The association of patient's family, leisure time, and work situation with sickness certification in primary care in Sweden

Objective. To investigate associations between patients' family, leisure time, and work-related factors and physicians' measure as to whether or not to sickness certify the patient in connection with the consultation. Design. Questionnaire survey to physicians in general practice and their patients. Setting. General practitioners (GPs) and their patients in Orebro county, Sweden. Subjects. A total of 474 patient-physician consultations from 65 physicians with up to 10 patients each. Main outcome measure. Whether or not a sickness certificate was issued. Results. Among work-related factors, high "authority over decisions" and high "social support" correlated with 30% or more reduced sickness certification probability. Worrying about becoming ill or being injured from work correlates with almost doubled sickness certification risk. Among family and leisure-time variables, only living with a common law partner and having no children correlated with increased sickness certification risk. In addition to analyses of the whole group (all diagnoses), the two largest diagnostic subgroups, infectious diseases and musculoskeletal diseases, were examined. For the infectious diseases subgroup, high demands in work correlated with increased sickness certification risk, while in the musculoskeletal diseases subgroup, worry about work-related injury or illness was the main factor correlating with increased risk for sickness certification. Conclusions. Work-related factors were the most important factors related to sickness certification in this study. Determinants for sickness certification risk differed between diagnostic subgroups.