A study of psychiatric referrals for fitness for work

BACKGROUND: There are very few Indian studies regarding the psychiatric evaluation of state government workers referred for psychiatric fitness for work. AIM: This study aimed to examine the reasons for referral, psychiatric diagnosis, and outcome of psychiatric referrals for fitness for work at a tertiary-level referral government hospital. MATERIALS AND METHODS: The study evaluated consecutive psychiatric referrals at a tertiary-level referral government hospital with their informed consent utilizing a specially prepared pro forma, Kuppuswamy's Socioeconomic Status Scale and the Mini International Neuropsychiatric Interview plus. Psychiatric diagnoses were based on the International Classification of Diseases 10th Edition Diagnostic Criteria for Research. RESULTS: The study included 67 male and 8 female psychiatric referrals with a mean age of 39.5 years. Most of the psychiatric referrals were married (82.6%), Hindu by religion (97.3%), from urban areas (80%), belonged to upper middle class (46.7%), and had rotating shifts or emergency duties (50%). Psychiatric referrals were usually made for a single reason (57%), most commonly absenteeism (84%) followed by undisciplined behavior (38%). A past history of disciplinary action taken against them was given by 56% of the referrals. The most common psychiatric diagnosis was psychoactive substance-use disorder (21.3%) followed by psychotic disorders (20%) and mood disorders (14.7%). No psychopathology was detected in 18.7% of the referrals. Most of the psychiatric referrals (68%) were fit for work, though 22.67% were declared unfit for work (permanent invalidation). Psychiatric referrals with multiple reasons for referrals, longer duration of psychiatric illness (>5 years), and diagnosis of organic mental disorder or psychotic disorder received invalidation (permanent unfitness) on psychiatric grounds. CONCLUSIONS: Psychiatric referral for fitness for work is most commonly for absenteeism. The most common psychiatric diagnosis was substance-use disorder followed by psychoses. The majority (68%) were found fit for work after treatment though 22.6% required invalidment from service.