General practitioners' attitudes and practices regarding sick leave certification for patients with depression in Norway - a cross-sectional study.

backgroundDepression is among the most frequent reasons for sick leave, whereas health authorities recommend a rather strict practice, arguing that work is health-promoting. We aimed to explore GPs' attitudes and practices regarding sick leave certification for depressed patients.

methodsA cross-sectional study using the Norwegian Physician Survey (N = 1617, 70% response rate) in 2021. The GPs in the panel (N = 221) responded to questions about sick leave certification and cooperation with employers and the Norwegian Labour and Welfare Administration (Norwegian acronym: Nav) regarding patients with depression. We used crosstabulation with chi square statistics and logistic regression models to assess differences among GPs.

resultsAmong 221 GPs, 62% often/very often perceived patients' questions for sick leave certification as the main reason for encountering. A total of 46% often/very often considered patients' expectations inappropriate, with female GPs more frequently than male GPs (36% vs 56%, p = 0.005) and younger GPs more frequently than their older counterparts (p < 0.001). Although 68% considered sick leave as part of treatment, only 16% often/very often initiated sick leave unless patients raised the question. Sixty-seven percent of GPs reported to often/very often avoid sick listing, if possible, more females than males. GPs who often/very often considered questions for sick leave inappropriate less often considered sick leave as part of treatment (odds ratio (OR): 0.25; 95% CI: 0.13-0.49), and less often report a well-functioning cooperation with Nav (OR:0.37; 95% CI:0.14-0.96). GPs who often/very often considered sick leave as part of treatment more often proposed sick leave for their patients (OR:4.70; 96% CI 1.57-14.01) and reported a less strict approach to sick listing (OR: 40; 95% CI: 0.20-0.79). Ninety-five percent of the GPs rarely/never had direct contact with patients' employers, whereas 92% often/very often asked patients about their dialogue with the workplace. Eighty-eight percent of the GPs often/very often experienced cooperation with NAV as good, and 87% often/very often felt trusted by them.

conclusionsMost GPs reported a strict attitude towards sick leave for depression, whereas one-third had a less strict approach. Different perceptions of the appropriateness of sick listing indicate variations in treatment and access to social security benefits.