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. 2004 Feb;54(499):86–91.

Patient factors associated with duration of certified sickness absence and transition to long-term incapacity.

Chris Shiels 1, Mark B Gabbay 1, Fiona Mary Ford 1
PMCID: PMC1314799  PMID: 14965385

Abstract

BACKGROUND: Despite a considerable increase in claims for long-term sickness benefits, and the impact of certifying sickness upon general practitioner (GP) workload, little is known about transition to long-term incapacity for work. AIM: To explore the relationship between patient factors and the transition from short-term to long-term work incapacity, in particular focusing on mild mental health and musculoskeletal problems. SETTING: Nine practices comprising the Mersey Primary Care R&D Consortium. DESIGN: Prospective data collection and audit of sickness certificate details. METHOD: GPs issued carbonised sickness certificates for a period of 12 months. The resulting baseline dataset included claimant diagnosis, age, sex, postcode-derived deprivation score, and sickness episode duration. Associations of patient factors with sickness duration outcomes were tested. RESULTS: Mild mental disorder accounted for nearly 40% of certified sickness. Relatively few claimants had their diagnosis changed during a sickness episode. Risk factors for longer-term incapacity included increasing age, social deprivation, mild and severe mental disorder, neoplasm, and congenital illness. For mild mental disorder claimants, age, addiction, and deprivation were risk factors for relatively longer incapacity. For musculoskeletal problems, the development of chronic incapacity was significantly related to the nature of the problem. Back pain claimants were likely to return to work sooner than those with other musculoskeletal problems. CONCLUSIONS: In addition to the presenting diagnosis, a range of factors is associated with the development of chronic incapacity for work, including age and social deprivation. GPs should consider these when negotiating sickness certification with patients.

