Background. Undetected Common Mental Disorders (CMDs) amongst people on sick leave complicate rehabilitation and return to work because appropriate treatments are not initiated. Aims. The aim of this study is to estimate (1) the frequencies of CMD, (2) the predictors of undetected CMD, and (3) the rate of return to work among sick listed individuals without a psychiatric disorder, who are registered on long-term sickness absence (LSA). Methods. A total of 2,414 incident individuals on LSA with a response rate of 46.4%, were identified for a two-phase study. The subsample of this study involved individuals registered on LSA who were sick-listed without a psychiatric sick leave diagnosis. In this respect, Phase 1 included 831 individuals, who were screened for mental disorders. In Phase 2, following the screening of Phase 1, 227 individuals were thoroughly examined by a psychiatrist applying Present State Examination. The analyses of the study were carried out based on the 227 individuals from Phase 2 and, subsequently, weighted to be representative of the 831 individuals in Phase 1. Results. The frequencies of undetected mental disorders among all sick-listed individuals were for any psychiatric diagnosis 21%, depression 14%, anxiety 4%, and somatoform disorder 6%. Conclusions. Undetected CMD may delay the initiation of appropriate treatment and complicate the rehabilitation and return to work. 1. Background Common Mental Disorders (CMDs) impose suffering on and reduce quality of life of the individuals. They also place economic burdens on society, primarily due to indirect costs in regards to sickness absence, early retirement, and early death [1, 2]. In addition, depressive disorders significantly influence the outcome of comorbid medical illnesses such as cardiac diseases, diabetes, and cancer [3]. Furthermore, the emergence of a depression in an individual is likely to cause family dysfunction and risks of mental and physical illnesses among family members as well [4]. The burden of CMD may be even heavier than estimated in previous studies of this kind because CMDs are overlooked. This has been documented in primary care [5–12], in work places [13], in granting of disability pension [14], and among patient populations such as patients with, for example, chronic musculoskeletal pain [15], and in writing sick leave certificates [16–18]. Undetected mental disorders in primary care and sick leave certificates apply to the present study because the study is based on sickness absence and because sick leave certificates for the most part are certified in
References
[1]
P. Andlin-Sobocki, B. J?nsson, H. U. Wittchen, and J. Olesen, “Cost of disorders of the brain in Europe,” European Journal of Neurology, vol. 12, supplement 1, pp. 1–27, 2005.
[2]
W. Hiller, W. Rief, and M. M. Fichter, “How disabled are patients with somatoform disorders?” General Hospital Psychiatry, vol. 19, no. 6, pp. 432–438, 1997.
[3]
P. Cassano and M. Fava, “Depression and public health: an overview,” Journal of Psychosomatic Research, vol. 53, no. 4, pp. 849–857, 2002.
[4]
M. Sobieraj, J. Williams, J. Marley, and P. Ryan, “The impact of depression on the physical health of family members,” British Journal of General Practice, vol. 48, no. 435, pp. 1653–1655, 1998.
[5]
K. S. Christensen, T. Toft, L. Frostholm, E. ?rnb?l, P. Fink, and F. Olesen, “Screening for common mental disorders: Who will benefit? Results from a randomised clinical trial,” Family Practice, vol. 22, no. 4, pp. 428–434, 2005.
[6]
H. Karlsson, M. Joukamaa, and V. Lehtinen, “Differences between patients with identified and not identified psychiatric disorders in primary care,” Acta Psychiatrica Scandinavica, vol. 102, no. 5, pp. 354–358, 2000.
[7]
T. L. Schwenk, M. S. Klinkman, and J. C. Coyne, “Depression in the family physician's office: what the psychiatrist needs to know: the Michigan Depression Project,” Journal of Clinical Psychiatry, vol. 59, no. 20, pp. 94–100, 1998.
[8]
J. C. Coyne, “Nondetection of depression by primary care physicians reconsidered,” General Hospital Psychiatry, vol. 17, no. 1, pp. 3–12, 1995.
