Skip to main content
Top
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Medically unexplained symptoms and the risk of loss of labor market participation - a prospective study in the Danish population

Authors: Katja Loengaard, Jakob Bue Bjorner, Per Klausen Fink, Hermann Burr, Reiner Rugulies

Published in: BMC Public Health | Issue 1/2015

Login to get access

Abstract

Background

Medically Unexplained Symptoms (MUS) are frequently encountered in general practice. However, little is known whether MUS affects labor market participation. We investigated the prospective association between MUS at baseline and risk of long-term sickness absence (LTSA), unemployment, and disability pensioning in a 5-year-follow-up study.

Methods

In the Danish Work Environment Cohort Study 2005, 8187 randomly selected employees from the Danish general population answered a questionnaire on work and health. Responses were linked with national registers on prescribed medication and hospital treatment. Participants were classified with MUS if they: a) had reported three or more symptoms during the last month, and b) did not have a chronic condition, neither in the self-reported nor the register data. We assessed LTSA, unemployment, and disability pensioning by linking our data with National registers of social transfer payments.

Results

Of the 8187 participants, 272 (3.3 %) were categorized with MUS. Compared to healthy participants, participants with MUS had an increased risk of LTSA (Rate ratio (RR) = 1.76, 95 % CI = 1.28–2.42), and of unemployment (RR = 1.48, 95 % CI = 1.02–2.15) during follow-up. MUS participants also showed an elevated RR with regard to risk of disability pensioning, however this association was not statistically significant (RR = 2.06, 95 % CI = 0.77–5.52).

