Psychiatric disorders in long-term sickness absence — a population-based cross-sectional study

Abstract

Aims: The study estimates the incidence of psychiatric disorders in long-term sickness absence (LSA; more than eight weeks of continuous sickness absence) over one year. The study is the first accounting for everybody on LSA by linking a psychiatric assessment for all persons on LSA to public registers. Methods: In a Danish population of 120,000 inhabitants all 2,414 incident persons on LSA within one year were posted a questionnaire, of whom 1,121 (46.4%) responded. In a two phase design the 1,121 sick-listed persons were screened for psychiatric disorders. Phase 2 consisted of 844 people with predefined scores on CMD-SQ of whom 423 were randomly invited to a psychiatric examination and 329 participated. A further 11 who did not fulfil the predefined criteria were invited, of whom eight participated. The examination included a diagnostic interview by Present State Examination. Results: The 329 examined persons in Phase 2 showed by binomial tests the following frequencies: any psychiatric disorder 57%, any depression 42%, and any anxiety 18%. In Phase 1, representative for everyone on LSA, the frequencies were 48% for any psychiatric disorder, 35% for any depression, 15% for any anxiety, and 7% for any somatoform disorder. Multivariable analyses showed that female sex and unemployment were predictors of a psychiatric disorder, whereas living with children below 18 years and being a skilled worker carried a reduced risk of a psychiatric disorder. Conclusions: The high frequency of psychiatric disorders necessitates further population-based studies documenting the efficiency of screening and psychiatric examinations in LSA.

Keywords

Demography diagnosis epidemiology sickness absence socio-demographic characteristics unreported diagnosis

Get full access to this article

View all access options for this article.

References

Bijl RV , Ravelli A. , van Zessen G. Prevalence of psychiatric disorder in the general population: results of The Netherlands Mental Health Survey and Incidence Study (NEMESIS). Soc Psychiatry Psychiatr Epidemiol 1998;33(12):587-95.

Hodiamont P. , Peer N. , Syben N. Epidemiological aspects of psychiatric disorder in a Dutch health area. Psychol Med 1987;17(2):495-505.

Jenkins R. , Lewis G. , Bebbington P. , Brugha T. , Farrell M. , Gill B. , et al. The National Psychiatric Morbidity surveys of Great Britain - initial findings from the household survey. Psychol Med 1997;27(4):775-89.

Lindeman S. , Hamalainen J. , Isometsa E. , Kaprio J. , Poikolainen K. , Heikkinen M. , et al. The 12-month prevalence and risk factors for major depressive episode in Finland: representative sample of 5993 adults . Acta Psychiatr Scand 2000;102(3):178-84.

Offord DR , Boyle MH , Campbell D. , Goering P. , Lin E. , Wong M. , et al. One-year prevalence of psychiatric disorder in Ontarians 15 to 64 years of age. Can J Psychiatry 1996;41(9):559-63.

Peen J. , Dekker J. , Schoevers RA , Have MT , De GR , Beekman AT

Is the prevalence of psychiatric disorders associated with urbanization?

Soc Psychiatry Psychiatr Epidemiol 2007 ;42(12):984-9.

Wittchen HU , Jacobi F. Size and burden of mental disorders in Europe - a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol 2005;15(4):357-76.

Andlin-Sobocki P. , Jonsson B. , Wittchen HU , Olesen J. Cost of disorders of the brain in Europe. Eur J Neurol 2005 ;12(Suppl 1):1-27.

Hensing G. , Andersson L. , Brage S. Increase in sickness absence with psychiatric diagnosis in Norway: a general population-based epidemiologic study of age, gender and regional distribution. BMC Med 2006;4:19.

10.

Hensing G. , Spak F. Psychiatric disorders as a factor in sick-leave due to other diagnoses. A general population-based study. Br J Psychiatry 1998;172:250-6.

11.

Christensen KS , Toft T. , Frostholm L. , Ornbol E. , Fink P. , Olesen F. The FIP study: a randomised, controlled trial of screening and recognition of psychiatric disorders. Br J Gen Pract 2003 ;53(495):758-63.

