Work-related functioning among long-term sick-listed workers with persistent subjective health complaints

The main aim of this thesis was to obtain insight into the work-related functioning of long-term sick-listed workers with SHC, and additionally, to evaluate whether these outcomes were observed in long-term sick-listed workers with other disorders as well. In chapter 2 physicians reached consensus on the level of functioning for 49 items in four cases, but they could not reach consensus in their advice on the level of functioning in the category of working hours and there was also a difference in the number and level of functioning of the remaining work-related functioning items between the four cases. Chapter 3 showed that insurance physicians advised full sick leave less often than occupational physicians. Furthermore, it seemed that insurance physicians deemed psychological diagnoses, private issues and reduced work ability less important than occupational physicians in their sick leave advice. Chapter 4 showed low to moderate correlations between two out of the four work-related functioning item clusters and six out of the eleven self-perceived health factors for all participants. Some of these correlations were lower for workers with SHC than for workers with other disorders. In Chapter 5 the most important prognostic factors for returning to work were “not receiving a work disability benefit” and “having a positive self-perceived possibility for returning to work”. In Chapter 6 the examination showed that most important prognostic factors for staying at work for both groups of workers were “not receiving full work disability benefits”, “good mental health” and “positive expectations for staying at work”. Other prognostic factors that seemed important for staying at work for workers with SHC were “no previous absenteeism for the same health complaints” and “good coping strategies”. Chapter 7, contains the general discussion. The results of this thesis indicate that psychosocial factors are important factors for work-related functioning after long-term sickness absence, both for workers with SHC and for those with other disorders. Irrespective of the underlying disorder, physicians should therefore also focus on psychosocial factors in their assessment, support and advice about the level of functioning, recovery, rehabilitation and participation possibilities. To give physicians better opportunities to focus on these psychosocial factors, modification of the policies and frameworks of the Dutch social security system towards a biopsychosocial model with a bilateral focus seems warranted. Consequently, workers’ individual capacities and needs could play a more central role, with support by (partial) work disability benefits. Further research is needed to detail the exact modifications to the policies and frameworks that are necessary, in order to make use of the new insights into important factors in returning to and staying at work for workers both with and without SHC.