Content uploaded by Lena Nordgren
Author content
All content in this area was uploaded by Lena Nordgren on Dec 17, 2015
Content may be subject to copyright.
This article was downloaded by: [Lena Nordgren]
On: 13 April 2015, At: 07:54
Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered
office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Click for updates
Psychology, Health & Medicine
Publication details, including instructions for authors and
subscription information:
http://www.tandfonline.com/loi/cphm20
Being on sick leave due to heart
failure: self-rated health, encounters
with healthcare professionals and
social insurance officers and self-
estimated ability to return to work
Lena Nordgrenabc & Anne Söderlundd
a School of Health, Care and Social Welfare, Mälardalen
University, Box 325, SE-631 05, Eskilstuna, Sweden
b Centre for Clinical Research Sörmland, Uppsala University,
Eskilstuna, Sweden
c Department of Public Health and Caring Sciences, Uppsala
University, Uppsala, Sweden
d School of Health, Care and Social Welfare, Mälardalen
University, Eskilstuna/Västerås, Sweden
Published online: 05 Feb 2015.
To cite this article: Lena Nordgren & Anne Söderlund (2015): Being on sick leave due to heart
failure: self-rated health, encounters with healthcare professionals and social insurance
officers and self-estimated ability to return to work, Psychology, Health & Medicine, DOI:
10.1080/13548506.2015.1007148
To link to this article: http://dx.doi.org/10.1080/13548506.2015.1007148
PLEASE SCROLL DOWN FOR ARTICLE
Taylor & Francis makes every effort to ensure the accuracy of all the information (the
“Content”) contained in the publications on our platform. However, Taylor & Francis,
our agents, and our licensors make no representations or warranties whatsoever as to
the accuracy, completeness, or suitability for any purpose of the Content. Any opinions
and views expressed in this publication are the opinions and views of the authors,
and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content
should not be relied upon and should be independently verified with primary sources
of information. Taylor and Francis shall not be liable for any losses, actions, claims,
proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or
howsoever caused arising directly or indirectly in connection with, in relation to or arising
out of the use of the Content.
This article may be used for research, teaching, and private study purposes. Any
substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,
systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Conditions of access and use can be found at http://www.tandfonline.com/page/terms-
and-conditions
Downloaded by [Lena Nordgren] at 07:54 13 April 2015
Being on sick leave due to heart failure: self-rated health, encounters
with healthcare professionals and social insurance officers and
self-estimated ability to return to work
Lena Nordgren
a,b,c
*and Anne Söderlund
d
a
School of Health, Care and Social Welfare, Mälardalen University, Box 325, SE-631 05,
Eskilstuna, Sweden;
b
Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna,
Sweden;
c
Department of Public Health and Caring Sciences, Uppsala University, Uppsala,
Sweden;
d
School of Health, Care and Social Welfare, Mälardalen University,
Eskilstuna/Västerås, Sweden
(Received 12 October 2014; accepted 8 January 2015)
Younger people with heart failure often experience poor self-rated health. Further-
more, poor self-rated health is associated with long-term sick leave and disability
pension. Socio-demographic factors affect the ability to return to work. However, lit-
tle is known about people on sick leave due to heart failure. The aim of this study
was to investigate associations between self-rated health, mood, socio-demographic
factors, sick leave compensation, encounters with healthcare professionals and social
insurance officers and self-estimated ability to return to work, for people on sick
leave due to heart failure. This population-based investigation had a cross-sectional
design. Data were collected in Sweden in 2012 from two official registries and from
a postal questionnaire. In total, 590 subjects, aged 23–67, responded (response rate
45.8%). Descriptive statistics, correlation analyses (Spearman bivariate analysis) and
logistic regression analyses were used to investigate associations. Poor self-rated
health was strongly associated with full sick leave compensation (OR = 4.1,
p< .001). Compared self-rated health was moderately associated with low income
(OR = 2.6, p= .003). Good self-rated health was strongly associated with positive
encounters with healthcare professionals (OR = 3.0, p= .022) and to the impact of
positive encounters with healthcare professionals on self-estimated ability to return to
work (OR = 3.3, p< .001). People with heart failure are sicklisted for long periods
of time and to a great extent receive disability pension. Not being able to work
imposes reduced quality of life. Positive encounters with healthcare professionals and
social insurance officers can be supportive when people with heart failure struggle to
remain in working life.
