Presentation M P22

M P22 (Poster Presentation):
A comparison of the abilities of the Symptom Check List of somatic symptoms, the Bodily Distress Syndrome Questionnaire and a one-item general self-rated health measure to predict return to work after long-term sickness absence in an observational study.

Presented by: Anne-Mette Hedeager Momsen

Authors

Momsen AH1, Stapelfeldt CM1, Nielsen CV2,1, Nielsen MD3,4, Rugulies R4,5,6, Jensen C7,8

  1. MarselisborgCentret, Public Health and Quality Improvement, Central Denmark Region
  2. Sections of Clinical Social Medicine and Rehabilitation, Institute of Public Health, Aarhus University, Denmark
  3. COWI, Lyngby, Denmark
  4. The National Research Centre for the Working Environment, Copenhagen, Denmark
  5. Department of Public Health, University of Copenhagen, Denmark
  6. Department of Psychology, University of Copenhagen, Denmark
  7. National Centre for Occupational Rehabilitation, Rauland, Norway
  8. Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway

Abstract

Background

Studies in populations with multiple symptoms report prolonged sickness absence and health-related job loss. Thus screening for symptoms may be helpful in sickness beneficiaries, as early recognition is important to prevent chronicity. Research is lacking on instruments to assess symptoms in relation to prediction of return to work (RTW). We compared three instruments’ ability to predict RTW in sick-listed beneficiaries in two Danish municipal jobcentres.

Methods

Participants (N=585) were working age adults on long-term sickness absence (>26 weeks). The instruments were the Symptom Check List of somatic distress symptoms (SCL-SOM), the Bodily Distress Syndrome questionnaire (BDSQ), and the one-item self-rated general health (SRH). RTW was identified in the Danish Register for Evaluation of Marginalisation, a register of public transfer payments. Different cut-points were analysed to find the highest number of correctly classified RTW cases (yes/no). The instruments’ predictive value was explored in a time-to event analysis and adjusted for age, gender, municipality, sick leave weeks the previous year and reason for sickness absence.

Results

Responders (n=312, 53%) were significantly older (p=0.03), and their reason for sickness absence differed from non-responders (p<0.001). Correctly classified absentees with RTW were achieved by cut-points derived from ROC curves with the three instruments: the SCL-SOM instrument (<16/>=16); corresponding to a sensitivity of 0.74 (95% CI: 0.67-0.80) and a specificity of 0.52 (95% CI: 0.43-0.61). With the BDSQ (<39/>=39); sensitivity was 0.76 (95% CI: 0.69-0.82) and specificity was 0.44 (95% CI: 0.36-0.54). For the one-item SRH (<5/=5); sensitivity was 0.86 (95% CI: 0.80-0.91) and specificity was 0.30 (95% CI: 0.22-0.39). However, 62.1% of absentees were correctly classified at the cut-point of SRH <4/=4 (fair-poor/good-excellent), at which the sensitivity declined to 0.78 and the corresponding specificity rose to 0.51. All three instruments were highly correlated. The relative risk (RR) regarding prediction of RTW adjusted for covariates was 0.89 (95% CI: 0.83-0.95), 0.89 (95% CI: 0.83-0.95), and 0.78 (95% CI: 0.70-0.86) per 5, 10 and 1 points increase in the SCL-SOM, BDSQ and SRH, respectively. When mutually adjusting for each of the instruments, only the RR 0.81 (95% CI: 0.72-0.92) for SRH remained significant.

Conclusions

All three instruments predicted RTW with the strongest prediction found for the one-item SRH instrument. The instruments were highly correlated. The sensitivities were relatively high; however, the specificities were low. The symptom scores were associated with the chance of RTW. The SRH item is easy to use and more suitable for the prediction of RTW after sickness absence than the SCL-SOM and BDSQ. Screening may thereby permit earlier and appropriate action in municipal jobcentres administrating sickness absence claimants. Using a shorter instrument has obvious benefits in terms of reduced costs and ease of interpretation.

Schedule Details

Monday September 29
12:45 - 13:45 Poster Viewing
Session: Disability measurement