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Open Access Highly Accessed Research article

"A powerful intervention: general practitioners'; use of sickness certification in depression"

Sara Macdonald1*, Margaret Maxwell2, Philip Wilson1, Michael Smith3, Will Whittaker4, Matt Sutton4 and Jill Morrison5

Author Affiliations

1 General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, 1, Horselethill Road, Glasgow, G12 9LX, UK

2 Mental Health, Nursing, Midwifery and AHP Research Unit, University of Stirling, Stirling, FK9 4LA, UK

3 Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, UK

4 Health Economics, Health Sciences Research Group, School of Community Based Medicine, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK

5 General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, 1, Horselethill Road, Glasgow, G12 9LX, UK

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BMC Family Practice 2012, 13:82  doi:10.1186/1471-2296-13-82

Published: 9 August 2012

Abstract

Background

Depression is frequently cited as the reason for sickness absence, and it is estimated that sickness certificates are issued in one third of consultations for depression. Previous research has considered GP views of sickness certification but not specifically in relation to depression.

This study aimed to explore GPs views of sickness certification in relation to depression.

Methods

A purposive sample of GP practices across Scotland was selected to reflect variations in levels of incapacity claimants and antidepressant prescribing. Qualitative interviews were carried out between 2008 and 2009.

Results

A total of 30 GPs were interviewed. A number of common themes emerged including the perceived importance of GP advocacy on behalf of their patients, the tensions between stakeholders involved in the sickness certification system, the need to respond flexibly to patients who present with depression and the therapeutic nature of time away from work as well as the benefits of work. GPs reported that most patients with depression returned to work after a short period of absence and that it was often difficult to predict which patients would struggle to return to work.

Conclusions

GPs reported that dealing with sickness certification and depression presents distinct challenges. Sickness certificates are often viewed as powerful interventions, the effectiveness of time away from work for those with depression should be subject to robust enquiry.

Keywords:
Depression; Mood disorder; Primary care; Occupational; Environmental medicine; Doctor-patient relationship; Mental health