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Multimorbidity and fit note receipt in working-age adults with long-term health conditions

Published online by Cambridge University Press:  08 September 2020

Sarah Dorrington Open the ORCID record for Sarah Dorrington [Opens in a new window] ,
Ewan Carr Open the ORCID record for Ewan Carr [Opens in a new window] ,
Sharon A.M. Stevelink Open the ORCID record for Sharon A.M. Stevelink [Opens in a new window] ,
Alex Dregan Open the ORCID record for Alex Dregan [Opens in a new window] ,
Charlotte Woodhead ,
Jayati Das-Munshi Open the ORCID record for Jayati Das-Munshi [Opens in a new window] ,
Mark Ashworth ,
Matthew Broadbent ,
Ira Madan Open the ORCID record for Ira Madan [Opens in a new window]  and
Stephani L Hatch Open the ORCID record for Stephani L Hatch [Opens in a new window]
...Show all authors
Sarah Dorrington*
Affiliation:
Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK South London and Maudsley NHS Foundation Trust, London, UK
Ewan Carr
Affiliation:
Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
Sharon A.M. Stevelink
Affiliation:
Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK King's Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Alex Dregan
Affiliation:
Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
Charlotte Woodhead
Affiliation:
Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
Jayati Das-Munshi
Affiliation:
Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
Mark Ashworth
Affiliation:
School of Population Health and Environmental Sciences, King's College London, Guy's Campus, Addison House, London SE1 1UL, UK
Matthew Broadbent
Affiliation:
South London and Maudsley NHS Foundation Trust, London, UK
Ira Madan
Affiliation:
Department of Occupational Health, Guy's and St Thomas’ NHS Foundation Trust, London, UK
Stephani L Hatch
Affiliation:
Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
Matthew Hotopf
Affiliation:
Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK South London and Maudsley NHS Foundation Trust, London, UK
*
Author for correspondence: Sarah Dorrington, E-mail: [email protected]
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Abstract

Background

Research on sickness absence has typically focussed on single diagnoses, despite increasing recognition that long-term health conditions are highly multimorbid and clusters comprising coexisting mental and physical conditions are associated with poorer clinical and functional outcomes. The digitisation of sickness certification in the UK offers an opportunity to address sickness absence in a large primary care population.

Methods

Lambeth Datanet is a primary care database which collects individual-level data on general practitioner consultations, prescriptions, Quality and Outcomes Framework diagnostic data, sickness certification (fit note receipt) and demographic information (including age, gender, self-identified ethnicity, and truncated postcode). We analysed 326 415 people's records covering a 40-month period from January 2014 to April 2017.

Results

We found significant variation in multimorbidity by demographic variables, most notably by self-defined ethnicity. Multimorbid health conditions were associated with increased fit note receipt. Comorbid depression had the largest impact on first fit note receipt, more than any other comorbid diagnoses. Highest rates of first fit note receipt after adjustment for demographics were for comorbid epilepsy and rheumatoid arthritis (HR 4.69; 95% CI 1.73–12.68), followed by epilepsy and depression (HR 4.19; 95% CI 3.60–4.87), chronic pain and depression (HR 4.14; 95% CI 3.69–4.65), cardiac condition and depression (HR 4.08; 95% CI 3.36–4.95).

Conclusions

Our results show striking variation in multimorbid conditions by gender, deprivation and ethnicity, and highlight the importance of multimorbidity, in particular comorbid depression, as a leading cause of disability among working-age adults.

