Søren Brage

Increase in sickness absence with psychiatric diagnosis in Norway: a general population-based epidemiologic study of age, gender and regional distribution

BackgroundThe aim of this study was to assess the incidence of sickness absence with psychiatric diagnoses from 1994–2000, and the distribution across gender, age groups, diagnostic groups and regions in a general population.MethodsThe population at risk was defined as all individuals aged 16–66 years who were entitled to sickness benefits in 1994, 1996, 1998 and 2000 (n = 2,282,761 in 2000). All individuals with a full-time disability pension were excluded. The study included approximately 77% of the Norwegian population aged 16–66 years. For each year, the study base started on 1 January and ended on 31 December. Individuals that were sick-listed for more than 14/16 consecutive days with a psychiatric diagnosis on their medical certificate were selected as cases. Included in this study were data for Norway, the capital city Oslo and five regions in the southeast of the country.ResultsSickness absence with psychiatric diagnoses increased in all age groups, in women and men, and in all regions. At the national level, the cumulative incidence increased in women from 1.7% in 1994 to 4.6% in 2000, and in men from 0.8% in 1994 to 2.2% in 2000. The highest cumulative incidence was found in middle-aged women and men (30–59 years). Women had a higher incidence than men in all stratification groups. The cumulative incidences in 2000 varied between 4.6% to 5.6% in women in the different regions, and for men the corresponding figures were 2.1% to 3.2%. Throughout the four years studied, women in Oslo had more than twice as high incidence levels of sickness absence with alcohol and drug diagnoses as the country as a whole. There were some differences between regions in sickness absence with specific psychiatric diagnoses, but they were small and most comparisons were non-significant.ConclusionSickness absence with psychiatric diagnoses increased between 1994 and 2000 in Norway. The increase was highest in the middle-aged, and in women. Few regional differences were found. That the increase pervaded all stratification groups supports general explanations of the increase, such as changes in attitudes to psychiatric disorders in both patients and doctors, and increased mental distress probably associated with societal changes at a more structural level.

Sickness absence with psychiatric disorders--an increased risk for marginalisation among men?

Abstractu2002n Background: Sickness absence with psychiatric disorders is a major public health problem with serious consequences for the individual, the employer and society. The aim was to assess the occurrence of psychiatric sickness absence with special focus on sex differences. Methods: A nationwide sickness insurance register was used. Population at risk was defined as all individuals entitled to sickness benefits in 1994 (Nu2009=u20091,978,030). Those who were sick-listed for more than 14 consecutive days with a psychiatric diagnosis (nu2009=u200928,799) were selected as cases. Results: Of the population under study, 1.46% had at least one psychiatric sickness absence episode. Women had twice the male cumulative incidence of sickness absence for a psychiatric diagnosis. Cumulative incidence was highest among those aged 45–59 years. Men had more sickness absence days. Depression was the most common diagnosis among both women and men. Conclusion: Increased efforts are needed to recognise, treat and rehabilitate individuals with a lowered work capacity due to sickness absence. The increased risk of long sick-leave spells among men needs further attention.

Development of ICF core set for disability evaluation in social security

Purpose. The purpose of this paper is to report on the development of an ICF core set for functional assessment in disability claims in European social security systems. Method. A formal decision-making process was applied. First, national meetings suggested categories to be included in the core set. Thereafter, the members of EUMASS working group for ICF selected a core set based on these suggestions, in a formal voting procedure. Results. From 191 different suggestions for ICF categories given by the national meetings, 20 were selected for the core set. Five were from body functions and 15 from activities and participation. No category from environmental factors was included. Conclusion. The EUMASS working group successfully reached consensus on a core set for functional assessments in disability benefit claims. The core set is generic, and should be used by medical doctors. It is intended for evaluation of rights to long term benefits. For the assessment in short term sickness absence, return to work, and vocational rehabilitation, other core sets need to be developed. The usefulness of the ICF qualifiers for the level of functioning in disability assessment has yet to be established.

