Patterns and determinants in the use of occupational health services two years prior to depressive or anxiety disorder diagnosis: a sequence analysis

Depressive and anxiety disorders place a burden on working populations, yet little is known about employees’ use of occupational health services (OHS) before receiving such diagnoses. This study examined patterns and determinants of OHS use during the two years preceding a depression or anxiety diagnosis, using Finnish national register-based data. Sequence analysis was used to identify patterns in OHS utilization. The sample included 55 207 individuals diagnosed within OHS between 2019 and 2022. Four distinct OHS use patterns emerged. The largest cluster (54%) showed stable service use but had fewer individual contacts than other clusters, consisting more often of younger men with higher socioeconomic status working in smaller organizations. In contrast, 5% were frequent service users with higher contact rates, more physiotherapy visits, and a higher likelihood of lower education, employment in large organizations, and prior work disability benefits. Two additional clusters showed relatively frequent (27%) and moderately frequent (14%) service use and were composed of lower-level white collar employees in professional or administrative fields. Across all clusters, psychological service contacts increased before diagnosis. Socioeconomic status was associated with service use patterns, with gender differences: men in the lowest income group were more often frequent service users than women. Employees in larger organizations used OHS more, likely reflecting better accessibility and more structured OHS practices. The findings demonstrate that patterns of OHS preceding a mental health diagnosis diverge and are shaped by both employee and organizational characteristics. Recognizing early indicators of deteriorating mental health and offering timely support in OHS for employees is essential for preventing mental disorders.