Work-related stress, reason for consultation and sick leave diagnosis in primary health care patients

BACKGROUND: Work-related stress is common and stress-related ill health is often managed in primary health care. The reason for consultation is important for diagnosis and treatment. This study aimed to improve the understanding of the association between reason for consultation, work-related stress and sick leave diagnosis in primary health care patients. METHODS: In all, 232 patients who sought care for mental and physical health complaints at primary health care centres in Sweden participated. At inclusion, the patients were employed and non-sick listed. Pearson chi-squared test and relative risk were used to assess the associations. RESULTS: Patients reporting high work-related stress, compared with low work-related stress, were more prone to seek care for mental symptoms (59% versus 18%), sleep disturbance (36% versus 17%) and fatigue (40% versus 26%). Among the high-stress patients, the risk for sick leave with a mental diagnosis was three times as high as in low-stress patients within a year of baseline (RR 2.97, 95% CI 1.59;5.55). However, no risk increase was seen in sick leave with a musculoskeletal diagnosis (RR 0.55, 95% CI 0.22;1.37). Stating mental symptoms, sleep disturbance or fatigue as reason for consultation were associated with future mental sick leave diagnosis (p-values < 0.001). Stating musculoskeletal symptoms as reason for consultation was also associated with future musculoskeletal sick leave diagnosis (p-value 0.009), but not in patients reporting high work-related stress. CONCLUSIONS: High-stress patients, compared with low-stress patients, more often sought care for mental symptoms, sleep disturbance and fatigue leading to a mental sick leave diagnosis. No such associations were found between stress, care seeking due to musculoskeletal symptoms and future musculoskeletal sick leave diagnosis. It can therefore be assumed that patients as well as general practitioners saw work-related stress as a mental issue. KEY MESSAGES: • Incorporating the reason for consultation increased the understanding of the association between work-related stress and sick leave. • Work-related stress was characterized as a mental issue, which could affect care seeking behaviors and measures taken.