Does multidisciplinary assessment of long-term sickness absentees result in modification of sick-listing diagnoses?

Abstract

Aims: The aim was to study whether sick-leave diagnoses of long-term sickness absentees were modified after a multidisciplinary assessment and if modifications differed with type of medical specialty of the latest physician to sick-list the patient. Methods: A sample of 635 long-term sickness absentees referred to a multidisciplinary assessment by Social Insurance Offices was included. Data were obtained through sickness certificates and medical records. Patients were examined by board-certified specialists in psychiatry, orthopaedic surgery, and rehabilitation medicine. Descriptive statistics were used. Results: The multidisciplinary assessment resulted in an increase from 1—2 to 2—3 diagnoses for most patients. Forty-five per cent of the male and 47% of the female patients had only somatic diagnoses at referral. After the multidisciplinary assessment these percentages were 20% and 29%, respectively. The rate of women and men given both psychiatric and somatic diagnoses increased from 30% at referral to about 55%. The shift from either only psychiatric or only somatic diagnoses to having these diagnoses in combination was associated with type of specialty of the physician who had sick-listed the patient. Conclusions: The study indicates that many patients on long-term sick-leave with unclear diagnoses may suffer from unrecognized, and therefore probably untreated, medical disorders and co-morbidity.

Keywords

Co-morbidity multidisciplinary assessment psychiatric diagnoses sick leave somatic diagnoses Sweden

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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 Publich Health 2004;63:1-263.

Waddell G. , Burton K. Is working good for your health and well-being? Cardiff & Huddersfield: Cardiff University & University of Huddersfield; 2006.

Waddell G. , Burton A. Concepts of rehabilitation for the management of common health problems . London: TSO; 2004.

Buist-Bouwman MA , de Graaf R. , Vollebergh WA , Ormel J. Comorbidity of physical and mental disorders and the effect on work-loss days. Acta Psychiatr Scand 2005;111(6):436-43.

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.

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;68:207-10.

Woivalin T. , Krantz G. , Mäntyranta T. , Ringsberg KC Medically unexplained symptoms: perceptions of physicians in primary health care. Fam Pract 2004;21:199-203.

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

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

10.

Salmi P. , Svedberg P. , Hagberg J. , Lundh G. , Linder J. , Alexanderson K. Multidisciplinary investigations recognize high prevalence of co-morbidity of psychiatric and somatic diagnoses in long-term sickness absentees. Scand J Public Health 2009;37(1):35-42.

11.

Salmi P. , Svedberg P. , Hagberg J. , Lundh G. , Linder J. , Alexanderson K. Outcome of multidisciplinary investigations of long-term sickness absentees . Disability Rehab 2009;31(2):131-7.

12.

Linder J. , Ekholm KS , Jansen GB , Lundh G. , Ekholm J. Long-term sick-leavers with difficulty in resuming work: comparisons between psychiatric-somatic comorbidity and monodiagnosis . Int J Rehab Research 2009;32:20-35.

13.

Linder J. , Schüldt Ekholm K. , Lundh G. , Ekholm J. Long-term sick-leavers with fibromyalgia: comparing their multidisciplinary assessed characteristics with those of others with chronic pain conditions and depression. J Multidisc Healthcare 2009;2:23-37.

14.

Linder J. , Svensson O. The impact of pain and depression on assessment of rehabilitation need: a cross-sectional study in long-term sick-listed patients . Int J Rehab Research 2007;30:255-60.

15.

World Health Organization. The International Statistical Classification of Diseases and Related Health Problems. 10th revision (ICD-10). Geneva: WHO; 2007.

16.

Labriola M. , Lund T. , Christensen KB , Albertsen K. , Bültmann U. , Jensen JN , et al. Does self-efficacy predict return-to-work after sickness absence? A prospective study among 930 employees with sickness absence for three weeks or more. Work 2007 ;29:233-8.

17.

Floderus B. , Göransson S. , Alexanderson K. , Aronsson G. Self-estimated life situation in patients on long-term sick leave. J Rehabil Med 2005;37(5):291-9.

18.

Rosendal M. , Olesen F. , Fink P. Management of medically unexplained symptoms . BMJ 2005;330:4-5.

19.

Ihlebaek C. , Brage S. , Eriksen HR Health complaints and sickness absence in Norway, 1996-2003. Occup Med ( Lond) 2007;57:43-9.

20.

Matsunaga M. , Okamoto Y. , Suzuki S. , Kinoshita A. , Yoshimura S. , Yoshino A. , et al. Psychosocial functioning in patients with treatment-resistant depression after group cognitive behavioral therapy . BMC Psychiatry 2010;10:22.

21.

Lackner JM , Gudleski GD , Keefer L. , Krasner SS , Powell C. , Katz LA Rapid response to cognitive behavior therapy predicts treatment outcome in patients with irritable bowel syndrome. Clinical Gastroenterol Hepatol 2010:8(5): 426-32.

22.

Ostelo Rwjg , van Tulder MW , Vlaeyen JWS , Linton SJ , Morley S. , Assendelft WJJ. Behavioural treatment for chronic low-back pain. The Cochrane Library 20054.

23.

Norlund A. , Ropponen A. , Alexanderson K. Multidisciplinary interventions: review of studies of return to work after rehabilitation for low back pain . J Rehabil Med 2009;41(3):115-21.

24.

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

25.

Isometsä E. , Katila H. , Aro T. Disability pension for major depression in Finland. Am J Psychiatry 2000;157:1869-72.

26.

APA. Diagnostic and statistical manual of mental disorders 4th ed. Washington DC: American Psychiatric Association; 1994.

27.

Munce S. , Stewart D. Gender differences in depression and chronic pain conditions in a national epidemiology survey. Psychosomatics 2007;48(5):394-9.

28.

Hooten M. , Townsend C. , Decker P. Gender differences among patients with fibromyalgia undergoing multidisciplinary pain rehabilitation . Pain Medicine 2007;8(8): 624-32.