Do patients with different psychiatric diagnoses require different strategies for certifying sick leave? - first indications from a prospective study.

AIM To analyze the relationship between duration of prior certified sick leave and the course of symptom severity in a prospective study. METHODS The severity of psychiatric symptoms was assessed in 109 patients of a psychosomatic/psychotherapeutic polyclinic. Using a basic patient documentation and the Symptom-Check-List SCL-90-R, sociodemographic information, diagnosis, symptom duration, and duration of sick leave were assessed at admission and four to six months later. Intra-individual difference scores were calculated for each patient to assess changes in the severity of psychiatric symptoms. RESULTS A highly significant interaction between the course of symptom severity, duration of prior sick leave, and diagnostic group was found with two-factorial analysis of variance (F=2.888; P>/=0.01). At the second assessment, patients with anxiety disorders and longer sick leave showed a higher degree of deterioration in symptoms compared with anxiety patients with shorter or no prior sick leave. The patients with depression disorders and long certified sick leave achieved a higher degree of improvement in symptoms compared with depressive patients with shorter or no prior certified sick leave. CONCLUSION Different diagnostic groups of psychiatric patients require different strategies for certifying sick leave.