Keywords: adults; cross-sectional studies; heart failure; return to work; sick leave
Introduction
A number of studies have found that younger people with heart failure (HF) perceive
self-rated health (SRH) as poorer than older people (Chamberlain et al., 2014; Iqbal,
Francis, Reid, Murray, & Denvir, 2010; Moser et al., 2013; Sacco, Park, Suresh, &
Bliss, 2014). It has also been described that depression is associated with HF, especially
in younger persons and in women (Dekker, Peden, Lennie, Schooler, & Moser, 2009;
Moraska et al., 2013; Sacco et al., 2014). In addition, depression has been described as
*Corresponding author. Email: lena.nordgren@mdh.se
© 2015 Taylor & Francis
Psychology, Health & Medicine, 2015
http://dx.doi.org/10.1080/13548506.2015.1007148
Downloaded by [Lena Nordgren] at 07:54 13 April 2015
a risk predictor for hospitalizations (Chamberlain et al., 2014; Gottlieb et al., 2004;
Moraska et al., 2013) and high mortality (Jiang et al., 2001; Moser et al., 2013;
Rodriguez-Artalejo et al., 2005). Depression and low mood in people with HF can
express itself in terms of sadness, anxiety, lack of energy, negative thinking and losses
due to not being able to work (Dekker et al., 2009). In addition, the condition can,
among other things, lead to decreased sexual intimacy, a sense of worthlessness because
of inability to work, dullness, guilt, dependency on other people and unsatisfactory
understanding about the condition. Moreover, living with HF can contain experiences of
abandonment from healthcare providers (Nordgren, Asp, & Fagerberg, 2007; Sacco
et al., 2014). Thus, living with HF implies suffering and limitations (Nordgren et al.,
2007).
Little is known about sick leave for people with HF. However, in a general population,
SRH is associated with number of sick days, long-term sick leave, disability pension and
mortality (Eriksson et al., 2008; Halford et al., 2012; Henderson, Stansfeld, & Hotopf,
2013; Swedish Council on Technology Assessment in Health, 2004). Immigrants, people
with a low level of education or lower income are more likely to become long-term sick
listed. Gender is another factor associated with long-term sick leave (Allebeck &
Mastekaasa, 2004). In addition, high age and the individual’s sick leave history affect the
ability to return to work (RTW) (Lidwall, 2014). Encounters between healthcare profes-
sionals and sick-listed people are another aspect, which can have significance for sick-
listed persons’ability to RTW (Lynoe, Wessel, Olsson, Alexanderson, & Helgesson, 2011;
Mussener, Svensson, Soderberg, & Alexanderson, 2008).
In Sweden, people whose work capacity is reduced due to illness are entitled to sick
leave compensation from the social insurance system. The Social Insurance Agency can
entitle the sick-listed individual full or partial sickness benefit. People unlikely to work
again can be awarded partial or full-time disability pension, known as sickness compen-
sation.
The aim of this study was to investigate associations between SRH, mood, socio-
demographic factors, sick leave compensation, encounters with healthcare professionals
(HCPs) and social insurance officers (SIOs) and self-estimated ability to RTW, for
people on sick leave due to HF.
Methods
Design
This was a population-based study with a cross-sectional design.
Sample
The target group in this study was people with HF entitled to sick leave compensation
from the Swedish Social Insurance Agency. Eligibility criteria:
People registered under the diagnosis I50 HF in the Swedish Social Insurance
Agency’s sick leave registry.
People entitled to sick leave compensation at any time during the period of 1
March 2012–31 May 2012.
The identified target group comprised 1351 individuals.
2L. Nordgren and A. Söderlund
Downloaded by [Lena Nordgren] at 07:54 13 April 2015
Data collection
Data were collected from three sources: (1) The Swedish Social Insurance Agency’s sick
leave registry (diagnosis; sick leave spells; amount of sick leave compensation; and,
what kind of sick leave compensation the individuals had been entitled to during the
period 1 January 2010–31 August 2012); (2) Statistics Sweden’s population register
(sex; year of birth; age at the end of 2012; marital status, country of birth; education;
and annual income); (3) A postal survey questionnaire which contained questions about
encounters with HCPs and SIOs. The responders were asked to consider encounters
with HCPs and SIOs and to answer ‘Yes’or ‘No’regarding whether they had experi-
enced positive or negative encounters. They were also asked to rate how positive and
negative encounters impacted on their ability to RTW (‘Self-estimated ability to return
to work’; here labelled S-RTW). They could choose from five response options ranging
from ‘Facilitated very much’to ‘Impeded very much’. There were also two single-
question measures of SRH. One measure was non-comparative ( here labelled ‘SRH’)
which contained five response options ranging from ‘Very good’to ‘Very poor’. During
analysis, the responses were dichotomized to ‘Fair/good/very good’and ‘Poor/very
poor’. The second measure included a comparison with others of the same age ( here
labelled ‘C-SRH’) with reply alternatives: Better, Equal and Worse. During analysis, the
responses were dichotomized to ‘Better/equal’and ‘Worse’. A single-question measure
of mood was also included. The responders were asked to answer ‘Yes’or ‘No’to
the question: ‘Have you ever in the past 12 months, been in a low mood and/or had less
interest in activities for most of the day for at least two consecutive weeks?’
