individuals diagnosed with ASD in childhood and adulthood has markedly increased. Despite these increases, and a growing evidence base linking ASD with several adverse life trajectories, studies on occupational outcomes are limited. There are currently no comprehensive investigations on specific risk factors for labour market marginalisation (LMM), comprising sickness absence, disability pension, and long-term unemployment. Moreover, studies on the effectiveness of pharmacological treatments in terms of preventing adverse labour-related outcomes are similarly sparse. There is also a dearth of qualitative evidence describing the work accommodations that can help individuals with ASD in maintaining employment.The overall aim of the project is therefore to characterise risk factors of LMM in individuals with ASD. Furthermore, we intend to estimate the effectiveness of specific pharmacotherapies in preventing LMM, and through qualitative interview data examine work accommodations that can help these individuals to have a sustainable working life.Data and methodsThis project will utilise a mix of linked data from multiple nationwide registers in Sweden and qualitative interview data. To investigate patterns of LMM, their risk factors, and the effectiveness of pharmacological therapies, we will study all individuals who received a diagnosis of ASD between 5 and 55 years 2003 to 2018 (N=84 012), as well as two comparison groups: 1) individuals from the general population

and 2) full siblings. To study work accommodations that can prevent LMM, we will intervju individuals in employment diagnosed with ASD (up to 25 persons). Cutting edge methodology such as machine learning models and novel methods in pharmacoepidemiology will be applied, as well as adequate qualitative interview methods.Societal relevance and utilisationSickness absence and unemployment contribute to significant societal costs in terms of healthcare expenses and productivity loss, as well as considerable personal suffering and social disadvantage for affected individuals. The project aims to generate knowledge that can form the basis for preventive strategies and interventions that can reduce exclusion from the workforce among individuals with ASD. Through its multidisciplinary approach, this project will provide crucial and actionable scientific knowledge which is useful for both individuals with ASD and their families as well as several different stakeholders in the society. The results will also enhance public understanding of ASD and help employers to enable a sustainable working life for individuals with ASD. Plan for project realisationThis project will involve interdisciplinary collaboration including epidemiologists, psychologists, statisticians, and individuals with lived experience of ASD. We have assembled a group with extensive expertise in the area and an excellent track record of producing top-quality and high-impact research. The project will span over three years, structured into distinct phases for data collection, analysis, and dissemination. An advisory board which conistis of representatives from several stakeholders and individuals with lived experiences will guarantee that findings remain relevant and applicable. The projects budget includes funding for staff time dedicated to data analyses and publication, rental costs and attendance at conferences and meetings to facilitate dissemination of the projects results. Collaboration with international networks and national ASD-organisations will enhance the project´s impact and ensure an even broader distribution of the research outcomes.

Research problem and specific questions: Around 50% of the population will experience menopause transition during their working life. Whilst for some women, this will have minimal impact, it has been increasingly recognised that severe menopausal symptoms can limit work ability. As such, there have been calls in Sweden to improve healthcare for women with menopausal and perimenopausal disorders (MPDs) and increase knowledge of these conditions. Preliminary work indicates that there has been a marked increase in women accessing specialist care for MPDs in the past 15 years, but that there are substantial sociodemographic and geographic inequalities. Consistent with these findings, studies in the UK and US show that prescribing of hormonal therapy varies by ethnicity and area-level deprivation. However, the impact of psychiatric comorbidities on diagnosis and treatment receipt, and the extent to which there might also be disparities in occupational outcomes, has yet to be explored. The Managing Equity in Menopausal and Perimenopausal Healthcare in Sweden (MEMPHIS) project will address critical knowledge gaps regarding temporal trends and potential inequalities in the diagnosis, occupational burden, and pharmacological treatment of MPDs.Data and method: We will analyse data from the extensive healthcare and social insurance registers in Sweden using advanced, cutting-edge methodologies. In study 1, mixed-effects Poisson models will be used to determine the influence of sociodemographic factors, psychiatric comorbidities, and geographic region on MPDs diagnosed in secondary care (national data) and primary care (regional data). Using joinpoint regression, we will also test whether incidence rates of MPDs in secondary care and age at diagnosis over a 20-year period vary across MPD conditions and across key sociodemographic factors and their intersections. In study 2, we will use cluster analysis to delineate patterns of overall occupational burden (unemployment, sickness absence, and disability pension days) in the 5 years following diagnosis and investigate whether living situation and occupation type influence these patterns. In study 3, we will examine initiation of hormonal therapy, type of therapy received, and patterns of treatment duration (derived using univariate mixture models) over 5 years and determine whether country of birth, education level, and income are associated with these outcomes. Societal relevance and utilisation: Whilst there has been increased recognition of the societal and economic impact of MPDs, menopause research is globally underfunded. Our primary goal is to increase scientific knowledge of these disorders and provide actionable insights that will enable policy makers to develop strategies to ensure equitable care for women with MPDs. The findings from our project will be of high importance to women in Sweden, who report having insufficient knowledge regarding the menopause transition and treatment options. In the longer-term, we anticipate that our findings will lead to better healthcare and occupational outcomes for women with MPDs.     Plan for project realisation: Our project includes a multidisciplinary team of clinical academics (spanning obstetrics and gynaecology, psychiatry, and psychology) and epidemiologists with expertise in public health, insurance medicine, pharmacology, and social inequalities. We will develop a comprehensive strategy for engaging with key stakeholders and the public that builds on our existing connections with government agencies, health care providers, and non-profit organisations. The funds will be used to host a freely-available conference that will enable us to foster dialogue between key stakeholders and people with lived experience via interactive sessions. Our findings will be disseminated in scientific publications, traditional and social media, and in the form of a freely-available white paper.

Research problem and specific questionsKnowledge is limited on the role of multimorbidity, work-related and social factors as well as treatment on the path to labor market marginalization after sick leave due to common mental disorders (CMDs), i.e., depression, anxiety, and stress-related disorders. This project aims to gain knowledge on how (1) social- and work-related factors, multi-morbidity, and (2) sick-leave patterns and treatment are associated with subsequent labor market marginalization after sick leave due to CMDs.Data and methodWe will use individually linked Swedish register data. Individuals, between the age of 21-50, residing in Sweden in 2006-09 (n=3,661,300), and among them those who started sick leave due to CMDs (49,903) will be included and followed regarding labor market outcomes. We will use sequence analysis and multi-state models to examine labor market marginalization patterns and transitions between labor market states in relation to prognostic factors after sick leave due to CMDs. Furthermore, all individuals living in the Stockholm region in 2014-19 (n=1,215,437) will form an additional study base. Network- and regression analyses will be used to examine the association between multi-morbidity patterns, treatment options and labor market marginalization.Plan for project realizationThis interdisciplinary project involves international collaborations analyzing data that has already been acquired. The three year project budget will cover 50% of the salaries for a postdoctoral researcher and the main applicant, 5% of salaries for co-applicants and costs including drug use modeling, data management, administrative costs such as knowledge exchange and dissemination, publication and premises.RelevanceThere is a large number of individuals with work disability and sick leave due to CMDs in Europe and in Sweden. Keeping individuals in the labor market and avoiding their labor market marginalization after sick leave due to CMDs is important both from a societal and an individual’s perspective and for achieving sustainable working life goals. Knowledge on risk factors and treatment can provide the basis for tailor-made, person-centered interventions.