title: Regional trends in awards of incapacity benefit by cause.
abstract: BACKGROUND
  Since the early 1990s, rates of incapacity benefit (IB) in Britain for musculoskeletal complaints have declined, and they have been overtaken by mental and behavioural disorders as the main reason for award of IB.
  
  
  OBJECTIVE
  To explore reasons for this change.
  
  
  METHODS
  Using data supplied by the Department for Work and Pensions, we analysed trends in the ratio of new IB awards for mental and behavioural disorders to those for musculoskeletal disorders during 1997-2007 by Government region.
  
  
  RESULTS
  In Great Britain overall, the above ratio more than doubled over the study period, as a consequence of falling numbers of new awards for musculoskeletal disorders. The extent to which the ratio increased was smallest in London (50%) and South-East England (56%), and was progressively larger in more northerly regions (>150% in North-East England and Scotland).
  
  
  CONCLUSIONS
  The differences in trends between regions seem too large to be explained by differential changes in working conditions, patterns of employment or the rigour with which claims were assessed. An alternative explanation could be that the main driver for the trends has been culturally determined changes in health beliefs and expectations, and that these cultural changes began in London and the South-East, only later spreading to other parts of Britain.
authors.affiliation: MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Kings College, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Cattrell
authors.forename: E C
authors.initials: EC
authors.lastname: Harris
authors.forename: K T
authors.initials: KT
authors.lastname: Palmer
authors.forename: M
authors.initials: M
authors.lastname: Kim
authors.forename: M
authors.initials: M
authors.lastname: Aylward
authors.forename: D
authors.initials: D
authors.lastname: Coggon
mesh_terms: D006801:Humans; D018868:Insurance, Disability / Q000706:statistics & numerical data / Q000639:trends*; D001523:Mental Disorders / Q000453:epidemiology*; D009140:Musculoskeletal Diseases / Q000453:epidemiology*; D012943:Social Security / Q000706:statistics & numerical data / Q000639:trends*; D006113:United Kingdom / Q000453:epidemiology