http://hdl.handle.net/1956/995 Search the Channel search http://bora.uib.no/simple-search http://hdl.handle.net/1956/2141 Title: Returning disability pensioners with back pain to work <br/> <br/>Authors: Magnussen, Liv Heide <br/> <br/>Abstract: The main purpose of this thesis was to investigate whether a group of disability pensioners with back pain would have a potential for a successful return to work. Perceived barriers against work, physical and mental functioning and the effect of a vocational- oriented intervention were evaluated. The thesis consists of three papers. The first paper deals with the pensioners’ perceived barriers against work and perceptions of their own health. This was considered likely to have an impact on the process of returning to work. To explore these perceptions, focus group interviews in a sample of 17 disability pensioners were carried out. Several perceived barriers against a successful return to work appeared: earlier negative experiences related to the disability process and previous work, poor self - judgement of work ability, low self-esteem, lack of support from social security authorities and unsuitable economic arrangements. The second paper explores whether the level of physical and mental functioning would influence on a successful return to work in patients on disability pension due to back pain. Both self-report and physical performance measures disclosed considerably reduced physical functioning among these disability pensioners. High levels of pain, fear avoidance beliefs, emotional distress and other health complaints were also reported. The majority rated their working ability as poor and did not expect that they could ever return to work. However, a subgroup with a more positive expectancy was found. In this group we found a better physical and mental functioning. In the third paper, a randomised controlled trial was conducted to evaluate the effect of a brief vocational-oriented intervention. The intervention focused on the issues emerging from Paper 1 and 2. The intervention had no statistically significant effect on return to work during the following year. However, twice as many in the intervention group as in the control group had entered into a return to work process at 1-year follow-up which gave a number needed to treat of 9. Prognostic factors for having entered this process included a more positive expectancy for a return to work, less pain and better physical performance. This thesis confirms that the effort of returning disability pensioners with back pain to work is a challenging task. Due to the large economical implication of returning disability pensioners to work, the modest effect of the intervention used in the present study may still be of clinical and economical relevance, at least for a selected group of pensioners. Candidates for vocational rehabilitation seem to be more likely to succeed if they have a positive attitude towards returning to work, have less pain and when they are not severely physically impaired. Candidates in future rehabilitation programmes should probably be selected based on these criteria. They seem also to need very close follow-up from all parts involved in the return to work process. http://hdl.handle.net/1956/2095 Title: Sick Leave and Subjective Health Complaints <br/> <br/>Authors: Tveito, Torill Helene <br/> <br/>Abstract: The aims of this thesis were to identify risk factors for high levels of sick leave and investigate what – if anything – can be done to reduce sick leave. What is the role of “subjective health complaints”, coping, and psychosocial work factors in relation to sick leave, and to what extent do these factors and the sick leave relate to quality of life? Are there any interventions with a documented effect on sick leave in the literature? Is it possible to influence sick leave through an intervention tailored to target the risk factors for sick leave including both psychological and physiological health factors? Finally, the aim was to identify and describe employees with a high level of sick leave. “Subjective health complaints” are complaints without known pathology or where the pathological findings are less than expected. Such complaints are the cause of more than 50% of the sick leave in Norway. Musculoskeletal complaints are one subgroup of subjective health complaints and are responsible for nearly half of the sick leave. Low back pain is the most common diagnosis in this group. Employees in the health sector are the work group with most sick leave and highest recruitment to disability pension. In Paper 1 employees in two nursing homes for the elderly were assessed for subjective health complaints as well as for health related quality of life. In addition, personal and work factors were monitored. High levels of subjective health complaints did relate to low quality of life. High expectancies of being able to cope and low work demands were associated to high quality of life; and low coping expectancies and high work demands were associated to low quality of life. Since low back pain is the most common reason for sick leave and a frequent complaint among the employees in the nursing homes, the literature for work place interventions targeted at low back pain was searched. In Paper 2 the results from this systematic literature review of controlled work place interventions are presented. We identified 31 