Multidisciplinary investigations recognize high prevalence of co-morbidity of psychiatric and somatic diagnoses in long-term sickness absentees

Abstract

Aims: In Sweden, the Social Insurance Offices each year refer long-term sickness absentees to comprehensive investigations to clarify medical conditions. However, there is a lack of scientific knowledge about these patients and their morbidity. The aim was to characterize a population of these sickness absentees regarding prevalence of somatic and psychiatric diagnoses and possible associations with sociodemographic, lifestyle, and health characteristics. Methods: A cross-sectional study was made up of 635 sickness absentees below the age of 64, who the local Social Insurance Offices in Stockholm County, Sweden, referred to a special unit for multidisciplinary investigation. Data was obtained from questionnaires and medical records. The patients were examined by board certified specialists in psychiatry, orthopaedic surgery, and rehabilitation medicine. Relative risks were estimated by use of modified Poisson regression to assess the associations between characteristics and diagnose outcomes. Results: About 80% of the patients had more than one diagnosis. The vast majority had a psychiatric diagnosis, and approximately 55% had that in combination with at least one somatic diagnosis. An increased risk for being given a psychiatric diagnosis was found for men and unemployed people. In addition, lack of social life and friends and self-reported mental health problems were associated with psychiatric diagnoses but also among those who were given somatic diagnoses in combination with psychiatric diagnoses. Increased risks for somatic diagnoses were found for women and for patients with a higher education. Conclusions: Long-term sickness absentees referred to multidisciplinary investigations display high co-morbidity of psychiatric and somatic diagnoses and are a heterogeneous group with diverse sociodemographic and medical characteristics.

Keywords

Alcohol consumption co-morbidity mental disorders musculoskeletal disorders sick leave

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References

Alexanderson K, Nordlund A, editors. Sickness absence - causes, consequences, and physicians' sickness certification practice. A systematic literature review by the Swedish Council on Technology Assessment in Health Care. Scand J Public Health. Supplement. 2004;63:1-263.

Henderson M. , Glozier N. , Holland Elliott K. Long term sickness absence . BMJ 2005;330(7495):802-03.

Jaörvisalo J. , Anderson B. , Boedeker W. , Houtman I. Mental disorders as a major challenge in prevention of work disability. Social Security and Health reports. Vol. 66. Helsinki: Kela; 2005.

Stein MB , Cox BJ , Afifi TO , Belik SL , Sareen J. Does comorbid depressive illness magnify the impact of chronic physical illness? A population-based perspective. Psychol Med 2006;36(5):587-96.

Sareen J. , Jacobi F. , Cox BJ , Belik SL , Clara I. , Stein MB Disability and poor quality of life associated with comorbid anxiety disorders and physical conditions. Arch Intern Med 2006 ;166(19):2109-16.

Buist-Bouwman MA , de Graat R. , Vollebergh WAM , Orme J. Comorbidity of physical and mental disorders and the effect on work-loss days. Acta Psychiatr Scand 2005;111:436-43.

Carson AJ , Ringbauer B. , Stone J. , McKenzie L. , Warlow C. , Sharpe M. Do medically unexplained symptoms matter? A prospective cohort study of 300 new referrals to neurology outpatient clinics. J Neurol Neurosurg Psychiatry 2000;68(2):207-10.

Timpka T. , Hensing G. , Alexanderson K. Dilemmas in sickness certification among Swedish physicians. Eur J Public Health 1995;5:215-19.

Melsom H. , Noreik K. , Grant Carlsen T. The beneficial effect of using psychiatrists in social security medicine . Tidsskr Nor Laegeforen (Norwegian) 1993 ;113(30):3760-1.

10.

Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 2004 ; 159:702-06.

11.

Linder J. , Schuldt Ekholm K. , Brodda Jansen G. , Lundh G. , Ekholm J. Long-term sick-leavers with difficulty in resuming work: comparisons between psychiatric-somatic co-morbidity and monodiagnosis . Int J Rehabilitation Res (in press).

12.

Ydreborg B. , Ekberg K. , Nordlund A. Health, quality of life, social network and use of health care: a comaprison between those granted and those not granted disability pension. Disability & Rehabilitation 2006;28(1):25-32.

13.

Cairney J. , Corna LM , Veldhuizen S. , Kurdyak P. , Streiner DI The social epidemiology of affective and anxiety disorders in later life. Can J Psych 2008;53:104.

14.

Statistics Sweden (SCB); 2005.

15.

Akhavan S. , Bildt CO , Franzen EC , Wamala S. Health in realtion to unemployment and sick leave among immigrants in Sweden from a gender perspective. J Immigr Health 2004;6:103-17.

16.

Loöfvander MB , Engstroöm AW The immigrant patient having widespread pain. Clinical findings by physicians in Swedich primary care. Disability & Rehabilitation 2007; 29:381-8.

17.

Ydreborg B. , Ekberg K. , Nilsson K. Swedish social insurance officer's experiences of difficulties in assessing applications for disability pensions - an interview study. BMC Public Health 2007;7:1-9.

18.

Mussener U. , Upmark M. , Borg K. , Alexanderson K. Sick-listed person's experiences of positive encounters within healthcare and social insurance. Submitted, 2006.

19.

House JS , Landis KR , Umberson D. Social relationships and health. Science 1988 ;241:540-5.

20.

Holt-Lunstad J. , Birmingham W. , Jones BQ Is there something unique about marriage? The relative impact of marital status, relationship quality, and network social support on ambulatory blood pressure and mental health . Ann Behav Med 2008;35:239-44.