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Purpose: The purpose of this article is to investigate actions taken by the Social Insurance Agency (SIA) for long-term sickness absentees and possible associations of this with future sick leave or disability pension., Method: For 384 long-term sickness absentees who had had a multidisciplinary medical assessment (MMA) during 2001-2006, three types of data were obtained: (1) case file information about SIA actions, (2) suggested rehabilitation measures from the MMA and (3) sickness absence and disability pension data., Results: Most individuals had been subject to a range of actions by the SIA. Sixty percent had been invited to a coordination meeting, and half of those who assessed by the MMA for vocational rehabilitation were approved to get it by the SIA. Few SIA actions were associated with full or partial return to work., Conclusions: Although the studied individuals had been on sick leave for a long time, the number of SIA actions related to vocational rehabilitation was limited and came late in the sick-leave spell. The information from the MMA was often not used as a basis for further SIA action and seldom resulted in return to work. The positive MMA views on the potential of vocational rehabilitation were not met by SIA actions., Implications for Rehabilitation: Suggestions on vocational rehabilitation from a medical assessment was in many cases not used by the social insurance agency in relationship to long-term sickness absentees. Active rehabilitation measures by the social insurance agency were few and came late in the sickness absence process. Few of the activities taken by the social insurance agency enhanced return to work.

Objective: To assess the associations between psychological factors and return to work among long-term sickness absentees., Design: Longitudinal study with a 3-year follow-up., Subjects: Long-term sickness absentees (n = 905) who had undergone a multidisciplinary medical assessment., Methods: Three years after multidisciplinary medical assessment, return to work status (full, partial, or none) was determined according to whether the individuals received full, partial, or no sickness benefits. Multinomial logistic regression analyses were performed to assess the odds ratios with 95% confidence intervals for return to work related to indecision, lassitude, fatigability, reduced sleep, social functioning, emotional role limitations, and vitality., Results: After adjusting for socio-demographic factors and medical diagnoses most of the studied psychological factors were significantly associated with full (odds ratios 2.13-1.50) and partial (odds ratios 2.25-1.63) return to work in the follow-up period. Low level of lassitude was associated with full return to work (odds ratio 1.72) even when the other psychological factors were controlled for. Similarly, low fatigability was associated with partial return to work (odds ratio 1.81)., Conclusion: This study indicates that psychological factors are important for both full and partial return to work among long-term sickness absentees who have undergone a multidisciplinary medical assessment.

Aims: The aim was to study whether sick-leave diagnoses of long-term sickness absentees were modified after a multidisciplinary assessment and if modifications differed with type of medical specialty of the latest physician to sick-list the patient., Methods: A sample of 635 long-term sickness absentees referred to a multidisciplinary assessment by Social Insurance Offices was included. Data were obtained through sickness certificates and medical records. Patients were examined by board-certified specialists in psychiatry, orthopaedic surgery, and rehabilitation medicine. Descriptive statistics were used., Results: The multidisciplinary assessment resulted in an increase from 1-2 to 2-3 diagnoses for most patients. Forty-five per cent of the male and 47% of the female patients had only somatic diagnoses at referral. After the multidisciplinary assessment these percentages were 20% and 29%, respectively. The rate of women and men given both psychiatric and somatic diagnoses increased from 30% at referral to about 55%. The shift from either only psychiatric or only somatic diagnoses to having these diagnoses in combination was associated with type of specialty of the physician who had sick-listed the patient., Conclusions: The study indicates that many patients on long-term sick-leave with unclear diagnoses may suffer from unrecognized, and therefore probably untreated, medical disorders and co-morbidity.

