Sick leave certification: a unique perspective on frequency and duration of episodes - a complete record of sickness certification in a defined population of employees in Malta

Data collected by company-employed FPs from a defined population was used: all employees of selected Maltese companies served by a group of FPs. The database included episode-based data from home visits over three years (01/01/1997 – 31/12/1999), by 9 company-appointed FPs regarding 421 employees of five companies.3015 episodes of sickness absenteeism, with an average duration of 2.9 days, were documented. Employees who did intensive manual work had relatively higher rates. Furthermore, a relatively higher incidence of work injury, sprains and strains, anxiety and depression and low back pain as found in manual workers, and in male workers. This trend was shown to be statistically significant.The frequency of sick-leave certification in Malta is comparable to that in other European countries, but the average duration of certificates is much less than reported in other studies that generally did not include data on short-term illness and certification. This has important implications on future research in the field. A number of common disorders were found to be significantly more prevalent causes of sickness certification in manual workers, amongst them anxiety and depression.Sick leave certification is an important element of family physicians' (FPs') day-to-day work, contributing significantly to their workload, as is certainly the case in Malta [1-7]. Certification of sick leave is a reflection of the burden of illness in the community, and of the influence of national, cultural and social characteristics. Notwithstanding the importance of sickness leave certification, which may exceed as a financial burden on society even the costs of drug prescribing [5,6], relatively little discussion of it is available in the literature. The FP's certification practice has been the subject of relatively little research as compared to studies focusing on absence from work because of sickness itself and on the extent to which the working environment contributes to health problem