Six-month period after injury a potential “window of opportunity” to identify and address mental health problems
Reprinted from "Workplace: Transitions" issue of Visions Journal, 2016, 11 (3), pp. 8-10
If you work with injured workers or have been injured on the job yourself, you should be aware that feeling depressed—and by that I mean frequently feeling many of the symptoms of depression—is common among people who have been physically hurt at work and need to take time off to recover.
About half of workers without a diagnosis of depression in the year before a work-related injury may feel depressed at some point during the year after their injury, and one in four may feel depressed at the one-year mark. Importantly, symptoms of depression are common among those who are not working one year after their injury, or who try to go back to work but are unable to continue.
These statements are based upon the results of a study1 by a team of researchers at the Institute for Work & Health, a not-for-profit research organization based in Toronto. I was a member of this team and led the analysis and write-up of the part of the research that considered what happens to the mental health of people during the first year following a work injury.
Our findings suggest that the first six months after a workplace injury are particularly important to an injured worker’s future mental health. This six-month period may be a window of opportunity to screen for symptoms of depression (and to provide the necessary support to those who need it) in order to prevent mental health problems in future.
How did we do our study?
We interviewed 332 people who were off work for at least five days due to a work-related musculoskeletal injury, though many were off work for longer than this. That is, they had injured their back, neck, shoulder, elbow, wrist or hand at work and had filed a workers’ compensation claim. For this study, we included only those people who reported no physician-diagnosed depression during the year before their injury.
We interviewed all study participants by telephone 1 month, 6 months and 12 months after their injury to see how they were doing. We asked about their workplace, their injury, their health and whether they were working or not. We also specifically asked about 20 symptoms of depression, including sadness, poor appetite, difficulty concentrating, restless sleep, crying spells and more—if they were feeling them and, if so, how often.
What did we discover?
Our key findings included the following:
During the first 12 months after participants’ work injury, symptoms of depression were common. About half of the workers in our study frequently felt symptoms of depression at some point in the 12 months following the injury. Almost 1 in 10 were diagnosed by a physician with depression during this period.
The mental health of most participants in our study improved over time during the 12 months after injury. Only 1 in 10 workers worsened in terms of their depressive symptoms over the 12-month period; about 25% of participants saw improvement in their depressive symptoms. At the 12-month mark, 75% reported not feeling depressed (although 25% reported they did feel depressed).
Not feeling depressed 1 month after a work injury seemed to be a good indication that an injured worker would remain feeling that way over the course of the next 12 months. In our study, about 60% of all participants did not feel depressed at the 1-month mark, and most of them (9 out of 10) still felt that way when we talked to them at 6 and 12 months.
For workers who experienced frequent symptoms of depression at 1 month, the picture seemed to be a little more complicated. In our study, 40% of all participants felt depressed at the 1-month mark. By 6 months, half of these people continued to feel depressed; the other half did not. How they felt at the 6-month mark, however, did turn out to be a good indicator of whether they would feel depressed at 12 months. 7 out of 10 injured workers in our study who reported frequent symptoms of depression at 1 month and at 6 months also reported frequent symptoms of depression at 12 months.
Frequent symptoms of depression were more common among participants who were having trouble returning to work. Among workers in our study who reported feeling depressed at 1 month, 6 months and 12 months after the injury, only 10% were able to return to work and stay at work. The remaining 90% either had never made a return-to-work attempt or had tried to return to work but had at least one recurrence of work absence.
In other words, in our study, of those who were not working 12 months after their injury, about half reported frequent symptoms of depression. In comparison, among those who were working at the 12-month mark, approximately 20% reported frequent symptoms of depression at the 12-month mark.
Unemployment and Mental Health
My colleagues at the Institute for Work & Health (IWH) took a look at the research on mental health and unemployment3 to find out what we know. (Someone who is “unemployed” is someone who is not working for pay but is actively looking for paid work.) They found evidence that becoming unemployed has a negative effect on mental health. Those whose mental health is fine beforehand are at risk of developing mental health problems when they are no longer going to work.
The link between loss of employment and poorer mental health could be related to a number of things. Job loss often means a drop in one’s standard of living or, at the very least, increased anxiety and insecurity about future income. It can also result in loss of status among family and friends, as well as loss of contact with an important social circle—work colleagues. Interestingly, some studies have shown that it’s the non-financial issues (the drop in quality of life and a decreased sense of well-being) that have a greater effect on one’s mental health during unemployment.
It’s likely that losing a “good” job is even harder on one’s mental health. Research suggests that poorer-quality jobs (those that don’t pay well, don’t provide enough hours of work, etc.) are linked to a higher likelihood of mental health problems while one is working than are higher-quality jobs. My IWH colleagues also found that people with mental health problems are more likely than others to become unemployed.
Since loss of work increases the risk of mental health problems, and since mental health difficulties increase the risk of job loss, it is important not only to help unemployed workers find new jobs quickly but also to help workers manage mental distress.
For more IWH findings on mental health and work, visit our website at www.iwh.on.ca/topics/mental-health-at-work. To keep up on all the latest research from IWH, sign up for our monthly e-alert at www.iwh.on.ca/e-alerts
What does it mean?
Our findings support the idea that feeling depressed is a natural response to having a workplace injury. They also show that, for the most part, how injured workers feel about their mental health at the six-month mark is a good indication of how they are going to feel 12 months after the injury.
This suggests to me that what is done during the first six months post-injury is important to the future well-being and mental health of injured workers. This six-month period represents a chance to screen injured workers to detect those at risk of clinical depression. Even though workers who are experiencing some symptoms of depression are not necessarily clinically depressed and do not necessarily require medical treatment, it’s still important for them to make their health care providers aware of these symptoms so that appropriate supports can be put in place.
With effective support, injured workers who are frequently feeling symptoms of depression following their injury may receive the help they need to feel better by the six-month mark. According to our study, if an injured worker feels better at 6 months, he or she will likely also feel better at 12 months.
Symptoms of depression are also linked in some ways to returning to work, given that our study found that only 1 in 10 who reported frequent symptoms of depression at all three points during the year had returned to work. It does beg the question: Do symptoms of depression contribute to difficulties in returning to work, or does having difficulties returning to work contribute to symptoms of depression? Our study couldn’t answer that question, but we suspect there is a complex interaction between the two factors.
Being at work is important. Research has clearly shown that returning to work after a work injury is good for both physical and mental health.2 It’s a virtuous circle: people who return to work are likely to feel better mentally, and people who feel better mentally are more likely to be working.
About the author
Nancy Carnide is a Research Associate at the Institute for Work & Health, a not-for-profit research organization based in Toronto. She is also a PhD student in epidemiology at the University of Toronto
Carnide, N., Franche, R-L., Hogg-Johnson, S., Côté, P., Breslin, F.C., Severin, C.N., Bültmann, U. & Krause, N. (2015, Sep 1). Course of depressive symptoms following a workplace injury: A 12-month follow-up update. Journal of Occupational Rehabilitation. Epub; doi 10.1007/s10926-015-9604-3
Rueda, S., Chambers, L., Wilson, M., Mustard, C., Rourke, S.B., Bayoumi, A. Raboud, J. & Lavis, J. (2012). Association of returning to work with better health in working-aged adults: A systematic review. American Journal of Public Health, 102(3):541–56; Epub; doi: 10.2105/AJPH.2011.300401
Saunders, R. (2009, August). Unemployment and mental health. Issue Briefing. Toronto, ON: Institute for Work & Health. www.iwh.on.ca/briefings/unemployment-and-mental-health