The duration of a person's unfitness for work is determined by more than his/her primary diagnosis. Patients often report psychological problems and a feeling of being burnt out. Antonius Schneider and colleagues analyzed whether an association exists between such psychological symptoms and the length of sick leave, even if patients received their sick note because of purely physical symptoms, such as back pain (Dtsch Arztebl Int 2017; 114: 291-7).
The researchers studied the data of 225 patients, from 14 general practices, who had been issued with a sickness certificate. The diagnoses that prompted the sick leave varied. Respiratory disorders and disorders of the musculoskeletal system were the most common diagnoses. The longest mean periods of sick leave were documented for patients with diagnoses of skin diseases and mental disorders. All study participants completed a questionnaire that included the Maslach Burnout Inventory, General Survey, and Patient Health Questionnaire, with the scales depression, somatization, and anxiety. Patients' characteristics such as sex, age, relationship status, and educational attainment were also captured.
For the total study population, doctors' sick notes were associated with longer periods of sick leave in patients with a lower level of educational attainment (less than 10 years of schooling), independently of the primary diagnosis. An association existed between the length of the sick leave period and emotional exhaustion, depersonalization, depression, anxiety, and somatization. When study participants were excluded whose unfitness for work was primarily due to psychological and psychiatric diagnoses, the sick leave period correlated with emotional exhaustion, somatization, and—almost statistically significantly—with depression. Sex and relationship status were not relevant.
In a secondary analysis, age and formal education were associated with the duration of sick leave. Each year of increase in age led to an increase in the length of the sick leave period by 1.7%. In persons with higher levels of education, the length of sick leave was reduced by 40%. In terms of the psychological burden, an association of anxiety symptoms with the duration of unfitness to work was primarily noted.
The authors conclude that a holistic approach in patient-centered communication, such as is applied in case of depression and anxiety, may be helpful in psychological or physical symptoms of unknown origin during the consultation with the primary care physician.