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Severe MUPS in a sick-listed population: a cross-sectional study on prevalence, recognition, psychiatric co-morbidity
Rob Hoedeman1, Boudien Krol, Nettie Blankenstein
1Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. rob.hoedeman@arboned.nl
Background:
Medically unexplained physical symptoms (MUPS) have a high prevalence in the general population and are associated with psychiatric morbidity. There are indications that MUPS are an important determinant of frequent and long-term disability. The primary objective was to assess the prevalence of MUPS in sick-listed-employees and its associations with depressive disorders, anxiety disorders, health anxiety, distress and functional impairment. Secondary objectives were to investigate the classification of the occupational health physicians (OHPs), their opinions about the causes as well as the attributions of the employee.
Methods:
In a cross-sectional study of 489 sick-listed employees from 5 OHP group practices, MUPS, depressive disorders, anxiety disorders, health anxiety, distress and functional impairment were assessed with the Patient Health Questionnaire (PHQ), the Whitely Index (WI), the Four-Dimensional Symptom Questionnaire (4DSQ) and the Short-Form 36 Health Survey (SF-36). We used a cut off score of 15 on the PHQ for the categorisation of severe MUPS. The opinions of the OHPs were evaluated by means of a separate questionnaire with regard to the presence of employees physical symptoms, and the symptoms attributions, and the diagnoses of the OHPs.
Results:
Severe MUPS had a prevalence of 15.1% in this population of sick-listed employees. These employees had 4-6 times more depressive and anxiety disorders, and were more impaired. Female gender and PHQ-9 scores were determinants of severe MUPS. Most of the time the OHPs diagnosed employees with severe MUPS as having a mental disorder. The employees attributed their physical symptoms in 66% to mental or to both mental and physical causes.
Conclusion:
The prevalence of severe MUPS is higher in long-term sick-listed employees than in the non-sick- listed working population and at least equals the prevalence in the general practice population. Severe MUPS are associated with psychiatric morbidity and functional impairment and must therefore be specifically recognised as such. Validated questionnaires, such as the PHQ-15, are useful instruments in order to help OHPs to recognise severe MUPS.
Insights
Medically unexplained physical symptoms (MUPS) are prevalent in sick-listed employees, often linked to mental health issues and functional impairment. Early recognition of severe MUPS is crucial for effective management and support.
Area of Science:
- Occupational Health
- Psychiatry
- General Practice
Background:
- Medically unexplained physical symptoms (MUPS) are common and linked to psychiatric conditions.
- MUPS may significantly contribute to frequent and long-term work disability.
- Understanding MUPS prevalence in sick-listed employees is vital for targeted interventions.
Purpose of the Study:
- Assess MUPS prevalence in sick-listed employees.
- Examine associations between MUPS and mental health disorders (depression, anxiety), health anxiety, distress, and functional impairment.
- Investigate occupational health physicians' (OHPs) classifications, opinions on causes, and employee attributions.
Main Methods:
- Cross-sectional study of 489 sick-listed employees.
- Utilized Patient Health Questionnaire (PHQ), Whitely Index (WI), 4-Dimensional Symptom Questionnaire (4DSQ), and SF-36 for assessments.
- Defined severe MUPS using a PHQ cutoff score of 15; assessed OHP opinions via a separate questionnaire.
Main Results:
- Prevalence of severe MUPS was 15.1% among sick-listed employees.
- Employees with severe MUPS showed 4-6 times higher rates of depressive and anxiety disorders and greater functional impairment.
- Female gender and higher PHQ-9 scores were associated with severe MUPS; OHPs frequently diagnosed mental disorders, and employees attributed symptoms to mental causes.
Conclusions:
- Severe MUPS are more prevalent in long-term sick-listed employees than in the general working population.
- Severe MUPS correlate with psychiatric morbidity and functional impairment, necessitating specific recognition.
- Validated tools like the PHQ-15 can aid OHPs in identifying severe MUPS effectively.
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