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The Implications of Psychological Symptoms for Length of Sick Leave
Antonius Schneider1, Sven Hilbert, Johannes Hamann
1Institute of General Practice, Klinikum rechts der Isar der Technischen Universität München; Institute of Psychological Methods and Diagnostics, Department of Psychology, Ludwig-Maximilians-Universität München; Faculty for Psychology, Pedagogy and Sport Science, University of Regensburg; Clinic and Polyclinic for Psychiatry and Psychotherapy, Technische Universität München; Institute of Psychology, University of Innsbruck, Austria; Department of Psychosomatic Medicine and Psychotherapy, Center for Internal Medicine, Universitätsklinikum Hamburg Eppendorf.
Background:
In this cross-sectional study, we aimed to determine the relation between sick leave duration, burnout symptoms, depression, anxiety, and somatization in a primary care setting.
Methods:
Patients receiving a sickness certificate in one of 14 participating primary care practices were consecutively asked by their primary care physician to fill in a questionnaire comprising the Maslach Burnout Inventory-General Survey (MBI-GS) and the Patient Health Questionnaire (PHQ) containing the depression (PHQ-9), somatization (PHQ-15), and anxiety (GAD-7) scales. The main diagnosis on the sickness certificate was documented by the issuing physician. A quasi-Poisson regression analysis was performed to estimate the influence of burnout symptoms, depression, and anxiety on length of sick leave.
Results:
225 patients participated, 122 (54.2%) were female; the mean age was 39.5 years. Length of sick leave correlated with emotional exhaustion (p = 0.005), depersonalization (p = 0.013), depression (p = 0.006), anxiety (p = 0.023), and somatization (p = 0.001). However, regression analysis revealed that the only predictors for length of sick leave were anxiety (exp[0.081] = 1.084; p = 0.013), age (exp[0.017] = 1.017; p = 0.041) and education (exp[- 0.508] = 0.602; p = 0:029). The pseudo R2 of the model was 0.25.
Conclusion:
The impact of anxiety on burnout symptoms and sick leave days might have been underestimated so far. A holistic approach in patient centered communication should comprise the evaluation of psychosomatic comorbidity under consideration of the established concepts of depression and anxiety disorder to ensure adequate diagnostic and therapeutic management.
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