Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
Region of Stockholm, Academic Primary Care Centre, Stockholm, Sweden.
BMJ Open. 2022 Jun 22;12(6):e057745. doi: 10.1136/bmjopen-2021-057745.
To investigate the correspondence between diagnoses on sick leave certificates and diagnoses made in structured psychiatric interviews. Secondary aims were to investigate length of sick leave by diagnoses on sick leave certificates, diagnoses made in structured interviews and symptom severity.
Observational study consisting of a secondary analysis of data from a randomised controlled trial and an observational study.
The regions of Stockholm and Västra Götaland, Sweden.
480 people on sick leave for common mental disorders.
Participants were examined with structured psychiatric interviews and self-rated symptom severity scales.
(1) Sick leave certificate diagnoses, (2) diagnoses from the Mini International Neuropsychiatric Interview and the Self-rated Stress-Induced Exhaustion Disorder (SED) Instrument (s-ED), (3) symptom severity (Montgomery-Asberg Depression Rating Scale-self-rating version and the Karolinska Exhaustion Disorder Scale) and (4) number of sick leave days.
There was little correspondence between diagnoses on sick leave certificates and diagnoses made in structured psychiatric interviews. Many participants on sick leave for SED, anxiety disorder or depression fulfilled criteria for other mental disorders. Most on sick leave for SED (76%) and anxiety disorder (67%) had depression (p=0.041). Length of sick leave did not differ by certificate diagnoses. Participants with SED (s-ED) had longer sick leave than participants without SED (144 vs 84 days; 1.72 (1.37-2.16); p<0.001). More severe symptoms were associated with longer sick leave.
Diagnoses on sick leave certificates did not reflect the complex and overlapping nature of the diagnoses found in the structured psychiatric interviews. This finding is relevant to the interpretation of information from health data registers, including studies and guidelines based on these data. A result of clinical interest was that more severe symptoms predicted long-term sick leave better than actual diagnoses.
调查病假条诊断与结构性精神访谈诊断之间的一致性。次要目的是调查病假条诊断、结构性访谈诊断和症状严重程度与病假长短的关系。
对一项随机对照试验和一项观察性研究的数据进行二次分析的观察性研究。
瑞典斯德哥尔摩和西约塔兰地区。
480 名因常见精神障碍而请病假的患者。
参与者接受了结构性精神访谈和自我评定症状严重程度量表的检查。
（1）病假条诊断，（2）来自 Mini 国际神经精神访谈和自我评定应激诱发衰竭障碍（s-ED）量表的诊断，（3）症状严重程度（蒙哥马利-阿斯伯格抑郁评定量表自评版和卡罗林斯卡衰竭障碍量表），（4）病假天数。
病假条诊断与结构性精神访谈诊断之间的一致性较差。许多因 s-ED、焦虑障碍或抑郁而请病假的患者符合其他精神障碍的诊断标准。大多数因 s-ED（76%）和焦虑障碍（67%）请病假的患者都患有抑郁（p=0.041）。病假长短与病假条诊断无关。患有 s-ED（s-ED）的患者比没有 s-ED 的患者病假时间更长（144 天比 84 天；1.72（1.37-2.16）；p<0.001）。症状越严重，病假时间越长。
病假条诊断未能反映结构性精神访谈中发现的诊断的复杂和重叠性质。这一发现与对健康数据登记处信息的解释有关，包括基于这些数据的研究和指南。一个具有临床意义的结果是，更严重的症状比实际诊断更能预测长期病假。