[9]
R. Stromberg, E. Wernering, A. Aberg-Wistedt, A. K. Furhoff, S. E. Johansson, and L. G. Backlund, “Screening and diagnosing depression in women visiting GPs' drop in clinic in Primary Health Care,” BMC Family Practice, vol. 9, article no. 34, 2008.
[10]
M. Balestrieri, M. G. Carta, S. Leonetti, G. Sebastiani, F. Starace, and C. Bellantuono, “Recognition of depression and appropriateness of antidepressant treatment in Italian primary care,” Social Psychiatry and Psychiatric Epidemiology, vol. 39, no. 3, pp. 171–176, 2004.
[11]
P. Munk-J?rgensen, P. Fink, J. I. Brevik et al., “Psychiatric morbidity in primary public health care: a multicentre investigation. Part II. Hidden morbidity and choice of treatment,” Acta Psychiatrica Scandinavica, vol. 95, no. 1, pp. 6–12, 1997.
[12]
J. Ormel, W. Van den Brink, M. W. J. Koeter et al., “Recognition, management and outcome of psychological disorders in primary care: a naturalistic follow-up study,” Psychological Medicine, vol. 20, no. 4, pp. 909–923, 1990.
[13]
R. Jenkins, “Minor psychiatric morbidity in employed young men and women and its contribution to sickness absence,” British Journal of Industrial Medicine, vol. 42, no. 3, pp. 147–154, 1985.
[14]
A. Mykletun, S. Overland, A. A. Dahl et al., “A population-based cohort study of the effect of common mental disorders on disability pension awards,” American Journal of Psychiatry, vol. 163, no. 8, pp. 1412–1418, 2006.
[15]
P. Olaya-Contreras, T. Persson, and P. Styf, “Comparison between the Beck Depression Inventory and psychiatric evaluation of distress in patients on long-term sickness leave due to chronic musculoskeletal pain,” Journal of Multidisciplinary Healthcare, vol. 3, pp. 161–167, 2010.
[16]
G. Hensing and F. Spak, “Psychiatric disorders as a factor in sick-leave due to other diagnoses: a general population-based study,” British Journal of Psychiatry, vol. 172, pp. 250–256, 1998.
[17]
J. H. S?gaard and P. Bech, “Psychiatric disorders in long-term sickness absence—a population-based cross-sectional study,” Scandinavian Journal of Public Health, vol. 37, no. 7, pp. 682–689, 2009.
[18]
S. Stansfeld, A. Feeney, J. Head, R. Canner, F. North, and M. Marmot, “Sickness absence for psychiatric illness: the Whitehall II study,” Social Science and Medicine, vol. 40, no. 2, pp. 189–197, 1995.
[19]
K. S. Christensen, P. Fink, T. Toft, L. Frostholm, E. ?rnb?l, and F. Olesen, “A brief case-finding questionnaire for common mental disorders: The CMDQ,” Family Practice, vol. 22, no. 4, pp. 448–457, 2005.
[20]
SCAN, “Schedules for Clinical Assessment in Neuropsychiatry (Computer Program),” World Health Organization, Geneva, Switzerland, 1994, http://www.whoscan.org/.
[21]
World Health Organisation, International Statistical Classification of Diseases and Related Health Problems, World Health Organisation, Geneve, Switzerland, 2006.
[22]
L. R. Olsen, E. L. Mortensen, and P. Bech, “The SCL-90 and SCL-90R versions validated by item response models in a Danish community sample,” Acta Psychiatrica Scandinavica, vol. 110, no. 3, pp. 225–229, 2004.
[23]
L. R. Derogatis, SCL-90-R. Administration, Scoring, and Procedures. MANUAL-II, Clinical Psychometric Research, Towson, Md, USA, 1983.
[24]
P. Fink, E. ?rnb?l, M. S. Hansen, L. S?ndergaard, and P. De Jonge, “Detecting mental disorders in general hospitals by the SCL-8 scale,” Journal of Psychosomatic Research, vol. 56, no. 3, pp. 371–375, 2004.