12.

Stansfeld S. , Feeney A. , Head J. , Canner R. , North F. , Marmot M. Sickness absence for psychiatric illness: the Whitehall II Study. Soc Sci Med 1995;40(2):189-97.

13.

Soegaard H. , Bech P. Design involving screening and psychiatric examination for detection of undetected mental disorders in long-term sickness absence. A population based study. Scand J Public Health, Submitted.

14.

Christensen KS , Fink P. , Toft T. , Frostholm L. , Ornbol E. , Olesen F. A brief case-finding questionnaire for common mental disorders: the CMDQ. Fam Pract 2005 ; 22(4):448-57.

15.

SCAN Schedules for Clinical Assessment in Neuropsychiatry [computer program]. Geneva: World Health Organization ; 1994.

16.

Dunn G. , Pickles A. , Tansella M. , Vazquez-Barquero JL Two-phase epidemiological surveys in psychiatric research. Br J Psychiatry 1999;174:95-100.

17.

Bisoffi G. , Mazzi MA , Dunn G. Evaluating screening questionnaires using Receiver Operating Characteristic (ROC) curves from two-phase (double) samples . Int J Methods Psychiatr Res 2000;9(3):121-33.

18.

Kraemer HC Evaluating medical tests: objective and quantitative guidelines. Newbury Park, CA: SAGE Publications; 1992.

19.

STATA 10.0 [computer program]. Texas: Stata Corp; 2006.

20.

Toft T. , Fink P. , Oernboel E. , Christensen K. , Frostholm L. , Olesen F. Mental disorders in primary care: prevalence and co-morbidity among disorders. results from the functional illness in primary care (FIP) study . Psychol Med 2005;35(8):1175-84.

21.

Fink P. , Ornbol E. , Toft T. , Sparle KC , Frostholm L. , Olesen F. A new, empirically established hypochondriasis diagnosis. Am J Psychiatry 2004;161(9):1680-91.

22.

Angst J. Depression and anxiety: a review of studies in the community and in primary health care. In: Sartorius N , Goldberg D , de Girolamo G , Costa e Silva JA , Lecrubier Y , Wittchen H-U , editors. Psychological disorders in general medical settings . Toronto: Hogrefe & Huber; 1990. pp. 60-8.

23.

Akhtar-Danesh N. , Landeen J. Relation between depression and sociodemographic factors. Int J Ment Health Syst 2007;1(1):4.

24.

Alonso J. , Angermeyer MC , Bernert S. , Bruffaerts R. , Brugha TS , Bryson H. , et al. Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004; (420):21-7.

25.

Bebbington P. , Dunn G. , Jenkins R. , Lewis G. , Brugha T. , Farrell M. , et al. The influence of age and sex on the prevalence of depressive conditions: report from the National Survey of Psychiatric Morbidity. Int Rev Psychiatry 2003;15(1-2):74-83.

26.

Bijl RV , De GR , Ravelli A. , Smit F. , Vollebergh WA Gender and age-specific first incidence of DSM-III-R psychiatric disorders in the general population. Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Soc Psychiatry Psychiatr Epidemiol 2002;37(8):372-9.

27.

Kessler RC , McGonagle KA , Zhao S. , Nelson CB , Hughes M. , Eshleman S. , et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51(1):8-19.

28.

Arbejdsmarkedsstyrelsens DREAM-register: http://www.ams.dk/Arbejdsmarkedsstyrelsen/Organisation/Arbejdsomraader/4-kontors-arbejdsomrAader.aspx , 2006. Arbejdsmarkedsstyrelsen, København.

29.

Soegaard HJ , Bech P. Compensating for total non-participation in a study estimating the incidence of psychiatric disorders in long-term sickness absence by a two-phased desgin. Scand J Pub Health , Submitted.

30.

Marcellus L. Are we missing anything? Pursuing research on attrition. CJNR 2004;36(3):82-98.