Common mental disorders and long-term sickness absence in a general working population. The Hordaland Health Study.

OBJECTIVE: To examine and compare the prospective effect of the common mental disorders (CMD) anxiety and depression on duration and recurrence of sickness absence (SA), and to investigate whether the effect of CMD on SA is detectable over time. METHOD: Information from a large epidemiological health study (N = 13 436) was linked with official records of SA episodes lasting ≥16 days up to 6 years after participation. Common mental disorders were assessed with the Hospital Anxiety and Depression Scale (HADS). Associations were analysed with Cox regression and multinomial logistic regression models controlling for potential covariates. RESULTS: Comorbid anxiety and depression, and anxiety only were significant risk factors for SA after adjusting for covariates, whilst depression only was not. Anxiety and depression were stronger predictors for longer duration of SA episodes compared with shorter duration and associated with more frequent recurrence of SA. There was a general trend toward the effect of CMD on SA becoming weaker over time; however, the effect of anxiety only on SA remained stable throughout the follow-up. CONCLUSION: Common mental disorders are long-lasting predictors of onset, duration and recurrence of SA. Anxiety appears to be a more important contributor to long-term SA than previously described in the literature.

Personality disorders, common mental disorders and receipt of disability benefits: evidence from the British National Survey of Psychiatric Morbidity.

BACKGROUND: Common mental disorders (CMDs) are associated with occupational impairment and the receipt of disability benefits (DBs). Little is known about the relationship between personality disorders (PDs) and work disability, and whether the association between CMDs and work disability is affected by the presence of co-morbid PDs. The aim of this study was to examine the association between DB and individual categories of PDs, with special attention to the effect of co-morbid CMDs on this association. METHOD: The association between DB and PD was examined using data from the 2000 British National Survey of Psychiatric Morbidity. Probable PD caseness was identified using the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) screening questionnaire. The impact of CMDs, assessed with the revised version of the Clinical Interview Schedule (CIS-R), was examined as a covariate and in a stratified analysis of co-morbidity. Other covariates included sociodemographic factors, long-standing illnesses and substance use. RESULTS: Probable PD was associated with DB, with the strongest associations found for borderline, dependent and schizotypal PD. Antisocial PD was not associated with DB. The relationship between PD and DB was strongly modified by CMD, reducing the association from an odds ratio (OR) of 2.84 to 1.34 [95% confidence interval (CI) 1.00-1.79)]. In the stratified analysis, co-morbid PD and CMD showed a stronger association with DB than PD without CMD but, when fully adjusted, this effect was not significantly different from the association between CMD without PD. CONCLUSIONS: Individuals screening positive for PD are more likely to experience severe occupational outcomes, especially in the presence of co-morbid CMD.

Widespread pain and medically certified disability pension in the Hordaland Health Study.

Widespread pain (WSP) is common in the general population and is associated with poor outcomes. The aim of this study was to quantify the risk for medically certified disability pension from WSP. We further studied how other common physical symptoms, common mental disorders and functional limitations influenced this risk. A prospective cohort design was established by linking the large population based Hordaland Health Study (n > 18000 individuals aged 40-46) with an administrative registry on disability pension awards. We modelled hazard ratios for later all-cause and diagnosis specific disability pensioning from WSP, adjusted for potential confounders and examined the impact of other co-occurring health problems and functional limitations. WSP was common (12.4%) and associated with a range of mental health, and non-specific and non-musculoskeletal symptoms. As expected, WSP was a strong predictor for disability pension award. Hazard ratios (HR) adjusted for socio-economic status, health behaviours and comorbid medical diagnoses indicated WSP was strongest in predicting pensioning for musculoskeletal diagnoses (HR = 5.91, 95% CI 4.64-7.54), but also predicted pensioning for mental disorder (HR = 3.13, 95% CI 2.20-4.46) and other diagnoses (HR = 1.81, 95% CI 1.30-2.51). Further adjustments for other common symptoms, including mental illness, reduced, but did not abolish these risks. WSP is a major risk factor for disability pensions, and not only pensions for musculoskeletal disorders. The global impact of WSP, and its close association to other symptoms, suggests prevention of the severe occupational outcomes for this group must have a broad focus and move beyond symptom directed approaches.

Classification of pain in cancer patients--a systematic literature review.

One of the aims of the European Palliative Care Research Collaborative (EPCRC) is to achieve consensus on a classification system for cancer pain. We performed a systematic literature review to identify existing classification systems and domains/items used to classify cancer patients with pain. In a systematic search in the databases Medline and Embase, covering 1986-2006, 692 hits were obtained. 92 papers were evaluated to address pain classification. Six standardised classification systems were identified; three of them systematically developed and partially validated. Both pain characteristics and patient characteristics relevant for cancer pain classification were included in the classification systems. All but one of the standardised systems aim at predicting treatment response or adequacy of treatment. Several domains and items used to describe cancer pain but not formally described as part of a classification system were also identified and systematized. The existing approaches to pain classification in cancer patients are different, mostly not thoroughly validated, and none is widely applied. An internationally accepted classification system for cancer pain could improve research and cancer pain management. This systematic review suggests a need for developing an international consensus on how to classify pain in cancer patients.