[25]
P. Fink, H. Ewald, J. Jensen et al., “Screening for somatization and hypochondriasis in primary care and neurological in-patients: a seven-item scale for hypochondriasis and somatization,” Journal of Psychosomatic Research, vol. 46, no. 3, pp. 261–273, 1999.
[26]
I. Pilowsky, “Dimensions of illness behaviour as measured by the illness behaviour questionnaire: a replication study,” Journal of Psychosomatic Research, vol. 37, no. 1, pp. 53–62, 1993.
[27]
D. A. Fiellin, M. C. Reid, and P. G. O'Connor, “Screening for alcohol problems in primary care: a systematic review,” Archives of Internal Medicine, vol. 160, no. 13, pp. 1977–1989, 2000.
[28]
H. J. S?gaard and P. Bech, “Predictive validity of common mental disorders screening questionnaire as a screening instrument in long term sickness absence,” Scandinavian journal of public health, vol. 38, no. 4, pp. 375–385, 2010.
[29]
H. Lamberts and M. Wood, ICPC, International Classification of Primary Care, Oxford University Press, Oxford, UK, 1987.
[30]
G. Bisoffi, M. A. Mazzi, and G. Dunn, “Evaluating screening questionnaires using Receiver Operating Characteristic (ROC) curves from two-phase (double) samples,” International Journal of Methods in Psychiatric Research, vol. 9, no. 3, pp. 121–130, 2000.
[31]
G. Dunn, A. Pickles, M. Tansella, and J. L. Vázquez-Barquero, “Two-phase epidemiological surveys in psychiatric research: Editorial,” British Journal of Psychiatry, vol. 174, pp. 95–100, 1999.
[32]
R. Str?mberg, L. G. Backlund, and M. L?fvander, “Psychosocial stressors and depression at a Swedish primary health care centre. A gender perspective study,” BMC Family Practice, vol. 12, article 120, 2011.
[33]
P. A. Nutting, K. Rost, M. Dickinson et al., “Barriers to initiating depression treatment in primary care practice,” Journal of General Internal Medicine, vol. 17, no. 2, pp. 103–111, 2002.
[34]
N. Akhtar-Danesh and J. Landeen, “Relation between depression and sociodemographic factors,” International Journal of Mental Health Systems, vol. 1, article no. 4, 2007.
[35]
J. Alonso, M. C. Angermeyer, S. Bernert et al., “Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project,” Acta Psychiatrica Scandinavica, Supplement, vol. 109, supplement 420, pp. 21–27, 2004.
[36]
P. Bebbington, G. Dunn, R. Jenkins et al., “The influence of age and sex on the prevalence of depressive conditions: report from the National Survey of Psychiatric Morbidity,” International Review of Psychiatry, vol. 15, no. 1-2, pp. 74–83, 2003.
[37]
R. V. Bijl, A. Ravelli, and G. Van Zessen, “Prevalence of psychiatric disorder in the general population: results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS),” Social Psychiatry and Psychiatric Epidemiology, vol. 33, no. 12, pp. 587–595, 1998.
[38]
R. V. Bijl, R. de Graaf, A. Ravelli, F. Smit, and W. A. M. Vollebergh, “Gender and age-specific first incidence of DSM-III-R psychiatric disorders in the general population. Results from the Netherlands mental health survey and incidence study (NEMESIS),” Social Psychiatry and Psychiatric Epidemiology, vol. 37, no. 8, pp. 372–379, 2002.
[39]
R. Jenkins, G. Lewis, P. Bebbington et al., “The National Psychiatric Morbidity Surveys of Great Britain—initial findings from the Household Survey,” Psychological Medicine, vol. 27, no. 4, pp. 775–789, 1997.
[40]
R. C. Kessler, K. A. McGonagle, S. Zhao et al., “Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey,” Archives of General Psychiatry, vol. 51, no. 1, pp. 8–19, 1994.
[41]
S. Lindeman, J. H?m?l?inen, E. Isomets? et al., “The 12-month prevalence and risk factors for major depressive episode in Finland: representative sample of 5993 adults,” Acta Psychiatrica Scandinavica, vol. 102, no. 3, pp. 178–184, 2000.
