The impact of psychiatric comorbidity on the return to work in patients undergoing herniated disc surgery – a longitudinal observational study

With an estimated life-time prevalence of 60 to 80% back pain constitutes one of the most common complaints among long-term sick and disability pensioners. According to the statistics of the Deutsche Rentenversicherung, in the year 2007 16.2% of early retirement claims resulted from muscular, skeletal and connective tissue illnesses. This study examines (1) return to work (RTW) and ability to work (ATW) rates, and the association with (2) psychiatric comorbidity and (3) socio-demographic, illness-related, vocational and rehabilitation-related characteristics in herniated disc surgery patients. In this longitudinal observational study 305 consecutive patients took part in face-to-face interviews during hospital stay. 277 patients also participated in a 3-month follow-up survey via telephone (drop-out rate 9%). Psychiatric comorbidity was assessed with the Composite International Diagnostic Interview (CIDI-DIA-X). Calculations were conducted via Chi-Square-tests, independent t-tests and binary logistic regression analyses. 40.1% of the herniated disc patients in this study were able to RTW, 44.4% had regained their ATW three months after surgery. Psychiatric comorbidity appeared to be an important risk factor for RTW and ATW. Other risk factors were lower educational qualification, unemployment status, a lower subjective prognosis of gainful employment, a higher number of herniated discs in medical history, cervical disc surgery, and the existence of other chronic diseases, a longer hospital stay and higher pain intensity. Patients who did not RTW, or did not regain their ATW participated more often in inpatient rehabilitation. An important risk factor for RTW and ATW seems to be psychiatric comorbidity. An accompanying assessment of psychiatric comorbidity, pain and the subjective prognosis of gainful employment during hospital and rehabilitation treatment should be considered to identify a high risk group at an early stage. We strongly recommend specific interventions for patients belonging in this risk group.