Intended for healthcare professionals

CCBYNC Open access
Research

Predicting which people with psychosocial distress are at risk of becoming dependent on state benefits: analysis of routinely available data

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c3838 (Published 17 August 2010) Cite this as: BMJ 2010;341:c3838
  1. Will Whittaker, research associate in health economics1,
  2. Matt Sutton, professor of health economics1,
  3. Margaret Maxwell, professor of mental health2,
  4. Rosalia Munoz-Arroyo, senior information analyst3,
  5. Sara MacDonald, research fellow4,
  6. Andrew Power, medical prescribing adviser5,
  7. Michael Smith, senior research fellow6,
  8. Philip Wilson, senior research fellow4,
  9. Jill Morrison, professor of general practice4
  1. 1Health Sciences Research Group, School of Community Based Medicine, University of Manchester, Jean McFarlane Building, Manchester M13 9PL
  2. 2Nursing, Midwifery and AHP Research Unit, University of Stirling, Stirling FK9 4LA
  3. 3Information Services Division, NHS National Services Scotland, Area 122A, Edinburgh EH12 9EB
  4. 4Division of Community Based Sciences, Faculty of Medicine, University of Glasgow, Glasgow G12 9LX
  5. 5Pharmacy and Prescribing Support Unit, Queens Park House, Victoria Infirmary, Glasgow G42 9TT
  6. 6Department of Psychological Medicine, Division of Community Based Sciences, Gartnavel Royal Hospital, Glasgow G12 0XH
  1. Correspondence to: J Morrison jmm4y{at}clinmed.gla.ac.uk

    Abstract

    Objectives To examine whether there was significant variation in levels of claiming incapacity benefit across general practices. To establish whether it is possible to identify people with mental health problems who are more at risk of becoming dependent on state benefits for long term health problems based on their general practice consulting behaviour.

    Design Interrogation of routinely available data in the Scottish Health Surveys and the British Household Panel Survey.

    Setting Scotland and the United Kingdom.

    Participants Respondents to the Scottish Health Surveys in 1995, 1998, and 2003 (7932, 12 939 and 11 472 respondents, respectively). Respondents to the British Household Panel Survey, 1991-2007 (more than 5000 households).

    Main outcome measures Intracluster correlation coefficient for probability of work incapacity by general practice. Caseness according to the general health questionnaire (GHQ-12) and frequency of consultation with general practitioner in years before and after starting to claim incapacity benefit.

    Results There was a small and non-significant amount of variation across general practices in Scotland in rate of claims for incapacity benefit after adjustment for other explanatory variables (intracluster correlation coefficient 0.01, P=0.135). There was a significant increase in rates of GHQ-12 caseness from two years before the start of claiming incapacity benefit (odds ratio 1.6, 95% confidence interval 1.3 to 1.9) and an increase in frequent consultation with a general practitioner from three years before the start of claiming incapacity benefit (1.8, 1.3 to 2.4). People with GHQ-12 caseness showed a significant increase in frequent consultations with a general practitioner from two years before the start of claiming incapacity benefit (2.1, 1.4 to 3.2).

    Conclusions There was no variation in levels of claiming incapacity benefit across general practices in Scotland after adjustment for differences in population characteristics and so initiatives targeted at practices with high levels are unlikely to be effective. People with mental health problems who are likely to have problems remaining in work can be identified up to three years before they transit on to long term benefits related to ill health.

    Footnotes

    • Contributors: WW undertook the detailed analyses, provided a report on which this paper was based, and contributed to writing the paper. MS is a grant holder and member of the steering group for this study; he supervised the analyses and contributed to writing this paper. MM, RM-A, SMacD, AP, MS, and PW are grant holders and members of the steering group for this study and contributed to discussions of the results and writing the paper. JM is the principal investigator and wrote the grant for this study, drafted the paper and coordinated the writing of the final version, and is guarantor.

    • Funding: This study was funded by the Chief Scientist Office of the Scottish Government (No CZH/4/400).

    • Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any institution for the submitted work; no financial relationships with any institutions that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

    • Ethical approval: This study was approved by the West of Scotland multicentre ethics committee 1 (No 07/SO703/58). This study involved analysis of routine, publicly available data and individual patient consent was not required. Both the Scottish Health Surveys and British Household Panel Surveys obtain individual participant informed consent.

    • Data sharing: The data used in this study are all in the public domain.

      This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

      View Full Text