Unemployed sick-leavers and vocational rehabilitation : a person-level study based on a national social insurance material

Sammanfattning: In Sweden and in many other western countries, the great number of long-term sick and disability pensioners represents a problem. To reintroduce sick and injured people to the labour market increasing emphasis has been put on vocational rehabilitation. However, many long-term sick are also unemployed. The primary aim of this study, therefore, was to investigate the unemployed long-term sicklisted and their vocational rehabilitation. The study is based on a sample of 3073 long-term sick-leave cases reported sick at social insurance offices in an urban area in Sweden. Unemployed people, especially men, were heavily overrepresented among the long-term sick. Among the men, more than one fourth of the cases were unemployed when reporting sick. Mental diagnoses were more frequent among the unemployed (45%) than among the employed (16%), especially among the younger men (54% vs. 18%). Unemployed people had to wait longer before rehabilitation started (367 vs. 271 days) and also more often moved on to temporary disability pensions. The study partly supports the hypothesis that unemployed people are disregarded in vocational rehabilitation: rehabilitation plans at the social insurance offices are more seldom drawn up for the unemployed. A more important finding, however, was the indication of major problems in vocational rehabilitation as a whole, irrespective of employment status. Neither the employer nor the social insurance office seem to fulfil their statuary obligations: vocational rehabilitation activities seem far too few and are initiated unnecessarily late. The effect of vocational rehabilitation on later sick-leave and disability pension was investigated. A pretest-posttest study without controls showed overall positive effects, while a study with matched controls only partly did so. Unemployed women were indicated as particularly difficult to rehabilitate. This finding could be explained by unemployed women having more complex problems than others, a hypothesis supported in the study. A finding was also that people receiving vocational rehabilitation, regardless of sex and employment status, had less complex problems than people without vocational rehabilitation. In a further analysis using stepwise logistic regression, factors associated with rehabilitation outcome were investigated. For employed men and women age, income and days on sick-leave before vocational rehabilitation measure were identified as factors associated with rehabilitation outcome: employed people of low age, high income and fewer days before rehabilitation were more likely than others to return to the labour-market; for employed men, education was also identified as more effective than other measures. Associates among the unemployed were days on sick-leave before vocational rehabilitation measure (only for men) and age (only for women). The study supports the hypothesis that early vocational rehabilitation is more effective than late.