Does Smoking Aggravate Musculoskeletal Pain

The present study was based on data from the Norwegian Health Survey 1985, a nationwide interview survey with members of a representative sample of households. Our sample comprised all adult respondents who had reported musculoskeletal pain (n = 4490). Smokers experienced more intense pain than nonsmokers. The association between smoking and considerable/intense pain was, however, only seen in persons younger than 67 years. In this age group, smoking was related to intense pain in a logistic regression analysis (OR = 1.58; 95% CI: 1.24-2.00; p < 0.001), adjusting for age, gender, socioeconomic status, civil status, having children under 16, physical exercise, the presence of a musculoskeletal disease, and mental distress. The association remained significant after adjusting for workplace factors, social network factors, alcohol consumption, and intake of cod liver oil as dietary supplement.

Prevalence of low back pain and sickness absence: A ``borderline'' study in Norway and Sweden

Aims: Low back pain (LBP) is a major public health problem in both Norway and Sweden. The aim of the study was to estimate the prevalence of LBP and sickness absence due to LBP in two neighbouring regions in Norway and Sweden. The two areas have similar socioeconomic status, but differ in health benefit systems. Methods: A representative sample of 1,988 adults in Norway and 2,006 in Sweden completed questionnaires concerning LBP during 1999 and 2000. For this study only individuals in part or full time jobs, (n=1,158 in Norway and n=1,129 in Sweden) were included. Results: In Norway the lifetime prevalence was 60.7% and in Sweden 69.6%, the one-year prevalence was 40.5% and 47.2%, and the point prevalence 13.4% and 18.2% respectively. There was a significantly higher risk of reporting LBP in Sweden, even after controlling for gender, age, education, and physical workload. There was no difference in risk of self-certificated short-term sickness absence (1—3 days), but it was a 40% lower risk of sickness absence with medical sickness certification in Sweden compared with Norway. Conclusion: The prevalence of LBP was higher in the Swedish area than in the Norwegian. The risk of self-certificated sickness absence, however, showed no differences and the risk of medically certificated sickness absence was lower in the Swedish area. This contradiction might partly be explained by the economical ``disincentives in the Swedish health compensation system.

Musculoskeletal Pain: Concepts of Disease, Illness, and Sickness Certification in Health Professionals in Norway

Concepts of disease, illness (being ill), and criteria for issuing sickness certificate for musculoskeletal pain have been investigated by a postal survey based on case histories. Questionnaires were filled in by 898 individuals; 194 General Practitioners, 76 medical consultants working for the National Insurance Administration, 307 insurance clerks, and a representative sample (N = 321) of the general public. The concepts disease and illness are meaningful and used consistently by medical doctors for infectious disease and somatic problems. Discrepancies between the medical profession representatives and the general public were, in general, attributable to differences in information and knowledge about these somatic conditions. However, for musculoskeletal pain all groups had conceptual problems. In particular, there was a lack of consensus for issuing sickness certificates. For musculoskeletal pain conditions the doctors, as a group, seemed to score at random or 50-50 level for sickness certification. All groups, including medical doctors, were reluctant to accept depression and social problems as diseases, or to accept social problems as reasons for sickness certification. The decision criteria should be identified and systematized in order to establish whether it is possible to reach a consensus for subjective complaints.

Musculoskeletal disorders as causes of sick leave and disability benefits

BACKGROUNDnMusculoskeletal disorders make up a heterogeneous group. Our aim was to describe the variation in social insurance benefits for the most prevalent disorders within this group.nnnMATERIAL AND METHODSnThe study was based on the Norwegian labour and welfare administrations registers on sickness benefits and disability benefits.nnnRESULTSnOf the musculoskeletal disorders, low back conditions are the most frequent causes of sick leave and disability benefits, and account for 11 and 9% respectively. Neck and shoulder disorders are also common causes of sick leave, while osteoarthritis and fibromyalgia are common causes of disability benefits and each account for 5% of all new cases.nnnINTERPRETATIONnThe labour and welfare administration should continue to focus on musculoskeletal disorders to prevent long-term sick leave and permanent absence from work.

