title: The contribution of high levels of somatic symptom severity to sickness absence duration, disability and discharge.
abstract: BACKGROUND
  The primary objectives were to compare the duration of sickness absence in employees with high levels of somatic symptom severity (HLSSS) with employees with lower levels of somatic symptom severity, and to establish the long-term outcomes concerning return to work (RTW), disability and discharge. Secondary objective was to evaluate determinants of the duration of sickness absence in employees with HLSSS.
  
  
  METHODS
  489 sick-listed employees registered with five Occupational Health Physician (OHP) group practices were included in this study. We measured their baseline scores for somatic symptoms severity, depressive disorders, anxiety disorders, health anxiety, distress and functional impairment. The OHPs filled in a questionnaire on their diagnosis. A prospective 2-year follow-up was carried out to assess the long-term outcomes concerning sickness absence, and retrospective information was gathered with regard to sickness absence during the 12 months before the employees were sick-listed.
  
  
  RESULTS
  The median duration of sickness absence was 78 days longer for employees with HLSSS. They more often remained disabled and were discharged more often, especially due to problems in the relationship between the employer and the employee. HLSSS, health anxiety and older age contributed to a longer duration of sickness absence of employees.
  
  
  CONCLUSIONS
  High levels of somatic symptom severity are a determinant of prolonged sickness absence, enduring disabilities and health-related job loss. Occupational health physicians should identify employees who are at risk and adhere to guidelines for medically unexplained somatic symptoms.
authors.affiliation: Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. rob.hoedeman@arboned.nl
authors.forename: Rob
authors.initials: R
authors.lastname: Hoedeman
authors.forename: Annette H
authors.initials: AH
authors.lastname: Blankenstein
authors.forename: Boudien
authors.initials: B
authors.lastname: Krol
authors.forename: Petra C
authors.initials: PC
authors.lastname: Koopmans
authors.forename: Johan W
authors.initials: JW
authors.lastname: Groothoff
mesh_terms: D000041:Absenteeism; D000328:Adult; D006233:Persons with Disabilities; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D054538:Occupational Health Physicians; D010555:Personality Inventory / Q000706:statistics & numerical data; D011446:Prospective Studies; D012720:Severity of Illness Index; D018582:Sick Leave / Q000706:statistics & numerical data*; D013001:Somatoform Disorders / Q000145:classification* / Q000523:psychology; D013997:Time Factors