Keywords

comorbiditydepressiondisabilityfit notehealth inequalitiesmultimorbiditysickness absenceprimary carepublic health
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 6 , April 2022 , pp. 1156 - 1165
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012). Epidemiology of multimorbidity and implications for health care, research, and medical education: A cross-sectional study. The Lancet, 380(9836), 37–43. doi: 10.1016/S0140-6736(12)60240-2.CrossRefGoogle ScholarPubMed
Benach, J., Muntaner, C., & Santana, V. (2006). Employment Conditions and Health Inequalities Final Report to the WHO Commission on Social Determinants of Health (CSDH) Employment Conditions Knowledge Network (EMCONET). Retrieved from https://www.who.int/social_determinants/resources/articles/emconet_who_report.pdf.Google Scholar
Black, C. (2008). Working for a healthier tomorrow. Retrieved from http://www.workingforhealth.gov.uk/documents/working-for-a-healthier-tomorrow-tagged.pdf.Google Scholar
Buist-Bouwman, M. A., de Graaf, R., Vollebergh, W. A., & Ormel, J. (2005). Comorbidity of physical and mental disorders and the effect on work-loss days. Acta Psychiatrica Scandinavica, 111(6), 436–443. doi: 10.1111/j.1600-0447.2005.00513.x.CrossRefGoogle ScholarPubMed
Carbado, D. W., Crenshaw, K. W., Mays, V. M., & Tomlinson, B. (2013). Intersectionality: Mapping the movements of a theory. Du Bois Review, 10(2), 303–312. doi: 10.1017/S1742058X13000349.CrossRefGoogle ScholarPubMed
Carnethon, M. R., Kinder, L. S., Fair, J. M., Stafford, R. S., & Fortmann, S. P. (2003). Symptoms of depression as a risk factor for incident diabetes: Findings from the national health and nutrition examination epidemiologic follow-up study, 1971-1992. American Journal of Epidemiology, 158(5), 416–423. doi: 10.1093/aje/kwg172CrossRefGoogle ScholarPubMed
Cornelius, L. R., van der Klink, J. J. L., Groothoff, J. W., & Brouwer, S. (2011). Prognostic factors of long term disability Due to mental disorders: A systematic review. Journal of Occupational Rehabilitation, 21, 259–274. doi: 10.1007/s10926-010-9261-5.CrossRefGoogle ScholarPubMed
Das-Munshi, J., Ashworth, M., Dewey, M. E., Gaughran, F., Hull, S., Morgan, C., … Prince, M. J. (2017). Type 2 diabetes mellitus in people with severe mental illness: Inequalities by ethnicity and age. Cross-sectional analysis of 588 408 records from the UK. Diabetic Medicine, 34(7), 916–924. doi: 10.1111/dme.13298.CrossRefGoogle ScholarPubMed
Das-Munshi, J., Stewart, R., Ismail, K., Bebbington, P. E., Jenkins, R., & Prince, M. J. (2007). Diabetes, common mental disorders, and disability: Findings from the UK national psychiatric morbidity survey. Psychosomatic Medicine, 69(6), 543–550. doi: 10.1097/PSY.0b013e3180cc3062.CrossRefGoogle ScholarPubMed
Dorrington, S., Carr, E., Stevelink, S. A. M., Dregan, A., Whitney, D., Durbaba, S., … Hotopf, M. (2020). Demographic variation in fit note receipt and long-term conditions in south London. Occupational & Environmental Medicine, 77(6), 418–426. doi: 10.1136/oemed-2019-106035.CrossRefGoogle ScholarPubMed
Dorrington, S., Roberts, E., Mykletun, A., Hatch, S., Madan, I., & Hotopf, M. (2018). Systematic review of fit note use for workers in the UK. Occupational & Environmental Medicine, 75(7), 530–539. doi: 10.1136/oemed-2017-104730.CrossRefGoogle ScholarPubMed
Dregan, A., Matcham, F., Harber-Aschan, L., Rayner, L., Brailean, A., Davis, K., … Hotopf, M. (2019). Common mental disorders within chronic inflammatory disorders: A primary care database prospective investigation. Annals of the Rheumatic Diseases, 78(5), 688–695. doi: 10.1136/annrheumdis-2018-214676.CrossRefGoogle ScholarPubMed
Eaton, W. W., Armenian, H., Gallo, J., Pratt, L., & Ford, D. E. (1996). Depression and risk for onset of type II diabetes. A prospective population-based study. Diabetes Care, 19(10), 1097–1102. doi: 10.2337/diacare.19.10.1097.CrossRefGoogle ScholarPubMed
