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Br J Gen Pract. Feb 2004; 54(499): 86–91.
PMCID: PMC1314799

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


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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  • Mechanic D. The concept of illness behaviour: culture, situation and personal predisposition. Psychol Med. 1986 Feb;16(1):1–7. [PubMed]
  • 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. [PubMed]
  • The Back Pages. Br J Gen Pract. 1998 Jun;48(431):1353–1370. [PMC free article]
  • Sawney Philip. Current issues in fitness for work certification. Br J Gen Pract. 2002 Mar;52(476):217–222. [PMC free article] [PubMed]
  • Ford FM, 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]
  • 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]
  • North F, Syme SL, Feeney A, Head J, Shipley MJ, Marmot MG. Explaining socioeconomic differences in sickness absence: the Whitehall II Study. BMJ. 1993 Feb 6;306(6874):361–366. [PMC free article] [PubMed]
  • Rael EG, Stansfeld SA, 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. [PMC free article] [PubMed]
  • Marmot MG, North F, Feeney A, Head J. Alcohol consumption and sickness absence: from the Whitehall II study. Addiction. 1993 Mar;88(3):369–382. [PubMed]
  • 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. [PMC free article] [PubMed]
  • Marmot M, Feeney A, Shipley M, North F, Syme SL. 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. [PMC free article] [PubMed]
  • 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. [PubMed]
  • Brage S, Nygård JF, Tellnes G. The gender gap in musculoskeletal-related long-term sickness absence in Norway. Scand J Soc Med. 1998 Mar;26(1):34–43. [PubMed]
  • Hensing G, Brage S, Nygård JF, 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. [PubMed]
  • Sandanger I, Nygård JF, 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]
  • 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. [PubMed]
  • 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. [PubMed]
  • Mastekaasa A. Parenthood, gender and sickness absence. Soc Sci Med. 2000 Jun;50(12):1827–1842. [PubMed]
  • 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]
  • Tellnes G, Bruusgaard D, Sandvik L. Occupational factors in sickness certification. Scand J Prim Health Care. 1990 Mar;8(1):37–44. [PubMed]
  • 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. [PubMed]
  • Reiso H, Nygård JF, 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]
  • 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. [PubMed]
  • 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. [PubMed]

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