The role of illness perceptions in labor participation of the chronically ill

Objective We aimed to investigate associations between work disability and illness perceptions, over and above medical assessment and self-reported health. Methods A representative sample of people aged 15-64 years with various chronic physical diseases was derived from the Panel of Patients with Chronic Diseases in the Netherlands. In this group, 189 patients were fully work-disabled and 363 were employed. In this cross-sectional study, associations between medical health status stated by the general practitioner, self-reported health, and illness perceptions about the consequences of the illness, the timeline (cyclical vs. chronical), control (treatment and personal), coherence and three causal dimensions (psychological, risk factors and immunity) and work disability were investigated. These associations were investigated in three separate steps using multivariate logistic regression analyses, with the employed patients as a reference group. All models were corrected for age, sex, and level of education. Results In the second multivariate model containing medical health status and self-perceived health, complete work disability was significantly associated with more fatigue (OR 2.42), more self-perceived functional limitations (OR 11.94), higher age, female sex, and lower education. Medical health status was not significantly associated with work disability. After adding illness perceptions to this model, the percentage of explained variance for work disability increased from 65 to 77%. In this final model, work disability was significantly associated with the patient's perception that the consequences of the disease were more severe (OR 5.34), and also with more self-perceived functional limitations (OR 14.27), lower education, being female, and a higher age. Illness perceptions and self-reported health status were significantly associated with work disability. Conclusion We conclude that illness perceptions are significantly associated with work disability in the chronically ill. Self-reported health is more strongly associated with work disability than the assessment of health status by the physician.