Statistics Sweden sent out the postal questionnaire and two reminders by mail. The
responders were asked to answer the questionnaire and return it to Statistics Sweden.
The returned questionnaires were registered and scanned by Statistics Sweden.
Data analysis
A total of 590 individuals (aged 23–67 years, mean 58.2, median 60.0, SD = 6.8)
responded to the questionnaire (Table 1). The overall response rate was 45.8%. Com-
pared with the study population, the responders were predominantly women, married,
older, Swedish-born or had high incomes.
Data were checked for quality, processed and whenever necessary grouped or
dichotomized in order to prepare for statistical analysis in SPSS. Descriptive statistics
were used for frequency distributions. Correlations between variables were investigated
using Spearman bivariate analysis. Next, significantly correlated variables were analysed
in logistic regression in order to identify which factors contributed to the associations.
The significance level was set at .05.
Ethical aspects
Ethical approval was obtained from the Uppsala Regional Ethical Review Board (Ref.
No. 2011/074). A supplementary letter contained information about the survey. The
responders were informed that participation was voluntarily. Informed consent was
obtained by return of the questionnaire.
Results
Most responders rated their general health as ‘Fair’. However, on comparison with other
people of the same age most responders rated their health as ‘Worse’. A majority of the
Psychology, Health & Medicine 3
Downloaded by [Lena Nordgren] at 07:54 13 April 2015
participants had experienced low mood for at least one consecutive period of two weeks
during the last 12 months (Table 2).
Table 1. Frequency distributions for socio-demographic variables.
Socio-demographic variables Responders n(%)
All responders
Gender 590 (100.0)
Men 414 (70.2)
Women 176 (29.8)
Age, years
23–59 269 (45.6)
60–67 321 (54.4)
Country of birth
Sweden 491 (83.2)
Other 99 (16.8)
Marital status
Married 316 (53.6)
Unmarried 150 (25.4)
Divorced/widowed 124 (21.0)
Level of education
Compulsory school 145 (24.6)
High school 344 (58.3)
University 100 (16.9)
Income
Low 108 (18.3)
Average 297 (50.3)
High 185 (31.4)
Table 2. Frequency distributions for self-rated health, compared self-rated health and mood in
the past 12 months.
Variables Frequency; nAgree; %
a
Self-rated health
Very good 19 3.3
Good 117 20.4
Fair 264 46.1
Poor 143 25.0
Very poor 30 5.2
Total 573 100.0
Compared self-rated health
Better 23 4.0
Equal 102 17.8
Worse 449 78.2
Total 574 100.0
Low mood
Yes 310 54.3
No 261 45.7
Total 571 100.0
a
Percentages of all responses.
4L. Nordgren and A. Söderlund
Downloaded by [Lena Nordgren] at 07:54 13 April 2015
Associations between socio-demographic factors and SRH, C-SRH and mood
SRH significantly correlated with income (r
s
=−.20, p< .001), country of birth (r
s
= .13,
p= .002) and education (r
s
=−.09, p= .037). Compared SRH correlated with income
(r
s
=−.15, p< .001) and mood correlated with income (r
s
=−.08, p= .043), country of
birth (r
s
= .08, p= .042) and age (r
s
=−.12, p= .005). The strongest association with
significant odds ratio was found between C-SRH and low income (Table 3).
Associations between sick leave compensation and health/mood
Self-reported sick leave compensation
The self-reporting questions about full or partial sick leave compensation were answered
by 262 responders (44.4%) (full sick leave compensation: 129; 49.2%; partial sick leave
compensation: 133; 50.8%).
Self-reported full sick leave compensation was significantly correlated with SRH
(r
s
=−.27, p< .001), C-SRH (r
s
=−.11, p= .007) and mood (r
s
= .14, p= .001).
In logistic regression analysis, the strongest association with significant odds ratio was
found between poor/very poor SRH and full sick leave compensation (OR 4.1, 95% CI
2.6–6.5, p< .001).
Registry-based sick leave compensation
According to the Social Insurance Agency’s sick leave registry, 367 (62.2%) of the
responders had received sickness benefit and 367 (62.2%) had received sickness
compensation.
Registry-based sickness benefit was significantly correlated with C-SRH (r
s
= .08,
p= .044), while registry-based sickness compensation correlated with both SRH
(r
s
= .13, p= .002) and C-SRH (r
s
= .15, p< .001). In logistic regression analysis, an
Table 3. Logistic regression models for associations between socio-demographic factors
(independent variables) and self-rated health, compared self-rated health and mood (dependent
variables).