The number of patients with difficulty in resuming work after long-term sick leave has increased in several European countries including Sweden. The general aim of this study was a comprehensive description--based on multidisciplinary diagnostics and assessments--of patients with the common feature of marked difficulty in resuming working life after a long absence. A particular aim was to elucidate the possible effect of comorbidity on pain descriptors, disability, quality of life, assessed working ability and rehabilitation needs. Six hundred and thirty-five long-term sick leavers were referred from National Insurance Offices and consecutively accepted for investigation. Several self-report questionnaires were used. All patients were examined by three board-certified specialist physicians in psychiatry, orthopaedic surgery and rehabilitation medicine, respectively. Fifty-five percent of the patients had psychiatric-somatic comorbidity. The three most frequent combinations of diagnoses in the comorbidity group were fibromyalgia/myalgia and depressive episode, fibromyalgia/myalgia and recurrent depression, spinal pain and depressive episode, whereas the three most frequent in those with psychiatric diagnosis only were depressive episode, recurrent depression, phobias/anxiety. Differences in pain descriptors and in difficulties with activities were found among the three groups. All had lower health-related quality of life than references. Only one-sixth had no assessed working capacity and only 3% were assessed as able to resume work without rehabilitation; 80% were multidisciplinarily assessed as needing rehabilitation. Patients with psychiatric diagnoses, with or without concomitant somatic diagnoses, need medical rehabilitation or medical/vocational rehabilitation in combination to a greater extent than patients with somatic diagnoses only. This implies that medical rehabilitation programmes ought to adapt increasingly to the needs of patients with psychiatric-somatic comorbidity.

Aims: In Sweden, the Social Insurance Offices each year refer long-term sickness absentees to comprehensive investigations to clarify medical conditions. However, there is a lack of scientific knowledge about these patients and their morbidity. The aim was to characterize a population of these sickness absentees regarding prevalence of somatic and psychiatric diagnoses and possible associations with sociodemographic, lifestyle, and health characteristics., Methods: A cross-sectional study was made up of 635 sickness absentees below the age of 64, who the local Social Insurance Offices in Stockholm County, Sweden, referred to a special unit for multidisciplinary investigation. Data was obtained from questionnaires and medical records. The patients were examined by board certified specialists in psychiatry, orthopaedic surgery, and rehabilitation medicine. Relative risks were estimated by use of modified Poisson regression to assess the associations between characteristics and diagnose outcomes., Results: About 80% of the patients had more than one diagnosis. The vast majority had a psychiatric diagnosis, and approximately 55% had that in combination with at least one somatic diagnosis. An increased risk for being given a psychiatric diagnosis was found for men and unemployed people. In addition, lack of social life and friends and self-reported mental health problems were associated with psychiatric diagnoses but also among those who were given somatic diagnoses in combination with psychiatric diagnoses. Increased risks for somatic diagnoses were found for women and for patients with a higher education., Conclusions: Long-term sickness absentees referred to multidisciplinary investigations display high co-morbidity of psychiatric and somatic diagnoses and are a heterogeneous group with diverse sociodemographic and medical characteristics.

Objective: The aim was to investigate the results of multidisciplinary investigations of long-term sickness absentees regarding diagnoses, degree and prognoses of work incapacity, and need of rehabilitation measures and whether this was associated with socio-demographic factors., Method: A cross-sectional study of 545 long-term (>1 year) sickness absentees referred to multidisciplinary investigations by the Social Insurance Office. Data was obtained from questionnaires and medical records. The patients were examined by specialists in psychiatry, orthopaedic surgery, and rehabilitation medicine who afterwards agreed on diagnoses, work incapacity, time to return to work (RTW), and rehabilitation measures. Descriptive statistics and logistic regression were used for description and analyses of data. Data on age, country of birth, education, employment and marital status were included., Results: The prevalence of psychiatric diagnoses was 72%, and 58% of the patients had that in combination with somatic diagnoses. Most patients were assessed to be capable of RTW within 6 - 24 months after further rehabilitation measures. Higher age was associated with a negative prognosis of RTW and those patients were less often recommended additional rehabilitation., Conclusion: Despite long-term sickness absence and high rates of psychiatric and somatic diagnoses in combination, RTW was considered possible for most patients after further rehabilitation measures.