Background: Government benefits paid to those unfit for work or the work market as a result of ill health have been rising dramatically in Great Britain, in parallel with increases throughout Europe and North America. Psychological conditions are known to be an important cause of sickness absence. This study set out to examine trends in government sickness and invalidity benefits in Britain between April 1984 and April 1995. The importance of mental disorders as a cause of 'incapacity' (the condition for which benefits are paid) was examined.
Methods: Data from the Department of Social Security were used to chart trends in incapacity according to gender, age group, employment category and cause. An exploratory ecological analysis of associations between regional rates of incapacity and socio-economic and health indices was also undertaken using correlation analysis and multiple regression.
Results: Steadily increasing rates of incapacity were observed, primarily reflecting increases in the longer-term 'invalidity' benefit. The non-employed made up a rising proportion of recipients. Regional incapacity rate was most strongly associated with socio-economic factors, particularly social class. Mental disorders were the second most numerous causal category and consisted mainly of milder conditions, namely depressive and neurotic disorders.
Conclusion: The dramatic increase in incapacity benefits is unlikely to be attributable to changes in population size or structure. It contrasts with improvements in the objective health status of the population. Mental disorders, and particularly milder conditions, account for a substantial and increasing amount of incapacity. The data are consistent with the hypothesis that sickness benefits increasingly represent disguised unemployment.