Economou, A., Grey, M., McGregor, J., Craddock, N., Lyons, R. A., Owen, M. J., … Lloyd, K. (2012). The health informatics cohort enhancement project (HICE): Using routinely collected primary care data to identify people with a lifetime diagnosis of psychotic disorder. BMC Research Notes, 5, 95. doi: 10.1186/1756-0500-5-95.CrossRefGoogle ScholarPubMed
Employment by Occupation. (2018). https://www.ethnicity-facts-figures.service.gov.uk/work-pay-and-benefits/employment/employment-by-occupation/latest : UK Government.Google Scholar
Fit notes issued by GP practices: December 2014 - March 2017: experimental statistics. (2017). Retrieved from https://digital.nhs.uk/catalogue/PUB30068.Google Scholar
Foundation, The Work. (2016). The impact of long term conditions on employment and the wider economy.Google Scholar
From One to Many: Exploring people's progression to multiple long-term conditions in an urban environment. (2018).Google Scholar
Gabbay, M., Shiels, C., & Hillage, J. (2016). Sickness certification for common mental disorders and GP return-to-work advice. Primary Health Care Research Development, 17, 1–11. doi: 10.1017/s1463423616000074CrossRefGoogle ScholarPubMed
Gaspar, F. W., Zaidel, C. S., & Dewa, C. S. (2018). Rates and predictors of recurrent work disability due to common mental health disorders in the United States. PLoS One, 13(10), e0205170. doi: 10.1371/journal.pone.0205170.CrossRefGoogle ScholarPubMed
Harvey, S. B., Henderson, M., Lelliott, P., & Hotopf, M. (2009). Mental health and employment: Much work still to be done. British Journal of Psychiatry, 194, 201–203. doi: 10.1192/bjp.bp.108.055111.CrossRefGoogle Scholar
Hatch, S. L., Frissa, S., Verdecchia, M., Stewart, R., Fear, N. T., Reichenberg, A., … Hotopf, M. (2011). Identifying socio-demographic and socioeconomic determinants of health inequalities in a diverse London community: The south east London community health (SELCoH) study. BMC Public Health, 11, 861. doi: 10.1186/1471-2458-11-861.CrossRefGoogle Scholar
Hatch, S. L., Gazard, B., Williams, D. R., Frissa, S., Goodwin, L., & Hotopf, M., & Team, SELCoH Study. (2016). Discrimination and common mental disorder among migrant and ethnic groups: Findings from a south east London community sample. Social Psychiatry and Psychiatric Epidemiology, 51(5), 689–701.CrossRefGoogle Scholar
Henderson, M., Clark, C., Stansfeld, S., & Hotopf, M. (2012). A lifecourse approach to long-term sickness absence-a cohort study. PLoS One, 7(5), e36645. doi: 10.1371/journal.pone.0036645.CrossRefGoogle Scholar
Impact of Quality and Outcomes Framework on Health Inequalities. (2011). Retrieved from The Kings Fund: https://www.kingsfund.org.uk/sites/default/files/Impact-Quality-Outcomes-Framework-health-inequalities-April-2011-Kings-Fund.pdf.Google Scholar
Indices of Deprivation: 2019 and 2015. Retrieved from http://dclgapps.communities.gov.uk/imd/iod_index.html.Google Scholar
Insecure work and ethnicity. (2017). Retrieved from https://www.tuc.org.uk/research-analysis/reports/insecure-work-and-ethnicity.Google Scholar
Jani, B. D., Hanlon, P., Nicholl, B. I., McQueenie, R., Gallacher, K. I., Lee, D., & Mair, F. S. (2019). Relationship between multimorbidity, demographic factors and mortality: Findings from the UK biobank cohort. BMC Medicine, 17(1), 74. doi: 10.1186/s12916-019-1305-x.CrossRefGoogle ScholarPubMed
Katon, W., & Ciechanowski, P. (2002). Impact of major depression on chronic medical illness. Journal of Psychosomatic Research, 53(4), 859–863.CrossRefGoogle ScholarPubMed
Katon, W., Lin, E. H., & Kroenke, K. (2007). The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. General Hospital Psychiatry, 29(2), 147–155. doi: 10.1016/j.genhosppsych.2006.11.005.CrossRefGoogle ScholarPubMed
Kausto, J., Miranda, H., Martimo, K. P., & Viikari-Juntura, E. (2008). Partial sick leave--review of its use, effects and feasibility in the Nordic countries. Scandinavian Journal of Work, Environment & Health, 34(4), 239–249.CrossRefGoogle ScholarPubMed