Socio-demographic factors
Self-rated health
OR, 95% CI, p
Compared self-rated
health OR, 95% CI, p
Mood
OR, 95% CI, p
Income
Low 1.7, 1.0–3.0, .046 2.6, 1.4–4.8, .003 1.5, .9–2.5, .112
Average 1.2, .7–3.1, .505 2.1, 1.4–3.3, .001 1.2, .8–1.7, .367
High Ref Ref Ref
Country of birth –
Sweden Ref –Ref
Other 1.9, 1.2–3.1, .007 –1.5, .9–2.4, .093
Level of education ––
Compulsory school 1.6, .9–2.8, .147 ––
High school 1.0, .9–2.8, .147 ––
University Ref ––
Age ––
<60 years ––1.6, 1.1–2.2, .007
≥60 years ––Ref
Psychology, Health & Medicine 5
Downloaded by [Lena Nordgren] at 07:54 13 April 2015
association with significant odds ratio was found between registry-based sickness
compensation and worse C-SRH (OR 1.1, 95% CI .7–1.6, p= .001).
For responders entitled to sickness compensation, correlations between SRH and
socio-demographic variables were estimated. SRH was significantly correlated with
country of birth (r
s
= .15, p= .004), income (r
s
=−.16, p= .002) and age
(r
s
=−.16, p= .008). Associations with significant odds ratio were found between
SRH and low income (OR 5.2, 95% CI 2.0–13.2, p= .001) and average income (OR
2.5, 95% CI 1.4–4.7, p= .003).
Associations between time with sick leave compensation and SRH, C-SRH and mood
According to the Social Insurance Agency’s sick leave registry, 184 (50.1%) of the
responders had received sickness benefit for less than one year, 171 (46.6%) for 1 to
3 years and 12 (3.3%) for 3–5 years. Sickness compensation had been received by 35
(9.5%) of the responders for less than one year, 88 (24.0%) for 1 to 3 years and 244
(66.5%) for more than 3 years.
The time with registry-based sickness benefit was negatively correlated with SRH
(r
s
=−.31, p< .001) and C-SRH (r
s
=−.24, p< .001). The time with sickness com-
pensation was negatively correlated with SRH (r
s
=−.11, p= .035). In logistic regres-
sion analysis, moderate associations with significant odds ratio were found between
length of time with sickness benefit and poor/very poor SRH (OR 2.4, 95% CI 1.4–3.9,
p= .001) and worse C-SRH (OR 2.4, 95% CI 1.4–4.1, p= .003).
Associations between positive encounters with healthcare professionals and social
insurance officers and SRH, C-SRH and mood
Almost all responders (569; 96.4%) had positive experiences of encounters with HCPs.
Nearly three-quarters of the responders (434; 73.6%) had experienced encounters with
SIOs as positive.
Positive encounters with HCPs were significantly correlated with SRH (r
s
= .09,
p= .035). However, positive encounters with SIOs did not correlate with SRH, C-SRH
or mood. For responders with positive experiences of encounters with HCPs, correla-
tions with socio-demographic factors were estimated. SRH was significantly correlated
with country of birth (r
s
= .12, p= .004), income (r
s
=−.20, p< .001) and education
(r
s
=−.09, p= .036). Logistic regression showed a strong association between fair/
good/very good SRH and positive encounters with HCPs (Table 4).
Associations between negative encounters with healthcare professionals and social
insurance officers and SRH, C-SRH and mood
One-fifth of the responders (117; 20.2%) had experienced encounters with HCPs as
negative. One-third of the responders (176; 30.7%) had experienced encounters with
SIOs as negative.
Negative encounters with HCPs were negatively correlated with SRH (r
s
=−.13,
p= .002) and mood (r
s
=−.12, p= .005). In addition, negative encounters with SIOs
were negatively correlated to SRH (r
s
=−.16, p< .001) and mood (r
s
=−.12,
p= .004).
For responders who had experienced encounters with HCPs as negative, SRH signif-
icantly correlated with country of birth (r
s
= .20, p= .029). Moreover, mood was
negatively correlated with age (r
s
=−.20, p= .036).
6L. Nordgren and A. Söderlund
Downloaded by [Lena Nordgren] at 07:54 13 April 2015
In responders who had experienced encounters with SIOs as negative, SRH
significantly correlated with country of birth (r
s
=.16,p= .034), income (r
s
=−.21,
p= .006) and age (r
s
=−.18, p= .022) and mood was negatively correlated with age
(r
s
=−.24, p= .001). For responders who had experienced encounters with HCPs as
negative, the strongest association was found between poor/very poor SRH and being
born in other countries. For responders who had experienced encounters with SIOs as
negative, the strongest association was found between low mood and being younger
than 60 years of age (Table 4).
