Sickness absence, marginality, and medically unexplained physical symptoms: A focus-group study of patients’ experiences

Abstract

Purpose. Medically unexplained physical symptoms (MUPS) form a major cause of sickness absence. The purpose of this study was to explore factors which may influence further marginalization among patients with MUPS on long-term sickness absence. Methods. Two focus-group discussions were conducted with a purposive sample of 12 participants, six men and six women, aged 24–59 years. Their average duration of sickness absence was 10.5 months. Participants were invited to share stories about experiences from the process leading to the ongoing sickness absence, with a focus on the causes being medically unexplained. Systematic text condensation was applied for analysis. Inspired by theories of marginalization and coping, the authors searched for knowledge of how patients’ positive resources can be mobilized to counteract processes of marginality. Results. Analysis revealed how invisible symptoms and lack of objective findings were perceived as an additional burden to the sickness absence itself. Factors that could counteract further marginalization were a supportive social network, positive coping strategies such as keeping to the daily schedule and physical activity, and positive attention and confidence from professionals. Conclusions. Confidence from both personal and professional contacts is crucial. GPs have an important and appreciated role in this aspect.

Key Words::

• Focus groups
• general practice
• medically unexplained physical symptoms
• Norway
• qualitative research
• sick leave

Acknowledgements

The authors would like to thank the GPs who recruited patients, the participants who shared their experiences with us the assistance from Eirik Abildsnes (MD PhD), who participated as observer in one of the focus groups, and Brona Fullen (BSc PhD) for linguistic advice.

Sources of funding

This study was supported by the Norwegian Medical Association's fund for research in general practice.

Ethical approval

This study was conducted with the approval of the Regional Ethical Committee (REK Vest, Postboks 7804, N-5020 Bergen, Norway) # 2010/3208. All patients provided written informed consent.

Declaration of interests

The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.