Mental Health Worse After Workplace vs Non-Workplace Injury

Patients with workplace injuries have worse mental health outcomes over time than patients with non-workplace injuries, according to recent research.

In a cohort study that included more than 35,000 patients, rates of anxiety and any mental disorder were more strongly associated with injury in the workplace than injury outside the workplace.

“There’s a lot of research detailing that workplace injury leads to bad mental health outcomes, but there’s not a lot of research comparing workplace injury to injury outside of the workplace head to head,” Co-author Anthony Wightman, MD, first-year internal medicine resident at the University of Manitoba in Winnipeg, told Medscape Medical News. “That’s what we wanted to determine.”

The study was published online on February 13 in JAMA Network Open.

Association With Anxiety

Using data from the Workers Compensation Board in Manitoba and the Manitoba Centre for Health Policy database, researchers assessed patients who had been hospitalized between 2002 and 2018 for an injury that required surgery.

They matched 7556 patients with workplace injury with 28,901 patients with non-workplace injury. The cohorts were matched for age, sex, geographic region, and injury severity. The main outcome was a diagnosis of mental disorder, including anxiety, depression, substance abuse, suicide attempt, and any mental disorder, measured 2 years before the injury and 2 years following the injury.

People in the military, people with traumatic brain injury, and people with repetitive strain injuries were excluded. “The exposure was traumatic physical injury that required surgery with anesthetic. We were looking for specific workplace injuries at a discrete point in time,” said Wightman.

Most patients in the workplace injury group were men (n = 5721; 75.7%). The group’s mean age was 44.8 years, 61.2% of patients (n = 4624) lived in urban areas, and 60.1% (n = 4545) were deemed to have low income.

The most frequent causes of injuries were objects in the environment (35.0%), followed by the environment (27.2%) and body position (22.1%). Half of the injuries were on an upper extremity. The most common types of injuries were strains, sprains, and tears (40.3%), followed by fractures and dislocations (25.2%). The service, construction, and manufacturing industries accounted for most of the workplace injuries.

In the 2 years before injury, the unadjusted rate ratio (URR) of all mental disorders was lower in the workplace injury cohort than in the non-workplace injury group (0.81). URRs for depression (0.89) and substance use disorder (0.87) were lower after their injury. But the group × care period interaction term was significant for anxiety and any mental disorder, suggesting a stronger association with workplace injury than with non-workplace injury.

‘An Additional Stress’

“We have done similar studies in the past, and this is our first study that showed there is a problem,” Co-author Sarvesh Logsetty, MD, professor of surgery, psychiatry, and children’s health at the University of Manitoba’s Max Rady College of Medicine, told Medscape Medical News.

“Part of our journey has been understanding there are stresses that are associated with, for example, a broken leg that everybody has: The pain, the time in hospital, the time you have to take away from work, the economic challenges, stress on your family, and things like that. But there is the additional stress of being at work, meaning that you are returning to the place where your injury occurred,” Logsetty said.

“If you had a skiing accident, you can stay away from skiing. But if you have injuries that occurred because you fell off the roof, and you have to go back to doing that work, it could be an additional stress,” he said.

Another stress is financial. “Even though workers’ compensation is generous these days, it doesn’t pay 100%. They only pay a portion, depending on which jurisdiction you are in, so there is a pattern of responding to the injury that is different than if you went skiing and broke your leg.”

The authors hope that their findings will increase awareness of the mental health consequences of workplace injuries and encourage those who sustain them to seek help.

“A big part of what we hope happens with our work is that individuals recognize that there may be mental health consequences that are associated with injuries in the workplace. Hopefully, this could help reduce some of the stigma around health-seeking individuals that may be expressing symptoms so they can seek help,” Rae Spiwak, PhD, assistant professor of surgery at the Max Rady College of Medicine, told Medscape Medical News.

“We know that seeking help early, especially if you are experiencing any mental health symptoms, is key to improving outcomes and helping people return to their life and work. Definitely, creating awareness around some of these potential consequences of workplace injury is important,” Spiwak said.

‘Valuable Research’

“This is valuable research,” commented Simon Sherry, PhD, professor of psychology and neuroscience at Dalhousie University in Halifax.

“It makes sense that stress over returning to the workplace in which you were injured and navigating the often difficult process of filing injury claims and securing compensation could contribute to deteriorating mental health. Both of those are issues unique to those who incurred workplace injuries,” Sherry said.

“Stress over lost income and pressure to return to work early could be equally felt by those who were injured outside of work but whose injury still requires leave. But the moral of this research is clear: Mental illness is prevalent after injury, and more can and should be done to support the mental health of the injured, whether they were injured in the workplace or not,” he said.

Funding for this study was obtained from a Research and Workplace Innovation Program grant from the Workers Compensation Board of Manitoba. Wightman, Logsetty, Spiwak, and Sherry reported no relevant financial relationships.