Recurrence of sickness absence episodes certified by general practitioners in the UK

Background: Compared to other areas of sickness certification, recurrence of certified sickness absence has been relatively under-researched.

Objectives: This study aims to report the extent and patterns of recurrence and to identify factors associated with higher rates of recurrence.

Methods: Sickness certification (‘fit note’) data were collected from 68 general practices in eight regions of the UK for 12 months.

Results: Twenty percent of 31,453 patients in the study had a recurrent certified sickness episode, with over half of these having the second episode in the same diagnostic category as their first. Mental health problems accounted for over a half of all days certified in same-diagnosis recurrent episodes. Male gender, residing in an area of social deprivation, a longer episode of initial certified sickness absence, not having return to work (‘may be fit’) advice in the first episode, having a mental disorder or musculoskeletal (particularly back) problem were all independently associated with a higher incidence of recurrence.

Conclusion: Differential risk of recurrence needs to be considered when designing return-to-work interventions. Evaluation of effectiveness of interventions (particularly for sickness absentees with mental health problems) has to consider the sustainability of employment after a return to work.