publications that satisfied our quality criteria. The inclusion criteria were: controlled intervention, work setting, and assessment of at least one of the four main outcome measures: sick leave, costs, new episodes of low back pain, and pain. All studies were scored on methodological quality. Physical exercise and comprehensive multidisciplinary interventions were the only interventions with a documented effect on low back pain. Physical exercise to prevent low back pain and comprehensive multidisciplinary interventions to treat employees with low back pain were effective in reducing sick leave, costs, and preventing recurrence of low back pain. In Paper 3 the effects of an intervention tailored to target the risk factors for sick leave including both psychological and physiological health factors related to sick leave are presented. Employees in one of the nursing homes from Paper 1 were invited to participate in an “Integrated Health Programme” consisting of physical exercise, health information, and stress management, in a randomised controlled study. The intervention group (n = 19) was allowed time off from work to participate in the intervention twice weekly for 9 months. The control group (n = 21) was offered the same “Integrated Health Programme” after the study was finished. The intervention had no significant effect on sick leave. Sick leave more than doubled in both groups during the intervention period. The intervention group reported less neck complaints compared to the control group, otherwise there were no effects on subjective health complaints. On the other hand, there were large positive subjective effects in the intervention group. The intervention group reported significant improvement in their experience of their own health, physical fitness, muscle pain, stress management, maintenance of health, and work situation. Still, this did not change the scores on health related quality of life. This may relate to the fact that the scores were about average for the group as a whole. Finally, in Paper 4, the distribution of sick leave in a population of power plant employees was described. A group of 10% of the employees was responsible for 82% of the sick leave, with an average number of 44 days of sick leave in the group of employees with much sick leave and 1 day in the group with low level of sick leave. The employees with much sick leave were characterised by high levels of subjective health complaints, low education, low coping, heavy manual work, and many health risk factors such as smoking, low job satisfaction, high reports of job stress, poor quality of sleep, and low level of physical activity. With sick leave among the employees distributed like this, demonstrating effect on sick leave of an intervention including all employees will be difficult. The conclusion from the thesis is that a minor part of the employees had the major part of the sick leave. The employees with much sick leave were characterised by having high levels of subjective health complaints, an unhealthy life style, low coping, a reduced quality of life, and low socioeconomic status. Subjective health complaints were important for daily life functioning. High coping and low job demands were associated with high quality of life. Physical exercise interventions at the work place had a documented effect on sick leave. A work place intervention including physical exercise was not effective in reducing sick leave and subjective health complaints, but had large subjective effects. The potential for reducing sick leave is small when targeting all employees in an organisation and this may explain why so few of the interventions aiming to reduce sick leave, including the one in this thesis, are effective. http://hdl.handle.net/1956/2029 Title: The nature of subjective health complaints in adolescence : dimensionality, stability, and psychosocial predictors <br/> <br/>Authors: Hetland, Jørn <br/> <br/>Abstract: Despite the fact that adolescence is regarded as a period in life with good health and where severe illness is uncommon, many adolescents struggle with different kinds of health complaints in their daily lives. From a preventive point of view it is crucial to gain insight into the nature of health complaints among children and adolescents, as well as their aetiology. The main purpose of the present thesis is to provide knowledge about the underlying structures in health complaints, the stability and development of health complaints, and the reciprocal relationship between psychosocial predictors in the school context and subjective health complaints in adolescence. Possible implications for the development of preventive efforts are also addressed. The thesis consists of three papers, and the papers apply data from three different studies. Paper one is based on data from two of the studies. First, a sub-sample, consisting of 1251 Norwegian students (11 -15 year olds) from the Health Promoting Schools study (ENHPS) was used. Second, data from a nation wide study amongst 7059 Norwegian students (aged 11, 13, 15, and 16) from the Health Behaviour in School-aged Children (HBSC) study was used. In paper two, panel data from the Norwegian Longitudinal Health Behaviour (NLHB) study (n = 891) was applied. Finally, in paper three, a cohort of 386 students in Grade 8 (aged 13) from the ENHPS study was used. Analyses were mainly conducted within the