New rules meet established sickness certification practice: A focus-group study on the introduction of functional assessments in Norwegian primary care

Objective. To explore how general practitioners view and handle new standards for functional assessments in sickness certification practice. Design. Qualitative study using focus group interviews. Data were analysed according to Giorgis phenomenological approach and supported by theories on knowledge. Setting. General practitioners from three neighbouring counties in Norway. Subjects. Four focus groups with a total of 23 participants were recruited through the Norwegian Medical Association and its Continuous Medical Education system. Results. The participants reported difficulties and reluctance to act in accordance with new functional assessment demands on both a practical and a conceptual level. In established sickness certification practice functional assessment was described as an unspoken part of the medical examination. After the introduction of formal, written functional assessments they identified problems of terminology, communication, and trust. Strategies were developed to circumvent these problems. Conclusions. A gap was noticeable between the participants’ established practice and the new standards’ demand for a more theoretical and communicative functional assessment. The general lack of training, being confronted with new terminology, and increasingly high pressure to reduce sickness absences create an atmosphere of insecurity when assessing function.

A randomised comparison of a four- and a five-point scale version of the Norwegian Function Assessment Scale

BackgroundThere is variation in the number of response alternatives used within health-related questionnaires. This study compared a four-and a five-point scale version of the Norwegian Function Assessment Scale (NFAS) by evaluating data quality, internal consistency and validity.MethodsAll inhabitants in seven birth cohorts in the Ullensaker municipality of Norway were approached by means of a postal questionnaire. The NFAS was included as part of The Ullensaker Study 2004. The instrument comprises 39 items derived from the activities/participation component in the International Classification for Functioning, Disabilities and Health (ICF). The sample was computer-randomised to either the four-point or the five-point scale version.ResultsBoth versions of the NFAS had acceptable response rates and good data quality and internal consistency. The five-point scale version had better data quality in terms of missing data, end effects at the item and scale level, as well as higher levels of internal consistency. Construct validity was acceptable for both versions, demonstrated by correlations with instruments assessing similar aspects of health and comparisons with groups of individuals known to differ in their functioning according to existing evidence.ConclusionData quality, internal consistency and discriminative validity suggest that the five-point scale version should be used in future applications.

Functional ability in a population: normative survey data and reliability for the ICF based Norwegian Function Assessment Scale

BackgroundThe increasing focus on functional ability assessments in relation to sickness absence necessitates the measurement of population functional levels. This study assessed the reliability of the Norwegian Function Assessment Scale (NFAS) and presents normative population data.MethodsAll inhabitants in seven birth cohorts in Ullensaker municipality in 2004 were approached by means of a postal questionnaire. The NFAS was included as part of The Ullensaker Study 2004. The instrument comprises 39 items derived from the activities/participation component in the International Classification for Functioning, Disabilities and Health (ICF). Based on the results of principal component analysis, these items comprise seven domains. Non-parametric tests for independent samples were used to compare subgroups. Internal consistency was assessed by Cronbachs alpha. Two-week test-retest reliability was assessed by total proportions of agreement, weighted kappa, and intraclass correlation coefficient (ICC).ResultsThe response rate was 54% (1620 persons) and 75.4% (101 persons) for the retest. Items had low levels of missing data. Test-retest reliability was acceptable with high proportions of absolute agreement; kappa and ICC values ranged from 0.38 to 0.83 and 0.79 to 0.83, respectively. No difficulty on all 39 functional activities was reported by 33.1% of respondents. Females, older persons and persons with lower levels of education reported more functional problems than their respective counterparts (p < 0.05). The age gradient was most evident for three of the physical domains. For females aged 24–56 and males aged 44–76, a clear education gradient was present for three of the physical domains and one mental domain after adjusting for age and gender.ConclusionThis study presents population based normative data on functional ability, as measured by the NFAS. These data will serve as basis for the development of national population norms and are necessary for score interpretation. Data quality and test-retest reliability of the NFAS were acceptable.