Predicting work disability and the outcome of vocational rehabilitation : the role of persistent physical symptoms and mental health

Abstract

Abstract In this Thesis, the relationship between Persistent Physical Symptoms (PPS), mental health, work disability and vocational rehabilitation outcome was examined in two samples. First, we looked at a sample of 324 people seeking vocational rehabilitation services and then at a subsample of 285 Non-Cardiac Chest Pain (NCCP) patients taken from a larger study on 504 chest pain patients that attended an Icelandic cardiac emergency department (CED). The participants in the vocational rehabilitation sample were between 18 and 65 years old, their mean age was 39.34 years and the majority of them were female (78.1%). Participants in NCCP study were between 18 and 66 years old, their mean age was 49.84 years and about half of them were female (54.0%) and a half of them male (46.0%). In both samples, participants filled out questionnaires measuring PPS and mental health problems. Information regarding the rehabilitation of the vocational rehabilitation service seekers and medical diagnoses of the chest pain patients was retrieved from the service providers. In the vocational rehabilitation sample, we firstly estimated the prevalence of PPS, examined how the extent of PPS related to mental health problems, and estimated how many rehabilitation seekers might benefit from psychological treatment for PPS. Secondly, we investigated whether the outcome of vocational rehabilitation and functional impairment at its beginning could be predicted by the presence of PPS, specific PPS types or symptoms of psychological distress using logistic- and hierarchical linear regression. In the CED sample, we examined the relationship between PPS, mental health and work disability from another angle by looking at patients diagnosed with NCCP. NCCP patients whose symptoms were severe enough to meet PPS criteria (n=85) were compared to other NCCP (n=200) patients in terms of work status, psychological symptoms, and total number of PPS. In our vocational rehabilitation sample, the prevalence of PPS was 80.9%, and the modal number of symptoms was three. Participants with PPS more commonly had depression, anxiety and health anxiety symptoms in the clinical range, and these symptoms were positively correlated with the number of PPS. Between 46.2% and 64.6% of our participants were identified as being likely to benefit from a specialised PPS treatment. Functional impairment at the beginning of service was predicted by depressive symptoms, PPS and social anxiety symptoms. Only persistent pain and depressive symptoms independently predicted not returning to work, and the rehabilitation duration was not related to the severity or number of psychological symptoms nor the presence or number of PPS. In the CED sample, NCCP patients whose symptoms met PPS criteria reported more symptoms of depression, anxiety and health anxiety than other NCCP patients. They also ruminated more, had a higher number of other PPS and were more likely to be inactive or unable to work. Within Icelandic vocational rehabilitation, special attention should be given to PPS and depressive symptoms as they are common, positively associated with functional impairment at the beginning of service and a specific combination of these symptoms was associated with a lower return to work rate. Overall, the results suggest a clear need for routine evaluation and specialised treatment for PPS within vocational rehabilitation and that such treatments should preferably be both transdiagnostic and work focussed. Furthermore, the results indicate that there might be value in identifying and treating PPS at earlier stages, such as through the CED.