Kessler, R. C., Ormel, J., Demler, O., & Stang, P. E. (2003). Comorbid mental disorders account for the role impairment of commonly occurring chronic physical disorders: Results from the national comorbidity survey. Journal of Occupational and Environmental Medicine, 45(12), 1257–1266. doi: 10.1097/01.jom.0000100000.70011.bb.CrossRefGoogle ScholarPubMed
Kumarapeli, P., Stepaniuk, R., de Lusignan, S., Williams, R., & Rowlands, G. (2006). Ethnicity recording in general practice computer systems. Journal of Public Health (Oxf), 28(3), 283–287. doi: 10.1093/pubmed/fdl044.CrossRefGoogle ScholarPubMed
Lambeth Council: State of the Borough. (2016). Retrieved from Lambeth Council: https://www.lambeth.gov.uk/sites/default/files/State%20of%20Borough%202016%20-%20v3.pdf.Google Scholar
Lambeth Datanet Community Engagement Project. (2017). Retrieved from http://www.healthwatchlambeth.org.uk/wp-content/uploads/2017/04/Lambeth-DataNet-IPRP-Consultation-Report-FINAL_Mar-17.pdf.Google Scholar
Lancet. (2018). Making more of multimorbidity: An emerging priority. The Lancet, 391(10131), 1637. doi: 10.1016/s0140-6736(18)30941-3CrossRefGoogle Scholar
Li, J., Green, M., Kearns, B., Holding, E., Smith, C., Haywood, A., … Relton, C. (2016). Patterns of multimorbidity and their association with health outcomes within Yorkshire, England: Baseline results from the Yorkshire health study. BMC Public Health, 16, 649. doi: 10.1186/s12889-016-3335-z.CrossRefGoogle ScholarPubMed
Lowe, B., Willand, L., Eich, W., Zipfel, S., Ho, A. D., Herzog, W., & Fiehn, C. (2004). Psychiatric comorbidity and work disability in patients with inflammatory rheumatic diseases. Psychosomatic Medicine, 66(3), 395–402.Google ScholarPubMed
LSOA Atlas. (2014). https://data.london.gov.uk/dataset/lsoa-atlas : Greater London Authority.Google Scholar
Ludman, E. J., Katon, W., Russo, J., Von Korff, M., Simon, G., Ciechanowski, P., … Young, B. (2004). Depression and diabetes symptom burden. General Hospital Psychiatry, 26(6), 430–436. doi: 10.1016/j.genhosppsych.2004.08.010.CrossRefGoogle ScholarPubMed
Matcham, F., Ali, S., Hotopf, M., & Chalder, T. (2015). Psychological correlates of fatigue in rheumatoid arthritis: A systematic review. Clinical Psychology Review, 39, 16–29. doi: 10.1016/j.cpr.2015.03.004.CrossRefGoogle ScholarPubMed
Mathur, R., Hull, S. A., Badrick, E., & Robson, J. (2011). Cardiovascular multimorbidity: The effect of ethnicity on prevalence and risk factor management. British Journal of General Practice, 61(586), e262–e270. doi: 10.3399/bjgp11X572454.CrossRefGoogle ScholarPubMed
Mixed and balanced communities. (2014). Retrieved from.Google Scholar
Multimorbidity: a priority for global health research. (2018). Retrieved from https://acmedsci.ac.uk/file-download/82222577.Google Scholar
Mykletun, A., Overland, S., Dahl, A. A., Krokstad, S., Bjerkeset, O., Glozier, N., … Prince, M. (2006). A population-based cohort study of the effect of common mental disorders on disability pension awards. American Journal of Psychiatry, 163(8), 1412–1418. doi: 10.1176/ajp.2006.163.8.1412.CrossRefGoogle ScholarPubMed
Naylor, C., Parsonage, M., McDaid, D., Knapp, M., Fossey, M., & Galea, A. (2012). Long-term conditions and mental health the cost of co-morbidities. Retrieved from.Google Scholar
Oke, A., Braithwaite, P., & Antai, D. (2016). Sickness absence and precarious employment: A comparative cross-national study of Denmark, Finland, Sweden, and Norway. International Journal of Occupational and Environmental Medicine, 7(3), 125–147. doi: 10.15171/ijoem.2016.713.CrossRefGoogle ScholarPubMed
Overview of London Boroughs. (2019). https://www.trustforlondon.org.uk/data/boroughs/overview-of-london-boroughs/. Trust for London: Tackling poverty and inequality.Google Scholar