Table 4. Logistic regression models for: (1) Associations between self-rated health and mood
(independent variables) and positive and negative encounters with healthcare professionals and
social insurance officers (dependent variables). (2) Associations between socio-demographic fac-
tors (independent variables) and positive and negative encounters with healthcare professionals or
social insurance officers (dependent variables).
Positive encounters with
healthcare professionals
OR, 95% CI, p.
Negative encounters with
healthcare professionals
OR, 95% CI, p.
Negative encounters with
social insurance officers
OR, 95% CI, p.
Self-rated
health
(1)
Fair/good/
very good
3.0, 1.2–7.8, .022 Ref Ref
Poor/very
poor
Ref 1.7, 1.1–2.7, .017 1.6, 1.1–2.4, .019
Country of
birth
(2)
Sweden 1.8, 1.1–3.0, .013 Ref Ref
Other Ref 2.7, 1.1–7.0, .033 2.1, .9–5.1, .083
Income
(2)
–
Low Ref –1.9, .7–4.7, .190
Average 1.5, .9–2.4, .105 –1.0, .5–2.2, .961
High 1.8, 1.0–3.2, .037 –Ref
Level of
education
(2)
––
Compulsory
school
Ref ––
High school 1.5, .9–2.3, .091 ––
University 1.5, .8–2.7, .199 ––
Age
(2)
––
<60 years ––2.1, 1.1–4.0, .025
≥60 years ––Ref
Low mood
(1)
–
Yes –1.6, 1.0–2.6, .039 1.5, 1.0–2.2, .038
No –Ref Ref
Age
(2)
–
<60 years –2.4, 1.0–5.4, .038 2.8, 1.5–5.4, .002
≥60 years –Ref Ref
Psychology, Health & Medicine 7
Downloaded by [Lena Nordgren] at 07:54 13 April 2015
Associations between the impact of positive encounters with healthcare professionals
and social insurance officers on self-estimated ability to return to work and SRH,
C-SRH and mood
The question about how positive encounters with HCPs impacted on S-RTW was
answered by 551 (93.4%) responders. Out of those, 255 (46.3%) agreed that positive
encounters with HCPs facilitated their ability to RTW to a certain extent or very much.
However, 258 responders (46.8%) answered that positive encounters had no impact on
their ability to RTW. The impact of positive encounters with HCPs on S-RTW was sig-
nificantly correlated with SRH (r
s
=−.28, p< .001), C-SRH (r
s
=−.17, p< .001) and
mood (r
s
=−.11, p= .014). For responders who perceived that positive encounters
with HCPs facilitated their S-RTW, SRH correlated with income (r
s
=−.14, p= .032).
In addition, C-SRH was correlated with income (r
s
=−.16, p= .011). Logistic regres-
sion showed a strong association between fair/good/very good SRH and the impact of
positive encounters on S-RTW (Table 5).
The question about how positive encounters with SIOs impacted on S-RTW was
answered by 480 responders (81.4%). Out of those, 174 responders (36.3%) agreed that
positive encounters with SIOs facilitated their ability to RTW to a certain extent or very
much. Then again, 285 responders (59.4%) answered that positive encounters had no
impact on their S-RTW. The impact of positive encounters with SIOs significantly corre-
lated with SRH (r
s
= .24, p< .001), C-SRH (r
s
=.11,p= .020) and mood (r
s
= .16,
p< .001). For responders who perceived that positive encounters with SIOs facilitated
their S-RTW, SRH was significantly correlated with income (r
s
=−.14, p= .014) and
age (r
s
=−.14, p= .016). There was a moderate association between SRH and the
impact of positive encounters on S-RTW (Table 5).
Associations between the impact of negative encounters with healthcare professionals
and social insurance officers on self-estimated ability to return to work and SRH,
C-SRH and mood
The question about how negative encounters with HCPs impacted on S-RTW was
answered by 269 responders (45.6%). Out of those, 34 responders (12.6%) agreed that
negative encounters with HCPs impeded their ability to RTW to a certain extent or very
much. On the other hand, 221 responders (82.2%) answered that negative encounters
had no impact on their ability to RTW. The impact of negative encounters with HCPs
was not significantly correlated with SRH, C-SRH or mood.
The question about how negative encounters with SIOs impacted on S-RTW was
answered by 314 responders (53.2%). Out of those, 53 responders (16.9%) agreed that
negative encounters with SIOs impeded their ability to RTW to a certain extent or very
much. Conversely, 240 responders (76.4%) answered that negative encounters had no
impact on their ability to RTW. The impact of negative encounters with SIOs was not
significantly correlated with SRH, C-SRH or mood.
Discussion
The most important finding of this study was that a majority of the responders graded
their health as worse when they compared themselves with other people of their own
age. Another important finding was that many responders had experienced low mood
for a consecutive period of at least two weeks during the last 12 months. In addition,
there were significant associations between low mood and being aged less than 60 years.