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Selected References

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  1. Akerlind I., Alexanderson K., Hensing G., Leijon M., Bjurulf P. Sex differences in sickness absence in relation to parental status. Scand J Soc Med. 1996 Mar;24(1):27–35. doi: 10.1177/140349489602400105. [DOI] [PubMed] [Google Scholar]
  2. Alexanderson K., Leijon M., Akerlind I., Rydh H., Bjurulf P. Epidemiology of sickness absence in a Swedish county in 1985, 1986 and 1987. A three year longitudinal study with focus on gender, age and occupation. Scand J Soc Med. 1994 Mar;22(1):27–34. doi: 10.1177/140349489402200105. [DOI] [PubMed] [Google Scholar]
  3. Alexanderson K. Sickness absence: a review of performed studies with focused on levels of exposures and theories utilized. Scand J Soc Med. 1998 Dec;26(4):241–249. doi: 10.1177/14034948980260040301. [DOI] [PubMed] [Google Scholar]
  4. Arrelöv Britt, Borgquist Lars, Ljungberg Dan, Svärdsudd Kurt. The influence of change of legislation concerning sickness absence on physicians' performance as certifiers. A population-based study. Health Policy. 2003 Mar;63(3):259–268. doi: 10.1016/s0168-8510(02)00081-7. [DOI] [PubMed] [Google Scholar]
  5. Blank N., Diderichsen F. Short-term and long-term sick-leave in Sweden: relationships with social circumstances, working conditions and gender. Scand J Soc Med. 1995 Dec;23(4):265–272. doi: 10.1177/140349489502300408. [DOI] [PubMed] [Google Scholar]
  6. Brage S., Nygård J. F., Tellnes G. The gender gap in musculoskeletal-related long-term sickness absence in Norway. Scand J Soc Med. 1998 Mar;26(1):34–43. doi: 10.1177/14034948980260010901. [DOI] [PubMed] [Google Scholar]
  7. Englund L., Svärdsudd K. Sick-listing habits among general practitioners in a Swedish county. Scand J Prim Health Care. 2000 Jun;18(2):81–86. doi: 10.1080/028134300750018954. [DOI] [PubMed] [Google Scholar]
  8. Feeney A., North F., Head J., Canner R., Marmot M. Socioeconomic and sex differentials in reason for sickness absence from the Whitehall II Study. Occup Environ Med. 1998 Feb;55(2):91–98. doi: 10.1136/oem.55.2.91. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Ford F. M., Ford J., Dowrick C. Welfare to work: the role of general practice. Br J Gen Pract. 2000 Jun;50(455):497–500. [PMC free article] [PubMed] [Google Scholar]
  10. Hensing G., Brage S., Nygård J. F., Sandanger I., Tellnes G. Sickness absence with psychiatric disorders--an increased risk for marginalisation among men? Soc Psychiatry Psychiatr Epidemiol. 2000 Aug;35(8):335–340. doi: 10.1007/s001270050247. [DOI] [PubMed] [Google Scholar]
  11. Marmot M. G., North F., Feeney A., Head J. Alcohol consumption and sickness absence: from the Whitehall II study. Addiction. 1993 Mar;88(3):369–382. doi: 10.1111/j.1360-0443.1993.tb00824.x. [DOI] [PubMed] [Google Scholar]
  12. Marmot M., Feeney A., Shipley M., North F., Syme S. L. Sickness absence as a measure of health status and functioning: from the UK Whitehall II study. J Epidemiol Community Health. 1995 Apr;49(2):124–130. doi: 10.1136/jech.49.2.124. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Mastekaasa A. Parenthood, gender and sickness absence. Soc Sci Med. 2000 Jun;50(12):1827–1842. doi: 10.1016/s0277-9536(99)00420-7. [DOI] [PubMed] [Google Scholar]
  14. Mechanic D. The concept of illness behaviour: culture, situation and personal predisposition. Psychol Med. 1986 Feb;16(1):1–7. doi: 10.1017/s0033291700002476. [DOI] [PubMed] [Google Scholar]
  15. North F., Syme S. L., Feeney A., Head J., Shipley M. J., Marmot M. G. Explaining socioeconomic differences in sickness absence: the Whitehall II Study. BMJ. 1993 Feb 6;306(6874):361–366. doi: 10.1136/bmj.306.6874.361. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. O'Neil M., Payne C., Read J. Read Codes Version 3: a user led terminology. Methods Inf Med. 1995 Mar;34(1-2):187–192. [PubMed] [Google Scholar]
  18. Pincus Tamar, Burton A. Kim, Vogel Steve, Field Andy P. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine (Phila Pa 1976) 2002 Mar 1;27(5):E109–E120. doi: 10.1097/00007632-200203010-00017. [DOI] [PubMed] [Google Scholar]
  19. Rael E. G., Stansfeld S. A., Shipley M., Head J., Feeney A., Marmot M. Sickness absence in the Whitehall II study, London: the role of social support and material problems. J Epidemiol Community Health. 1995 Oct;49(5):474–481. doi: 10.1136/jech.49.5.474. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Reiso H., Nygård J. F., Brage S., Gulbrandsen P., Tellnes G. Work ability and duration of certified sickness absence. Scand J Public Health. 2001 Sep;29(3):218–225. [PubMed] [Google Scholar]
  21. Sandanger I., Nygård J. F., Brage S., Tellnes G. Relation between health problems and sickness absence: gender and age differences--a comparison of low-back pain, psychiatric disorders, and injuries. Scand J Public Health. 2000 Dec;28(4):244–252. [PubMed] [Google Scholar]
  22. Sawney Philip. Current issues in fitness for work certification. Br J Gen Pract. 2002 Mar;52(476):217–222. [PMC free article] [PubMed] [Google Scholar]
  23. Tellnes G., Bruusgaard D., Sandvik L. Occupational factors in sickness certification. Scand J Prim Health Care. 1990 Mar;8(1):37–44. doi: 10.3109/02813439008994927. [DOI] [PubMed] [Google Scholar]
  24. Webb Clyde B., Broome Jon R. Sickness absence certification: time for a rethink? Br J Gen Pract. 2003 Apr;53(489):325–326. [PMC free article] [PubMed] [Google Scholar]

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