Young immigrants on long-term sick-leave

Sickness certification data for all immigrants 16–45 years of age on long-term sick-leave enlisted at a local health insurance office were studied. The diagnostic pattern was remarkably homogeneous, characterized by imprecise pain and/or imprecise mental disorders. Clinical data were provided by a multiaxial evaluation of 52 people (mean age 38 years, mean length of sick-leave 1 year, full-time). Ratings of pain behavior and functional ability regarding occupational duties were also included. Nearly half (44%) had few social contacts both within their ethnic group and Swedish society. Half (58%) were assessed as being exposed to moderate or severe psychosocial stressors, and many had an associated mild or moderate depressive disorder. Muscular pain was the most frequent physical disorder. Pain behavior was common and was associated with the length of sick-leave. Two-thirds were assessed as being able to work at least part-time. The multiaxial evaluation system proved useful for differentiating important incapacitating diagnostic factors. Nevertheless, the examining doctors seemed to have been influenced by the participants' pain presentations when rating their functional ability. The study thus illustrates the ease with which a vicious circle of pain behavior and further sickness certification could be created. In conclusion, social distress and iatrogenic factors may have played an important part in the sick-leave pattern seen in this group of young immigrants.