Objective - To explore the factors related to doctors' assessments of incapacity to work (IW). Material - Two general practitioners and 49 men and 102 women aged 20-45 years with ongoing sick leave. Methods - The doctors saw all the patients jointly and discussed their emotions afterwards. Mental status, psychosocial stress, pain behaviour, tender structures, mobility and self-rated inability to work were assessed. Finally, the doctors separately rated the degree (0-100%) of reduced capacity for vocational work (DRCW). The inter-rater agreement was measured by kappa statistics. Prevalence odds ratios (OR) with 95% confidence intervals (95% CI) for IW (75-100% DRCW) were calculated by logistic regression. Results - The patients were immigrants working in service. All reported pain, 53.7% had much psychosocial stress, 74. 8% said they were unable to work and 22.5% were depressed. We were often touched by their life stories. The women had many tender-structure locations and many men had restricted mobility. Two-thirds (67.5%) had pain behaviour. The kappa value on the DRCW was 0.73. A third of the men (38.8%) and 26.5% of the women were assessed as having IW. The raters disagreed only in a few cases. Depressed men or men with pain behaviour had high ORs for IW (OR 12.8, 95% CI 3.3-68.5 and OR 5.6, 95% CI 1.5-21.1, respectively) as did women with self-rated inability to work (OR 7.0; 95% CI 1.6-32.0). Conclusions - Factors not clearly related to function had determined doctors' assessments of IW.

emotions Pain behaviour immigrants Psychosocial stress Gender Inability to work Work capacity General practice sick leave

Sick Leave primary medical care logistic regression analysis mental health human immigration middle aged work disability mental stress pain general practitioner Sweden Humans health services research male female Reproducibility of Results Article major clinical study adult absenteeism vocation Observer Variation Emigration and Immigration Work Capacity Evaluation primary health care Family Practice