[Evidence-based expert testimonies on psychiatric disorders--risk factors for invalidity]

Psychiatric symptoms often lead to a claim for disability pension. Surprisingly, there is very little empirical data available on which variables may predict permanent job disability. A new empirically based risk assessment instrument was developed to predict the final pension outcome. This study used prospective data over a 4-year period to examine the variables of the assessment instrument and the final outcome. Data of 223 subjects with psychiatric complaints were assessed at the time of evaluation for an invalidity pension claim. 95 (42.6%) of them were without a reduction of capability, 128 (57.4%) had a reduction of capability. Eight variables assessed at the initial psychiatric evaluation correlated significantly with the subsequent expert testimony. After applying a logistic regression (maximum likelihood estimation) we found 2 variables assessed at the initial psychiatric evaluation which correlated significantly with the expert testimony. These variables were the resumption of social activities and self-estimation of the subject's health and capability. The proportion of response variation explained by the regressors (Nagelkerkes R2) was 22%. Further research should aim to differentiate subjects with "high risks" from those with a better prognosis, with respect to future disability pensioning. One major task facing disability adjudicators is to separate those who have a legitimate disability claim from those who should be recommended for more intensive treatment modalities in order to successfully prevent permanent job disability.