Welfare Benefits in Functional Somatic Disorders

Welfare Benefits for Individuals With Functional Somatic Disorders: DanFunD

The objective of this observational study is to estimate the number of weeks of welfare benefits, i.e. sickness benefit, unemployment benefit and social assistance, for individuals with functional somatic disorders and compare them to

1. healthy individuals, and
2. individuals with severe physical disease.

Study Overview

• Status: Completed
• Conditions: Irritable Bowel Syndrome; Fibromyalgia; Somatoform Disorders; Medically Unexplained Symptoms; Chronic Fatigue Syndrome; Bodily Distress Syndrome; Medically Unexplained Syndrome

Detailed Description

Functional somatic disorders (FSD) are common conditions characterized by persistent patterns of physical symptoms that cannot be better explained by other physical or mental conditions (1). The conditions may cause severe impairment for the patients who present with reduced physical and mental health, lower social status, and poor labour market association (2-4).

In 2005, it was estimated that FSD accounted for 3% of hospitalizations and 10-20% of health care expenses in Denmark (5), and a newer Danish primary care study has shown patients with FSD to have higher annual health care costs compared with conventionally-defined conditions (6). In other countries, studies in clinical samples have shown increased direct and indirect health care costs of FSD (7, 8) showing a dose-response relationship with severity of the FSD (9). These studies into highly selected clinical samples may induce high risk of selection bias, and studies including random selected general population samples are therefore needed. One Canadian population-based study on health care costs of children, adolescents, and young adults with FSD also found increased health care use and costs for this group (10). Studies investigating the socioeconomic burden in terms of welfare benefits of FSD in an adult random sample from the general population are, however, lacking.

Objective To estimate the number of weeks of welfare benefits, i.e. sickness benefit, unemployment benefit and social assistance, for individuals with FSD and compare them to individuals without FSD and individuals with severe physical disease.

• Study Type: Observational
• Enrollment (Actual): 9656

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 76 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Participants were randomly drawn from the adult general Danish population by means of the the Danish Civil Registration system.

The DanFunD baseline cohort comprises a total of 9,656 (33.7% of invited participants) men and women aged 18-76 years, born in Denmark, and living in the Western part of greater Copenhagen. All participants filled in questionnaires regarding physical symptoms and psychological factors, among others. A stratified subsample (n=2,450) of every tenth participant and every symptom high score participant on the DanFunD baseline symptom questionnaires were invited to participate in a diagnostic interview, the Research Interview for Functional somatic Disorders (RIFD), performed by trained family physicians (28); 1,590 (64.9%) accepted and participated in the interview.

Description

Inclusion Criteria:

• None

Exclusion Criteria:

• Not born in Denmark
• Not being a Danish citizen
• Pregnancy

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Cross-Sectional

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

DanFunD baseline; Data from the DanFunD baseline cohort will be included (11). It comprises a total of 9,656 (33.7% of the invited participants) men and women aged 18-76 years born in Denmark and living in the Western part of greater Copenhagen. Individuals with FSD are identified by means of self-reported questionnaires (n=9,656) (2) and diagnostic research interviews (n=1,590) (12). Participants with FSD will be defined as follows: FSD operationalised by the Bodily Distress Syndrome single- and multi-organ type will be defined with both self-reported questionnaires (14) and diagnostic interviews (3); Three functional somatic syndromes, i.e. irritable bowel (15), chronic widespread pain (16), and chronic fatigue (17) will be defined with questionnaires. Severe physical disease will be defined as having received at least one of the following five diagnoses: Cancer, stroke, myocardial infarction, other heart disease, and obstructive pulmonary disease.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Sickness benefit	Wellfare benefit disbursed to employed citizens being ill, unemployed citizens currently ill, citizens in activation programs currently ill, and citizens in flexible jobs but currently ill	10-year period before and 5-year period after the day the participant participated in the DanFunD baseline investigation
Unemployment benefit	Welfare benefit disbursed to unemployed citizens who receive unemployment benefit (full or part time, during vacation or activation) together with citizens on social assistance who are deemed ready-to-work, only receiving social assistance because of unemployment, but having no entitlement to unemployment benefit.	10-year period before and 5-year period after the day the participant participated in the DanFunD baseline investigation
Social assistance	A welfare payment administered by the municipal social service department and is allocated if citizens are unable to support themselves.	10-year period before and 5-year period after the day the participant participated in the DanFunD baseline investigation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
No transfer income/self-support	Individuals that do not receive welfare payments under the circumstances of sickness, unemployment, or social benefits. Including leave-of-absence schemes and grants from State Education Fund.	10-year period before and 5-year period after the day the participant participated in the DanFunD baseline investigation
Public retirement pension	Public retirement pension	10-year period before and 5-year period after the day the participant participated in the DanFunD baseline investigation
Emigration	Participant not resident in Denmark	10-year period before and 5-year period after the day the participant participated in the DanFunD baseline investigation
Death	Participant dead	10-year period before and 5-year period after the day the participant participated in the DanFunD baseline investigation

Collaborators and Investigators

• Sponsor: University of Aarhus
• Collaborators: Center for Clinical Research and Prevention
• Investigators: Study Chair: Per Fink, DMSc, Aarhus University Hospital

Study record dates

Study Major Dates

• Study Start (Actual): November 10, 2011
• Primary Completion (Actual): June 30, 2015
• Study Completion (Actual): August 30, 2015

Study Registration Dates

• First Submitted: November 3, 2022
• First Submitted That Met QC Criteria: November 3, 2022
• First Posted (Actual): November 10, 2022

Study Record Updates

• Last Update Posted (Actual): December 5, 2022
• Last Update Submitted That Met QC Criteria: December 1, 2022
• Last Verified: October 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Digestive System Diseases; Pathologic Processes; Central Nervous System Diseases; Nervous System Diseases; Virus Diseases; Infections; Disease; Gastrointestinal Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Muscular Diseases; Neuromuscular Diseases; Colonic Diseases, Functional; Colonic Diseases; Intestinal Diseases; Encephalomyelitis; Syndrome; Irritable Bowel Syndrome; Fibromyalgia; Somatoform Disorders; Fatigue Syndrome, Chronic; Medically Unexplained Symptoms
• Other Study ID Numbers: DanFunD welfare benefits

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No