Palacios, J., Khondoker, M., Mann, A., Tylee, A., & Hotopf, M. (2018). Depression and anxiety symptom trajectories in coronary heart disease: Associations with measures of disability and impact on 3-year health care costs. Journal of Psychosomatic Research, 104, 1–8. doi: 10.1016/j.jpsychores.2017.10.015.CrossRefGoogle ScholarPubMed
QOF Business Rules - version 35. (2017). Retrieved from Department of Health https://www.health-ni.gov.uk/publications/qof-business-rules-version-35.Google Scholar
Schofield, P., Saka, O., & Ashworth, M. (2011). Ethnic differences in blood pressure monitoring and control in south east London. British Journal of General Practice, 61(585), 190–196. doi: 10.3399/bjgp11X567126.CrossRefGoogle ScholarPubMed
Scott, K. M., Bruffaerts, R., Tsang, A., Ormel, J., Alonso, J., Angermeyer, M. C., … Von Korff, M. (2007). Depression-anxiety relationships with chronic physical conditions: Results from the world mental health surveys. Journal of affective disorders, 103(1-3), 113–120. doi: 10.1016/j.jad.2007.01.015.CrossRefGoogle ScholarPubMed
Shiwaku, K., Anuurad, E., Enkhmaa, B., Kitajima, K., & Yamane, Y. (2004). Appropriate body mass Index for Asian populations. The Lancet, 363(9414), 1077. doi: 10.1016/S0140-6736(04)15856-X.CrossRefGoogle ScholarPubMed
Sundstrup, E., Jakobsen, M. D., Mortensen, O. S., & Andersen, L. L. (2017). Joint association of multimorbidity and work ability with risk of long-term sickness absence: A prospective cohort study with register follow-up. Scandinavian Journal of Work and Environmental Health, 43(2), 146–154. doi: 10.5271/sjweh.3620.CrossRefGoogle ScholarPubMed
Teesson, M., Mitchell, P. B., Deady, M., Memedovic, S., Slade, T., & Baillie, A. (2011). Affective and anxiety disorders and their relationship with chronic physical conditions in Australia: Findings of the 2007 national survey of mental health and wellbeing. Australian and New Zealand Journal of Psychiatry, 45(11), 939–946. doi: 10.3109/00048674.2011.614590.CrossRefGoogle ScholarPubMed
Trends in Disease and Disability, Long Term Conditions and Multimorbidity. (2018). Retrieved from The Kings Fund: https://www.kingsfund.org.uk/projects/time-think-differently/trends-disease-and-disability-long-term-conditions-multi-morbidity.Google Scholar
Wallace, E., Salisbury, C., Guthrie, B., Lewis, C., Fahey, T., & Smith, S. M. (2015). Managing patients with multimorbidity in primary care. British Medical Journal, 350, h176. doi: 10.1136/bmj.h176.CrossRefGoogle ScholarPubMed
Watkins, L. L., Koch, G. G., Sherwood, A., Blumenthal, J. A., Davidson, J. R. T., O'Connor, C., & Sketch, M. H. (2013). Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease. Journal of the American Heart Association, 2(2), e000068–e000068. doi: 10.1161/jaha.112.000068.CrossRefGoogle ScholarPubMed
Woodhead, C., Ashworth, M., Schofield, P., & Henderson, M. (2014). Patterns of physical co-/multi-morbidity among patients with serious mental illness: A London borough-based cross-sectional study. BMC Family Practice, 15, 117. doi: 10.1186/1471-2296-15-117.CrossRefGoogle ScholarPubMed
Working With Multiple Health Conditions. (2016). Retrieved from The Work Foundation: http://www.theworkfoundation.com/wp-content/uploads/2016/11/409_Complexitieschallenges1-1.pdf.Google Scholar
World Report on Disability (1474-547X (Electronic). 0140-6736 (Linking)). (2011). Retrieved from https://www.who.int/disabilities/world_report/2011/report.pdf.Google Scholar
Wynne-Jones, G., Chen, Y., Croft, P., Peat, G., Wilkie, R., Jordan, K., & Petersson, I. F. (2018). Secular trends in work disability and its relationship to musculoskeletal pain and mental health: A time-trend analysis using five cross-sectional surveys (2002–2010) in the general population. Occupational & Environmental Medicine, 75(12), 877–883. doi: 10.1136/oemed-2018-105171.CrossRefGoogle ScholarPubMed
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