8L. Nordgren and A. Söderlund
Downloaded by [Lena Nordgren] at 07:54 13 April 2015
A recent Canadian study of 519 patients with HF (mean age 73.3 years) found that 13%
of the patients reported poor health and 32% reported fair health (Chamberlain et al.,
2014).These results, thus, which included younger patients (mean age 58.2 years) indi-
cate that younger people with HF have poorer health than older ones. This is well in
line with previous research findings (Chamberlain et al., 2014; Iqbal et al., 2010; Moser
et al., 2013; Sacco et al., 2014).
Poor quality of life and depression in younger people with HF is assumed to be
caused by a discrepancy between the person’s perceptions of their functional status and
their expectations, which can be more difficult for younger people to accept than for
older people (Gottlieb et al., 2004). Younger people expect to remain active and main-
tain their social, domestic and work roles, but these expectations are negatively changed
Table 5. Logistic regression models for: (1) Associations between self-rated health and mood
(independent variables) and impact of positive encounters with healthcare professionals and social
insurance officers on self-estimated ability to return to work (dependent variables). (2) Associa-
tions between socio-demographic factors (independent variables) and impact of positive encoun-
ters with healthcare professionals/social insurance officers on self-estimated ability to return to
work (dependent variables).
Impact of positive encounters with
healthcare professionals on self-estimated
ability to return to work OR, 95% CI, p
Impact of positive encounters with
social insurance officers on self-
estimated ability to return to work
OR, 95% CI, p
Self-rated
health
(1)
Fair/good/
very good
3.3, 2.1–5.1, <.001 2.2, 1.4–3.7, .002
Poor/very
poor
Ref Ref
Income
(2)
Low Ref Ref
Average 1.0, .3–3.3, .986 1.1, .6–2.0, .818
High 1.0, .3–3.3, .985 1.4, .7–2.8, .389
Age
(2)
–
<60 years –Ref
≥60 years –1.8, 1.1–3.0, .014
Compared self-
rated
health
(1)
Equal/better 1.7, 1.1–2.8, .022 1.4, .9–2.2, .174
Worse Ref Ref
Income
(2)
–
Low Ref –
Average 1.1, .4–3.2, .890 –
High 2.3, .8–6.6, .125 –
Low mood
(1)
Yes Ref Ref
No 1.0, .7–1.5, .918 1.3, .9–2.0, .192
Psychology, Health & Medicine 9
Downloaded by [Lena Nordgren] at 07:54 13 April 2015
by the limitations brought by the condition (Dekker et al., 2009; Moser et al., 2013),
implying reduced self-esteem and a changed self-image (Nordgren et al., 2007).
Previously, this discrepancy has been described in terms of ‘Loss and Disappointment’
(Moser et al., 2013).
These results showed moderate to strong associations between good SRH and the
impact on self-estimated ability to work of positive encounters with HCPs and SIOs.
Work is generally positive for people’s health and well-being. Work, thus, fulfils impor-
tant psychosocial needs for people’s identity, social roles and social status (Waddell &
Burton, 2006). Previously, it has been described that in order for people with HF to
cope with the condition social support and medical resources should be used (Sacco
et al., 2014). Negative thinking may be an important component of depression in people
with HF (Dekker et al., 2009). Subsequently, interventions that assist patients to see
new possibilities and to adopt new goals can be supportive for people with HF (Moser
et al., 2013).
Perceptions of SRH and well-being are based on five interacting dimensions: physi-
cal, psychological, social, ecological and existential (Melder, 2011). All dimensions
need to be considered in relation to people on long-term sick leave due to HF. However,
on the basis of existing knowledge about younger people being more depressed than
older, and that the cause for this is considered to be losses and disappointments, the
existential dimension can have a more prominent role than usually considered. This
dimension includes losses and changes which affect fundamental aspects of life (Melder,
2011). In addition, it includes experiences of a threatened existence (Melder, 2011),
which has been previously described by people living with HF (Nordgren et al., 2007).
People who are forced into new and less active roles due to illness and sick leave can
have difficulties in letting go of their previous self-image implying reduced self-esteem
(Jansson & Bjorklund, 2007; Lannerstrom, Wallman, & Holmstrom, 2013). Sick leave,
then, implies personal challenges concerning health, work, relationships and economy.
As a consequence, incapacity to work due to weakening health can lead to stigmatiza-
tion and social exclusion (Jansson & Bjorklund, 2007).
