Stress is now most likely reason for time off work

The stress of modern living has for the first time resulted in mental problems overtaking physical ailments as the chief cause of long-term sickness in Britain. Depression and anxiety account for more claims for incapacity benefit than problems such as back pain.

The stress of modern living has for the first time resulted in mental problems overtaking physical ailments as the chief cause of long-term sickness in Britain. Depression and anxiety account for more claims for incapacity benefit than problems such as back pain.

In 2003, 176 million working days were lost through sickness absence from work, 10 million more than the previous year. Incapacity and other benefits for sickness absence costs £13bn a year and reducing the bill is a government priority. Only one in five of those who claim incapacity benefit for at least six months return to work within five years. The cost to industry is estimated at £11bn a year.

In the British Medical Journal, Max Henderson of the Institute of Psychiatry and colleagues say: "It might be expected only severe illnesses would lead to such marked reduction in function but most long-term absence is due to common conditions that, for whatever reason, fail to improve sufficiently."

The most marked change in the past decade, they say, is the switch of emphasis from physical to mental disorders. Claims for back pain have fallen by 42 per cent since 1994-95 and surveys over the period have shown a doubling in the numbers of people claiming for stress caused or made worse by work.

Yet research suggests there has been no increase in mental problems in the population. The change has been in the readiness of workers to attribute their sickness to stress and claim incapacity benefit. The authors say: "Mental and behavioural disorders now account for more incapacity benefit claims than musculoskeletal disorders. This is despite no apparent increase, except for alcohol dependence, in their prevalence."

Mental problems such as depression and anxiety are mostly treated by GPs but there is a shortage of staff to provide psychological counselling and support and long waiting times are common. This has forced family doctors to fall back on antidepressant pills which the Medicines and Healthcare Products Regulatory Agency (MHRA) warned last year were being overprescribed.

After a year-long investigation triggered by fears over the antidepressant Seroxat, the chief executive of the MHRA, Professor Kent Woods, said the pills should not be used as a first-line treatment for mild depression where therapies or advice on sleep and exercise could be effective and risk free.

The BMJ authors say the best way of getting people to work after a long absence, when they may fear a return will exacerbate stress, is to involve occupational physicians who have a foot in the workplace. Britain has fewer of them than most countries in Europe.