Structural Equation Modeling (SEM) framework using AMOS 4.01 and 5.0. The results of the present thesis give no clear answer to the question of dimensionality underlying subjective health complaints. However, the findings in paper one suggest that there may be two underlying dimensions in subjective health complaints that may be labelled “somatic” and psychological” complaints, and that the two dimensions are highly correlated. All three papers in the thesis address developmental trends in subjective health complaints. While there is consistent evidence of an increase in complaints from early to mid adolescence among girls, the developmental trend is less pronounced among boys. Furthermore, the results from paper one and two indicate that differences in the developmental patterns between boys and girls result in an emergence of a gender difference that persists throughout adolescence. There is also evidence of a substantial relative stability in subjective health complaints during adolescence, reported in paper two, and an indication of an increasing relative stability with age. Finally, there is some evidence of a relationship between being bullied over time and a steeper developmental increase in subjective health complaints in paper three. Furthermore, social support from teachers and students is to some extent related to lower levels of complaints, while there is a clear relationship between support from fellow students and lower levels of being bullied across time. The findings in the present thesis confirm that the patterns of subjective health complaints may have developed already by adolescence and that there is considerable stability in such complaints. Consequently, interventions in adolescence may also have an impact on the prevalence of complaints later in life. Furthermore, findings from the present thesis indicate that psychosocial predictors, like being a victim of bullying and social support in the school context, may be important target factors for interventions aimed at promoting psychosocial aspects of health. http://hdl.handle.net/1956/1955 Title: Utilization of health services in relation to mental health problems in adolescents : a population based survey <br/> <br/>Authors: Zachrisson, Henrik D.; Rödje, Kjetil; Mykletun, Arnstein <br/> <br/>Abstract: Background: Only a minority of adolescents reporting symptoms above case-levels on screenings for mental health seeks and receives help from specialist health services. The objective of this study was to a) examine help-seeking for symptoms of anxiety and depression in relation to symptom load dimensionally, b) identify the level of specialization in mental health among service-providers, and c) identify associations between mental health problems and contact with different types of health services. Methods: This cross-sectional school-based study (response-rate 88%, n = 11154) is based on Norwegian health surveys among 15 and 16 year olds. Results: We found a dose-response association between symptom-load and help seeking. Only 34% of individuals with mental symptom-load above 99th percentile reported help-seeking in the last 12 months. Forty percent of help seekers were in contact with specialists (psychiatrists or psychologists), the remaining were mainly in contact with GPs. Mental health problems increased help seeking to all twelve service providers examined. Conclusion: It might not be reasonable to argue that all adolescents with case-level mental health problems are in need of treatment. However, concerning the 99th percentile, claiming treatment need is less controversial. Even in the Norwegian context where mental health services are relatively available and free of charge, help-seeking in individuals with the highest symptom-loads is still low. Most help seekers achieved contact with health care providers, half of them at a non specialized level. Our results suggest that adolescents' recognition of mental health problems or intention to seek help for these are the major "filters" restricting treatment. http://hdl.handle.net/1956/1925 Title: Employment status and perceived health in the Hordaland Health Study (HUSK) <br/> <br/>Authors: Overland, Simon; Glozier, Nicholas; Mæland, John Gunnar; Aarø, Leif Edvard; Mykletun, Arnstein <br/> <br/>Abstract: Background: Most western countries have disability benefit schemes ostensibly based upon requiring (1) a work inhibiting functional limitation that (2) can be attributed to a diagnosable condition, injury or disease. The present paper examines to what extent current practice matches the core premises of this model by examining how much poorer the perceived health of disability benefit recipients is, compared to the employed and the unemployed, and further to examine to what extent any poorer perceived health among benefit recipients can be attributed to mental or somatic illness and symptoms. Methods: Information on disability benefit recipiency was obtained from Norwegian registry data, and merged with health information from the Hordaland Health Study (HUSK) in Western Norway, 1997–99. Participants (N = 14 946) aged 40–47 were assessed for perceived physical and mental health (Short Form-12), somatic symptoms, mental health, and self reported somatic conditions and diseases treated with medication. Differences associated with employment status were tested in chi-square and t-tests, as well as