These results showed that two-third of the responders received full or partial sick-
ness compensation i.e. disability pension. Disability pension is a well-known factor for
social isolation and exclusion (Vingard, Alexanderson, & Norlund, 2004). For many
people with HF disability, pension can be a solution to work-related problems, but not
for all. People with HF, as with many others, perceive work and working life as impor-
tant aspects of life. These results also indicate that people who rated their health as poor
or worse in comparison with other people of the same age received sickness benefit for
longer periods of time than people who rated their health as fair or good. One explana-
tion could be that long-term sick leave affects psychosocial conditions (Melder, 2011)
which can hinder the patients from experiencing coherence, control or meaningfulness
implying existential ill-being. In turn, the sick-listed person’s perception of their general
health is affected. Thus, people’s perceptions of their health and consequences of long-
term sick leave have public health relevance for prevention and for interventions.
In Sweden, all existing sick leave spells are registered by the Social Insurance
Agency. Data, thus, from the two official registries in use are highly reliable. The postal
questionnaire has been used in several population-based studies (Lynoe et al., 2011;
Müssener, 2007; Mussener et al., 2008; Upmark, Borg, & Alexanderson, 2007; Upmark,
Hagberg, & Alexanderson, 2011; Wessel, 2013; Wessel et al., 2013), implying high
reliability and validity in data. However, there might be inaccuracies due to registration
10 L. Nordgren and A. Söderlund
Downloaded by [Lena Nordgren] at 07:54 13 April 2015
procedures. Because of the low response rate these results should be interpreted
cautiously.
To conclude, the sick leave and RTW process is a complex, multifaceted and
dynamic problem which includes individual, structural and environmental aspects. As
suggested by these results, positive encounters with both HCPs and SIOs can support
people with HF in their efforts to remain in working life. However, HCPs and SIOs
need to let patients/clients take responsibility and show them that they believe in what
they say and in their ability to RTW. Moreover, HCPs and SIOs need to consider the
existential dimension of patients/clients’SRH and well-being.
Acknowledgements
The authors thank Professor Kristina Alexanderson, Karolinska Institutet, Stockholm for permis-
sion to use the postal questionnaire, and Mr Simon Dyer, attain.se, for linguistic revision.
Funding
The work was supported by the Swedish Social Insurance Agency [grant number 25728/2010].
ORCID
Lena Nordgren http://orcid.org/0000-0003-0667-7111
References
Allebeck, P., & Mastekaasa, A. (2004). Swedish Council on Technology Assessment in Health
Care (SBU). Chapter 5. Risk factors for sick leave –General studies. Scandinavian Journal of
Public Health Supplement, 63,49–108.
Chamberlain, A. M., Manemann, S. M., Dunlay, S. M., Spertus, J. A., Moser, D. K., Berardi, C.,
…Roger, V. L. (2014). Self-rated health predicts healthcare utilization in heart failure. Jour-
nal of the American Heart Association, 3, e000931. doi:10.1161/JAHA.114.000931
Dekker, R. L., Peden, A. R., Lennie, T. A., Schooler, M. P., & Moser, D. K. (2009). Living with
depressive symptoms: Patients with heart failure. American Journal of Critical Care, 18,310–318.
Eriksson, H.-G., von Celsing, A.-S., Wahlström, R., Janson, L., Zander, V., & Wallman, T.
(2008). Sickness absence and self-reported health a population-based study of 43,600 individ-
uals in central Sweden. BMC Public Health, 8, 426. doi:10.1186/1471-2458-8-426
Gottlieb, S. S., Khatta, M., Friedmann, E., Einbinder, L., Katzen, S., Baker, B., …Thomas, S. A.
(2004). The influence of age, gender, and race on the prevalence of depression in heart failure
patients. Journal of the American College of Cardiology, 43, 1542–1549.
Halford, C., Wallman, T., Welin, L., Rosengren, A., Bardel, A., Johansson, S., …Svärdsudd, K.
(2012). Effects of self-rated health on sick leave, disability pension, hospital admissions and
mortality. A population-based longitudinal study of nearly 15,000 observations among Swed-
ish women and men. BMC Public Health, 12, 1103. doi:10.1186/1471-2458-12-1103
Henderson, M., Stansfeld, S., & Hotopf, M. (2013). Self-rated health and later receipt of work-
related benefits: Evidence from the 1970 British Cohort Study. Psychological Medicine, 43,
1755–1762.
Iqbal, J., Francis, L., Reid, J., Murray, S., & Denvir, M. (2010). Quality of life in patients with
chronic heart failure and their carers: A 3-year follow-up study assessing hospitalization and
mortality. European Journal of Heart Failure, 12, 1002–1008.
Jansson, I., & Bjorklund, A. (2007). The experience of returning to work. Work, 28, 121–134.
Jiang, W., Alexander, J., Christopher, E., Kuchibhatla, M., Gaulden, L. H., Cuffe, M. S., …
O’Connor, C. M. (2001). Relationship of depression to increased risk of mortality and rehos-
pitalization in patients with congestive heart failure. Archives of Internal Medicine, 161,
1849–1856.