Conclusion

MUS seem to have a negative effect on labor market participation defined by LTSA and unemployment, whereas it is more uncertain whether MUS affects risk of disability pensioning.
Literature
1.
go back to reference McFarlane AC, Ellis N, Barton C, Browne D, Van HM. The conundrum of medically unexplained symptoms: questions to consider. Psychosomatics. 2008;49(5):369–77.CrossRefPubMed McFarlane AC, Ellis N, Barton C, Browne D, Van HM. The conundrum of medically unexplained symptoms: questions to consider. Psychosomatics. 2008;49(5):369–77.CrossRefPubMed
2.
go back to reference Sharpe M, Carson A. “Unexplained” somatic symptoms, functional syndromes, and somatization: do we need a paradigm shift? Ann Intern Med. 2001;134(9 Pt 2):926–30.CrossRefPubMed Sharpe M, Carson A. “Unexplained” somatic symptoms, functional syndromes, and somatization: do we need a paradigm shift? Ann Intern Med. 2001;134(9 Pt 2):926–30.CrossRefPubMed
6.
go back to reference Mayou R, Farmer A. ABC of psychological medicine - functional somatic symptoms and syndromes. Br Med J. 2002;325(7358):265–8.CrossRef Mayou R, Farmer A. ABC of psychological medicine - functional somatic symptoms and syndromes. Br Med J. 2002;325(7358):265–8.CrossRef
7.
go back to reference Eriksen HR, Ihlebaek C, Ursin H. A scoring system for subjective health complaints (SHC). Scand J Public Health. 1999;27(1):63–72.CrossRefPubMed Eriksen HR, Ihlebaek C, Ursin H. A scoring system for subjective health complaints (SHC). Scand J Public Health. 1999;27(1):63–72.CrossRefPubMed
8.
go back to reference Cherry DK, Woodwell DA, Rechtsteiner EA. National Ambulatory Medical Care Survey: 2005 summary. Adv Data. 2007;387:1–39. Cherry DK, Woodwell DA, Rechtsteiner EA. National Ambulatory Medical Care Survey: 2005 summary. Adv Data. 2007;387:1–39.
9.
go back to reference Fink P, Rosendal M. Recent developments in the understanding and management of functional somatic symptoms in primary care. Curr Opin Psychiatry. 2008;21(2):182–8.CrossRefPubMed Fink P, Rosendal M. Recent developments in the understanding and management of functional somatic symptoms in primary care. Curr Opin Psychiatry. 2008;21(2):182–8.CrossRefPubMed
10.
go back to reference Tomenson B, McBeth J, Chew-Graham CA, MacFarlane G, Davies I, Jackson J, et al. Somatization and health anxiety as predictors of health care use. Psychosom Med. 2012;74(6):656–64.CrossRefPubMed Tomenson B, McBeth J, Chew-Graham CA, MacFarlane G, Davies I, Jackson J, et al. Somatization and health anxiety as predictors of health care use. Psychosom Med. 2012;74(6):656–64.CrossRefPubMed
11.
go back to reference Eriksen HR, Ursin H. Subjective health complaints, sensitization, and sustained cognitive activation (stress). J Psychosom Res. 2004;56(4):445–8.CrossRefPubMed Eriksen HR, Ursin H. Subjective health complaints, sensitization, and sustained cognitive activation (stress). J Psychosom Res. 2004;56(4):445–8.CrossRefPubMed
12.
go back to reference Hiller W, Rief W, Brahler E. Somatization in the population: from mild bodily misperceptions to disabling symptoms. Soc Psychiatry Psychiatr Epidemiol. 2006;41(9):704–12.CrossRefPubMed Hiller W, Rief W, Brahler E. Somatization in the population: from mild bodily misperceptions to disabling symptoms. Soc Psychiatry Psychiatr Epidemiol. 2006;41(9):704–12.CrossRefPubMed
13.
go back to reference Harris AM, Orav EJ, Bates DW, Barsky AJ. Somatization increases disability independent of comorbidity. J Gen Intern Med. 2009;24(2):155–61.CrossRefPubMed Harris AM, Orav EJ, Bates DW, Barsky AJ. Somatization increases disability independent of comorbidity. J Gen Intern Med. 2009;24(2):155–61.CrossRefPubMed
14.
15.
go back to reference Kroenke K, Price RK. Symptoms in the community. Prevalence, classification, and psychiatric comorbidity. Arch Intern Med. 1993;153(21):2474–80.CrossRefPubMed Kroenke K, Price RK. Symptoms in the community. Prevalence, classification, and psychiatric comorbidity. Arch Intern Med. 1993;153(21):2474–80.CrossRefPubMed
16.
go back to reference Whitehead LC. Quest, chaos and restitution: living with chronic fatigue syndrome/myalgic encephalomyelitis. Soc Sci Med. 2006;62(9):2236–45.CrossRefPubMed Whitehead LC. Quest, chaos and restitution: living with chronic fatigue syndrome/myalgic encephalomyelitis. Soc Sci Med. 2006;62(9):2236–45.CrossRefPubMed
