Long-term sick leavers with difficulty in resuming work: comparisons between psychiatric-somatic comorbidity and monodiagnosis.
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.
Linder
Jürgen
J
Department of Clinical Neuroscience, Division of Psychiatry, Diagnostic Centre, Danderyd Hospital, Karolinska, Sweden. jurgen.linder@ki.se
Ekholm
Kristina Schüldt
KS
Jansen
Gunilla Brodda
GB
Lundh
Göran
G
Ekholm
Jan
J
D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology / Q000534:rehabilitation*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005356:Fibromyalgia / Q000453:epidemiology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D010147:Pain Measurement; D010415:Pensions; D011788:Quality of Life; D018582:Sick Leave / Q000706:statistics & numerical data*; D013997:Time Factors