multivariate and univariate regression models to adjust for potential confounders. Results: Recipients of disability benefits (n = 1 351) had poorer perceived physical and mental health than employees (n = 13 156); group differences were 1.86 and 0.74 pooled standard deviations respectively. Self reported somatic diagnoses, mental health and symptoms accounted for very little of this difference in perceived health. The unemployed (n = 439) were comparable to the employed rather than the recipients of disability benefits. Conclusion: Recipients of disability benefits have poor perceived health compared to both the employed and the unemployed. Surprisingly little of this difference can be ascribed to respondents' descriptions of their illnesses and symptoms. Even allowing for potential underascertainment of condition severity, this finding supports the increasing focus on non-disease oriented contributing factors. Rehabilitation efforts aiming at return to work should have a strong focus on the patients' perceptions of their health in addition to symptom relief and social factors. http://hdl.handle.net/1956/1917 Title: The past, present and future of the International Journal of Behavioral Nutrition and Physical Activity <br/> <br/>Authors: Brug, Johannes; French, Simone; Wold, Bente http://hdl.handle.net/1956/1910 Title: General practitioners' self-perceived ability to recognize severity of common mental disorders: an underestimated factor in case identification? <br/> <br/>Authors: Olssøn, Ingrid; Mykletun, Arnstein; Dahl, Alv A. <br/> <br/>Abstract: Background: Several studies have shown that general practitioners (GPs) under-diagnose common mental disorders, and that training courses hardly improve this practice. The influence of GPs' self-perceived ability to recognize the severity of such disorders on these facts has not been investigated. This study explores: 1) GPs' perceived ability to recognize major depressive episode (MDE) and generalized anxiety disorder (GAD) in their patients; 2) The GPs' observed ability to recognize severity of these disorders; and 3) If the observed ability to recognize severity is associated with their perceived ability. Methods: In a cross-sectional design 40 Norwegian GPs examined 15 – 28 patients each (total N = 724). The GPs' rated their perceived ability to recognize MDE and GAD on a four-point Likertscale. The GPs' observed ability to recognize severity was defined as the mean of the correlations between the GPs rating of Clinical Global Impression-Severity Scale and the diagnostic reference standards for MDE and GAD filled in by patients. Results: Twenty-two GPs considered their perceived ability to recognize MDE as rather good, and the other 18 as moderate/bad. For GAD 12 GPs' perceived their ability as rather good, while 28 considered their ability to be moderate/bad. The observed ability to recognize severity concerning MDE was 0.63 and concerning GAD 0.45. There was no significant association between GPs' perceived and observed abilities to recognize MDE (p = 0.19) and GAD (p = 0.34) Conclusion: This study found a discrepancy between the GPs' perceived and observed ability to recognize common mental disorders. The lack of association between GPs' perceived and observed ability to recognize such disorders indicate low understanding of own recognition abilities. This might contribute to explain the low effectiveness of interventions aimed to increase GPs' abilities to recognize mental disorders. http://hdl.handle.net/1956/1905 Title: Mortality and work-related disability as long-term consequences of anxiety and depression : historical cohort designs based on the HUNT-2 study <br/> <br/>Authors: Mykletun, Arnstein <br/> <br/>Abstract: Over the last decades, quality epidemiological studies have repeatedly shown that the prevalence of mental illness is substantial, but still largely under-recognised and undertreated. Under-recognition in general health care might also explain the modest attention to possible detrimental effects of such illness in terms of disability and mortality, and the mechanisms it operates through, compared to similar issues in other important fields of public health. This thesis is based on three papers, all focusing on grave outcomes of two of the most common mental illnesses; anxiety and depression. First, we investigated empirically the contribution of psychiatric morbidity to the award of disability pensions. With the purpose of finding out if anxiety and depression are under-recognized as risk factors for disability pension award, we examined if they had an effect independent of awards for physical diagnoses. Effects of mental disorders on disability pension award are generally estimated by aggregation of diagnoses reported in medical certificates underlying applications for disability pension, which is vulnerable for biases including the above mentioned under-recognition of mental disorders. There are numerous reports of effects of depression on general mortality, and specifically for cardiovascular diseases (CVD) and suicide. The second and third papers address six uncertainties in this literature concerning (i) residual confounding, (ii) doseresponse effect of severity of depression, (iii) mechanisms driving the association, (iv) whether there is an effect of mortality beyond CVD and suicide, (v) effect-moderation by gender, and (vi) effect of comorbid anxiety.