17.
go back to reference Barsky AJ, Orav EJ, Bates DW. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry. 2005;62(8):903–10.CrossRefPubMed Barsky AJ, Orav EJ, Bates DW. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry. 2005;62(8):903–10.CrossRefPubMed
18.
go back to reference Fink P. The use of hospitalizations by persistent somatizing patients. Psychol Med. 1992;22(1):173–80.CrossRefPubMed Fink P. The use of hospitalizations by persistent somatizing patients. Psychol Med. 1992;22(1):173–80.CrossRefPubMed
19.
go back to reference Fink P. Surgery and medical-treatment in persistent somatizing patients. J Psychosom Res. 1992;36(5):439–47. Fink P. Surgery and medical-treatment in persistent somatizing patients. J Psychosom Res. 1992;36(5):439–47.
20.
go back to reference Reid S, Crayford T, Patel A, Wessely S, Hotopf M. Frequent attenders in secondary care: a 3-year follow-up study of patients with medically unexplained symptoms. Psychol Med. 2003;33(3):519–24.CrossRefPubMed Reid S, Crayford T, Patel A, Wessely S, Hotopf M. Frequent attenders in secondary care: a 3-year follow-up study of patients with medically unexplained symptoms. Psychol Med. 2003;33(3):519–24.CrossRefPubMed
21.
go back to reference Konnopka A, Schaefert R, Heinrich S, Kaufmann C, Luppa M, Herzog W, et al. Economics of medically unexplained symptoms: a systematic review of the literature. Psychother Psychosom. 2012;81(5):265–75. Konnopka A, Schaefert R, Heinrich S, Kaufmann C, Luppa M, Herzog W, et al. Economics of medically unexplained symptoms: a systematic review of the literature. Psychother Psychosom. 2012;81(5):265–75.
22.
go back to reference Konnopka A, Kaufmann C, König HH, Heider D, Wild B, Szecsenyi J, et al. Association of costs with somatic symptom severity in patients with medically unexplained symptoms. J Psychosom Res. 2013;75(4):370–5. Konnopka A, Kaufmann C, König HH, Heider D, Wild B, Szecsenyi J, et al. Association of costs with somatic symptom severity in patients with medically unexplained symptoms. J Psychosom Res. 2013;75(4):370–5.
23.
go back to reference Hansen MS, Fink P, Sondergaard L, Frydenberg M. Mental illness and health care use: a study among new neurological patients. Gen Hosp Psychiatry. 2005;27(2):119–24.CrossRefPubMed Hansen MS, Fink P, Sondergaard L, Frydenberg M. Mental illness and health care use: a study among new neurological patients. Gen Hosp Psychiatry. 2005;27(2):119–24.CrossRefPubMed
24.
go back to reference Aamland A, Malterud K, Werner EL. Phenomena associated with sick leave among primary care patients with medically unexplained physical symptoms: a systematic review. Scand J Prim Health Care. 2012;30(3):147–55.CrossRefPubMedPubMedCentral Aamland A, Malterud K, Werner EL. Phenomena associated with sick leave among primary care patients with medically unexplained physical symptoms: a systematic review. Scand J Prim Health Care. 2012;30(3):147–55.CrossRefPubMedPubMedCentral
25.
go back to reference Al-Windi A. The influence of complaint symptoms on health care utilisation, medicine use, and sickness absence: a comparison between retrospective and prospective utilisation. J Psychosom Res. 2005;59(3):139–46.CrossRefPubMed Al-Windi A. The influence of complaint symptoms on health care utilisation, medicine use, and sickness absence: a comparison between retrospective and prospective utilisation. J Psychosom Res. 2005;59(3):139–46.CrossRefPubMed
26.
go back to reference Hoedeman R, Blankenstein AH, Krol B, Koopmans PC, Groothoff JW. The contribution of high levels of somatic symptom severity to sickness absence duration, disability and discharge. J Occup Rehabil. 2010;20(2):264–73.CrossRefPubMedPubMedCentral Hoedeman R, Blankenstein AH, Krol B, Koopmans PC, Groothoff JW. The contribution of high levels of somatic symptom severity to sickness absence duration, disability and discharge. J Occup Rehabil. 2010;20(2):264–73.CrossRefPubMedPubMedCentral
27.
go back to reference Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002;64(2):258–66.CrossRefPubMed Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002;64(2):258–66.CrossRefPubMed