[42]
P. Hodiamont, N. Peer, and N. Syben, “Epidemiological aspects of psychiatric disorder in a Dutch health area,” Psychological Medicine, vol. 17, no. 2, pp. 495–506, 1987.
[43]
J. Peen, J. Dekker, R. A. Schoevers, M. ten Have, R. Graaf, and A. T. Beekman, “Is the prevalence of psychiatric disorders associated with urbanization?” Social Psychiatry and Psychiatric Epidemiology, vol. 42, no. 12, pp. 984–989, 2007.
[44]
D. R. Offord, M. H. Boyle, D. Campbell et al., “One-year prevalence of psychiatric disorder in Ontarians 15 to 64 years of age,” Canadian Journal of Psychiatry, vol. 41, no. 9, pp. 559–563, 1996.
[45]
W. E. Broadhead, D. G. Blazer, L. K. George, and C. K. Tse, “Depression, disability days, and days lost from work in a prospective epidemiologic survey,” Journal of the American Medical Association, vol. 264, no. 19, pp. 2524–2528, 1990.
[46]
R. C. Kessler and R. G. Frank, “The impact of psychiatric disorders on work loss days,” Psychological Medicine, vol. 27, no. 4, pp. 861–873, 1997.
[47]
R. C. Kessler, P. E. Greenberg, K. D. Mickelson, L. M. Meneades, and P. S. Wang, “The effects of chronic medical conditions on work loss and work cutback,” Journal of Occupational and Environmental Medicine, vol. 43, no. 3, pp. 218–225, 2001.
[48]
R. C. Kessler, J. Ormel, O. Demler, and P. E. Stang, “Comorbid mental disorders account for the role impairment of commonly occurring chronic physical disorders: results from the National Comorbidity Survey,” Journal of Occupational and Environmental Medicine, vol. 45, no. 12, pp. 1257–1266, 2003.
[49]
G. Hensing, S. Brage, J. F. Nyg?rd, I. Sandanger, and G. Tellnes, “Sickness absence with psychiatric disorders—an increased risk for marginalisation among men?” Social Psychiatry and Psychiatric Epidemiology, vol. 35, no. 8, pp. 335–340, 2000.
[50]
P. Esh?j, J. R. Jepsen, and C. V. Nielsen, “Long-term sickness absence—risk indicators among occupationally active residents of a Danish county,” Occupational Medicine, vol. 51, no. 5, pp. 347–353, 2001.
[51]
M. Marmot, A. Feeney, M. Shipley, F. North, and S. L. Syme, “Sickness absence as a measure of health status and functioning: from the UK Whitehall II study,” Journal of Epidemiology and Community Health, vol. 49, no. 2, pp. 124–130, 1995.
[52]
S. Gjesdal and E. Bratberg, “Diagnosis and duration of sickness absence as predictors for disability pension: results from a three-year, multi-register based* and prospective study,” Scandinavian Journal of Public Health, vol. 31, no. 4, pp. 246–254, 2003.
[53]
C. Shiels, M. B. Gabbay, and F. M. Ford, “Patient factors associated with duration of certified sickness absence and transition to long-term incapacity,” British Journal of General Practice, vol. 54, no. 499, pp. 86–91, 2004.
[54]
A. Feeney, F. North, J. Head, R. Canner, and M. Marmot, “Socioeconomic and sex differentials in reason for sickness absence from the whitehall II study,” Occupational and Environmental Medicine, vol. 55, no. 2, pp. 91–98, 1998.
[55]
P. Nystuen, K. B. Hagen, and J. Herrin, “Mental health problems as a cause of long-term sick leave in the Norwegian workforce,” Scandinavian Journal of Public Health, vol. 29, no. 3, pp. 175–182, 2001.
[56]
G. Hensing, K. Alexanderson, P. Allebeck, and P. Bjurulf, “Sick-leave due to psychiatric disorder: higher incidence among women and longer duration for men,” British Journal of Psychiatry, vol. 169, no. 6, pp. 740–746, 1996.