Long-term sick leavers with difficulty in resuming work: comparisons between psychiatric–somatic comorbidity and monodiagnosis

Abstract

The number of patients with difficulty in resuming work after long-term sick leave has increased in several European countries including Sweden. The general aim of this study was a comprehensive description--based on multidisciplinary diagnostics and assessments--of patients with the common feature of marked difficulty in resuming working life after a long absence. A particular aim was to elucidate the possible effect of comorbidity on pain descriptors, disability, quality of life, assessed working ability and rehabilitation needs. Six hundred and thirty-five long-term sick leavers were referred from National Insurance Offices and consecutively accepted for investigation. Several self-report questionnaires were used. All patients were examined by three board-certified specialist physicians in psychiatry, orthopaedic surgery and rehabilitation medicine, respectively. Fifty-five percent of the patients had psychiatric-somatic comorbidity. The three most frequent combinations of diagnoses in the comorbidity group were fibromyalgia/myalgia and depressive episode, fibromyalgia/myalgia and recurrent depression, spinal pain and depressive episode, whereas the three most frequent in those with psychiatric diagnosis only were depressive episode, recurrent depression, phobias/anxiety. Differences in pain descriptors and in difficulties with activities were found among the three groups. All had lower health-related quality of life than references. Only one-sixth had no assessed working capacity and only 3% were assessed as able to resume work without rehabilitation; 80% were multidisciplinarily assessed as needing rehabilitation. Patients with psychiatric diagnoses, with or without concomitant somatic diagnoses, need medical rehabilitation or medical/vocational rehabilitation in combination to a greater extent than patients with somatic diagnoses only. This implies that medical rehabilitation programmes ought to adapt increasingly to the needs of patients with psychiatric-somatic comorbidity.

Development and Testing of an ICF-Based Questionnaire to Evaluate Functioning in Vocational Rehabilitation: The Work Rehabilitation Questionnaire (WORQ)

“…The influence of psychological functioning might be underestimated in clients in vocational rehabilitation without psychiatric diagnosis. These assumption is also supported by the fact that none of the clients in our study population reported psychiatric conditions as primary health condition, but more than 75 % of the clients in our sample reported at least one comorbidity and indicated to experience periods of being depressed or anxious concerning their future -a finding that is consistent with the literature [55].…”

Occupation as described by academically skilled occupational therapists in Sweden: a Delphi study

“…Should such occupation be included in the occupational therapy context? Another example is individuals with depression, who often lose interest in daily occupations (26,27) at the same time as occupational therapy is recommended for this target group (28). These are additional areas which should be further discussed and studied.…”

Health in women on long-term sick leave because of pain or mental illness

“…The increase in long-term sick leave is mainly caused by an increase in mental health problems, which, often accompanied with chronic pain (Linder et al, 2009), are now among the most common reason for long-term sickness absence (Søgaard and Bech, 2009;Henderson et al, 2011). The increase in mental ill health is of societal interest as it has been proposed as a threat to the welfare of the state (Sundquist et al, 2007).…”