28.
go back to reference Roelen CAM, Koopmans PC, Groothoff JW. Subjective health complaints in relation to sickness absence. Work. 2010;37(1):15–21.PubMed Roelen CAM, Koopmans PC, Groothoff JW. Subjective health complaints in relation to sickness absence. Work. 2010;37(1):15–21.PubMed
29.
go back to reference Poulsen OM, Persson R, Kristiansen J, Andersen LL, Villadsen E, Ørbæk P. Distribution of subjective health complaints, and their association with register based sickness absence in the Danish working population. Scand J Public Health. 2013;41(2):150–7. Poulsen OM, Persson R, Kristiansen J, Andersen LL, Villadsen E, Ørbæk P. Distribution of subjective health complaints, and their association with register based sickness absence in the Danish working population. Scand J Public Health. 2013;41(2):150–7.
30.
go back to reference Feveile H, Olesen O, Burr H, Bach E. Danish work environment cohort study 2005: from idea to sample design. Stat Transit-New Ser. 2007;8(3):441–58. Feveile H, Olesen O, Burr H, Bach E. Danish work environment cohort study 2005: from idea to sample design. Stat Transit-New Ser. 2007;8(3):441–58.
31.
go back to reference Feveile H, Olsen O, Hogh A. A randomized trial of mailed questionnaires versus telephone interviews: response patterns in a survey. BMC Med Res Methodol. 2007;7:27.CrossRefPubMedPubMedCentral Feveile H, Olsen O, Hogh A. A randomized trial of mailed questionnaires versus telephone interviews: response patterns in a survey. BMC Med Res Methodol. 2007;7:27.CrossRefPubMedPubMedCentral
32.
go back to reference Burr H, Pedersen J, Hansen JV. Work environment as predictor of long-term sickness absence: linkage of self-reported DWECS data with the DREAM register. Scand J Public Health. 2011;39(7 Suppl):147–52.CrossRefPubMed Burr H, Pedersen J, Hansen JV. Work environment as predictor of long-term sickness absence: linkage of self-reported DWECS data with the DREAM register. Scand J Public Health. 2011;39(7 Suppl):147–52.CrossRefPubMed
33.
go back to reference Hjollund NH, Larsen FB, Andersen JH. Register-based follow-up of social benefits and other transfer payments: accuracy and degree of completeness in a Danish interdepartmental administrative database compared with a population-based survey. Scand J Public Health. 2007;35(5):497–502.CrossRefPubMed Hjollund NH, Larsen FB, Andersen JH. Register-based follow-up of social benefits and other transfer payments: accuracy and degree of completeness in a Danish interdepartmental administrative database compared with a population-based survey. Scand J Public Health. 2007;35(5):497–502.CrossRefPubMed
34.
go back to reference Mors O, Perto GP, Mortensen PB. The Danish psychiatric central research register. Scand J Public Health. 2011;39(7 Suppl):54–7.CrossRefPubMed Mors O, Perto GP, Mortensen PB. The Danish psychiatric central research register. Scand J Public Health. 2011;39(7 Suppl):54–7.CrossRefPubMed
35.
go back to reference Kildemoes HW, Sorensen HT, Hallas J. The Danish national prescription registry. Scand J Public Health. 2011;39(7 Suppl):38–41.CrossRefPubMed Kildemoes HW, Sorensen HT, Hallas J. The Danish national prescription registry. Scand J Public Health. 2011;39(7 Suppl):38–41.CrossRefPubMed
36.
go back to reference Labriola M, Christensen KB, Lund T, Nielsen ML, Diderichsen F. Multilevel analysis of workplace and individual risk factors for long-term sickness absence. J Occup Environ Med. 2006;48(9):923–9.CrossRefPubMed Labriola M, Christensen KB, Lund T, Nielsen ML, Diderichsen F. Multilevel analysis of workplace and individual risk factors for long-term sickness absence. J Occup Environ Med. 2006;48(9):923–9.CrossRefPubMed
37.
go back to reference Ihlebaek C, Brage S, Eriksen HR. Health complaints and sickness absence in Norway, 1996–2003. Occup Med (Lond). 2007;57(1):43–9.CrossRef Ihlebaek C, Brage S, Eriksen HR. Health complaints and sickness absence in Norway, 1996–2003. Occup Med (Lond). 2007;57(1):43–9.CrossRef
38.
