Risk of depressive and anxiety disorders in young adults with disabilities: a nationwide cohort study in South Korea

BACKGROUND: Although often associated with ageing, disability is becoming increasingly prevalent among young adults. While disability can pose a substantial psychological burden for young adults on critical pathways to establish the foundations for their future, the mental health risks faced by this population remain underexplored. AIMS: This study aimed to (1) assess the association between disability - including its presence, severity and type - and the risk of depressive and anxiety disorders, and (2) examine whether this association varies across sociodemographic factors, health behaviours and comorbidities in a young adult population. METHODS: We conducted a population-based cohort study using linked data from the National Disability Registry and the National Health Insurance Database of South Korea. A total of 6,058,290 individuals aged 20-39 years who underwent health check-ups between 2009 and 2012 were followed through 2022. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for depressive and anxiety disorders. RESULTS: Individuals with disabilities had significantly higher risks of depressive (aHR: 1.58, 95% CI: 1.55-1.60) and anxiety disorders (aHR: 1.50, 95% CI: 1.42-1.59). Increased risks were consistently observed across various disability types with the highest risk observed for mental health-related disabilities in depression (aHR: 4.98, 95% CI 4.62-5.37) and epilepsy-related disabilities in anxiety disorders (aHR: 12.05, 95% CI 8.73-16.63). Subgroup analyses revealed stronger associations among individuals in their 20s, low-income groups, non-smokers and those abstaining from alcohol, compared to their respective counterparts. CONCLUSIONS: Young adults with disabilities, a population that has been relatively overlooked in policy discussions, warrant greater policy attention in relation to their mental health.