Psychology, Health & Medicine 11
Downloaded by [Lena Nordgren] at 07:54 13 April 2015
Lännerström, L., Wallman, T., & Holmström, I. K. (2013). Losing independence –The lived
experience of being long-term sick-listed. BMC Public Health, 13, 745. doi:10.1186/1471-
2458-13-745
Lidwall, U. (2014). Sick leave diagnoses and return to work: A Swedish register study. Disability
and Rehabilitation [Epub ahead of print],1–15. doi:10.3109/09638288.2014.923521
Lynoe, N., Wessel, M., Olsson, D., Alexanderson, K., & Helgesson, G. (2011). Respectful
encounters and return to work: Empirical study of long-term sick-listed patients’experiences
of Swedish healthcare. BMJ open, 1, e000246.
Melder, C. A. 2011. Vilsenhetens epidemiologi. En religionspsykologisk studie i existentiell
folkhälsa [The epidemiology of lost meaning. A study in psychology of religion and existen-
tial public health in a Swedish context]. Acta Universitatis Upsaliensis. Psychologia et socio-
logia religionum 25. Uppsala. 305 pp. ISBN 978-91-554-7958-9. (Dissertation. In Swedish).
Moraska, A. R., Chamberlain, A. M., Shah, N. D., Vickers, K. S., Rummans, T. A., Dunlay, S.
M., …Roger, V. L. (2013). Depression, healthcare utilization, and death in heart failure: A
community study. Circulation: Heart Failure, 6, 387–394.
Moser, D. K., Heo, S., Lee, K. S., Hammash, M., Riegel, B., Lennie, T. A., …Watkins, J.
(2013). ‘It could be worse …lot’s worse!’Why health-related quality of life is better in older
compared with younger individuals with heart failure. Age and Ageing, 42, 626–632.
Müssener, U. (2007). Encouraging encounters: Experiences of people on sick leave in their meet-
ings with professionals (Dissertation). Linköping: Linköping University.
Mussener, U., Svensson, T., Soderberg, E., & Alexanderson, K. (2008). Encouraging encounters:
Sick-listed persons’experiences of interactions with rehabilitation professionals. Social Work
in Health Care, 46,71–87.
Nordgren, L., Asp, M., & Fagerberg, I. (2007). An exploration of the phenomenon of formal care
from the perspective of middle-aged heart failure patients. European Journal of Cardiovascu-
lar Nursing, 6, 121–129.
Nordgren, L., Asp, M., & Fagerberg, I. (2007). Living with moderate-severe chronic heart failure
as a middle-aged person. Qualitative Health Research, 17,4–13.
Rodríguez-Artalejo, F., Guallar-Castillón, P., Pascual, C. R., Otero, C. M., Montes, A. O., García,
A. N., …Herrera, M. C. (2005). Health-related quality of life as a predictor of hospital read-
mission and death among patients with heart failure. Archives of Internal Medicine, 165,
1274–1279.
Sacco, S. J., Park, C. L., Suresh, D. P., & Bliss, D. (2014). Living with heart failure: Psychosocial
resources, meaning, gratitude and well-being. Heart & Lung: The Journal of Critical Care.,
43, 213–218.
Swedish Council on Technology Assessment in Health. (2004). Sickness absence: Causes, conse-
quences, and physicians’sickness certification practice. A systematic literature review by the
Swedish Council on Technology Assessment in Health Care (SBU). Scandinavian Journal of
Public Health Supplement, 63,3–263.
Upmark, M., Borg, K., & Alexanderson, K. (2007). Gender differences in experiencing negative
encounters with healthcare: A study of long-term sickness absentees. Scandinavian Journal of
Public Health, 35, 577–584.
Upmark, M., Hagberg, J., & Alexanderson, K. (2011). Negative encounters with social insurance
officers –Experiences of women and men on long-term sick leave. International Journal of
Social Welfare, 20, 309–317.
Vingård, E., Alexanderson, K., & Norlund, A. (2004). Swedish Council on Technology Assess-
ment in Health Care (SBU). Chapter 9. Consequences of being on sick leave. Scandinavian
Journal of Public Health Supplement, 63, 207–215.
Waddell, G., & Burton, A. K. (2006). Is work good for your health and well-being? London:
TSO, p. 246s.
Wessel, M. (2013). Negative experiences of encounters in healthcare (Dissertation). Stockholm:
Karolinska Institutet.
Wessel, M., Helgesson, G., Olsson, D., Juth, N., Alexanderson, K., & Lynoe, N. (2013). When do
patients feel wronged? Empirical study of sick-listed patients’experiences with healthcare
encounters. The European Journal of Public Health, 23, 230–235.
12 L. Nordgren and A. Söderlund
Downloaded by [Lena Nordgren] at 07:54 13 April 2015