go back to reference Hoedeman R, Krol B, Blankenstein N, Koopmans PC, Groothoff JW. Severe MUPS in a sick-listed population: a cross-sectional study on prevalence, recognition, psychiatric co-morbidity and impairment. BMC Public Health. 2009;9:440.CrossRefPubMedPubMedCentral Hoedeman R, Krol B, Blankenstein N, Koopmans PC, Groothoff JW. Severe MUPS in a sick-listed population: a cross-sectional study on prevalence, recognition, psychiatric co-morbidity and impairment. BMC Public Health. 2009;9:440.CrossRefPubMedPubMedCentral
39.
go back to reference Hultin H, Lindholm C, Moller J. Is there an association between long-term sick leave and disability pension and unemployment beyond the effect of health status?--a cohort study. PLoS One. 2012;7(4):e35614.CrossRefPubMedPubMedCentral Hultin H, Lindholm C, Moller J. Is there an association between long-term sick leave and disability pension and unemployment beyond the effect of health status?--a cohort study. PLoS One. 2012;7(4):e35614.CrossRefPubMedPubMedCentral
40.
go back to reference Lamberg T, Virtanen P, Vahtera J, Luukkaala T, Koskenvuo M. Unemployment, depressiveness and disability retirement: a follow-up study of the Finnish HeSSup population sample. Soc Psychiatry Psychiatr Epidemiol. 2010;45(2):259–64.CrossRefPubMed Lamberg T, Virtanen P, Vahtera J, Luukkaala T, Koskenvuo M. Unemployment, depressiveness and disability retirement: a follow-up study of the Finnish HeSSup population sample. Soc Psychiatry Psychiatr Epidemiol. 2010;45(2):259–64.CrossRefPubMed
41.
go back to reference Chaturvedi SK, Desai G, Shaligram D. Somatoform disorders, somatization and abnormal illness behaviour. Int Rev Psychiatry. 2006;18(1):75–80.CrossRefPubMed Chaturvedi SK, Desai G, Shaligram D. Somatoform disorders, somatization and abnormal illness behaviour. Int Rev Psychiatry. 2006;18(1):75–80.CrossRefPubMed
42.
go back to reference Creed FH, Tomenson B, Chew-Graham C, Macfarlane GJ, Davies I, Jackson J, et al. Multiple somatic symptoms predict impaired health status in functional somatic syndromes. Int J Behav Med. 2013;20(2):194–205. Creed FH, Tomenson B, Chew-Graham C, Macfarlane GJ, Davies I, Jackson J, et al. Multiple somatic symptoms predict impaired health status in functional somatic syndromes. Int J Behav Med. 2013;20(2):194–205.
43.
go back to reference Sieurin L, Josephson M, Vingaard E. Positive and negative consequences of sick leave for the individual, with special focus on part-time sick leave. Scand J Public Health. 2009;37(1):50–6.CrossRefPubMed Sieurin L, Josephson M, Vingaard E. Positive and negative consequences of sick leave for the individual, with special focus on part-time sick leave. Scand J Public Health. 2009;37(1):50–6.CrossRefPubMed
44.
go back to reference Bryngelson A. Long-term sickness absence and social exclusion. Scand J Public Health. 2009;37(8):839–45.CrossRefPubMed Bryngelson A. Long-term sickness absence and social exclusion. Scand J Public Health. 2009;37(8):839–45.CrossRefPubMed
45.
go back to reference Floderus B, Alexanderson K, Aronsson G. Self-estimated life situation in patients on long-term sick leave. J Rehabil Med. 2005;37(5):291–9.CrossRefPubMed Floderus B, Alexanderson K, Aronsson G. Self-estimated life situation in patients on long-term sick leave. J Rehabil Med. 2005;37(5):291–9.CrossRefPubMed
46.
go back to reference Hoedeman R, Blankenstein AH, Koopmans PC, Groothoff JW. What bothers the sick-listed employee with severe MUPS? Scand J Public Health. 2013;41(3):256–9.CrossRefPubMed Hoedeman R, Blankenstein AH, Koopmans PC, Groothoff JW. What bothers the sick-listed employee with severe MUPS? Scand J Public Health. 2013;41(3):256–9.CrossRefPubMed
47.
go back to reference Werner A, Malterud K. It is hard work behaving as a credible patient: encounters between women with chronic pain and their doctors. Soc Sci Med. 2003;57(8):1409–19.CrossRefPubMed Werner A, Malterud K. It is hard work behaving as a credible patient: encounters between women with chronic pain and their doctors. Soc Sci Med. 2003;57(8):1409–19.CrossRefPubMed
Metadata
Title
Medically unexplained symptoms and the risk of loss of labor market participation - a prospective study in the Danish population
Authors
Katja Loengaard
Jakob Bue Bjorner
Per Klausen Fink
Hermann Burr
Reiner Rugulies
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-2177-4

Other articles of this Issue 1/2015

BMC Public Health 1/2015 Go to the issue