Physical injuries often come with collateral damage — depression, PTSD
Physical injuries are certainly costly and disruptive to the workplace in and of themselves, but in many cases they can cause a secondary injury as well.
There is a solid link between physical injuries and psychological injuries such as depression or post-traumatic stress disorder (PTSD), according to Therese Richmond, professor of nursing and associate dean for research and innovation at the University of Pennsylvania in Philadelphia. And those secondary psychological injuries can have a critical impact on recovery.
“Over the past 20 years, I’ve done a series of studies that look at what contributes to recovery or sub-optimal recovery after injury, and particularly injuries that are not big brain injuries or spinal cord injuries — we’re looking at general injuries,” she said.
“One of the things our early work really showed was, it wasn’t really the severity of the physical injury that was driving how people recovered or did not. It really was driven by the psychological consequences.
“When we first started looking at it, we were looking at post-traumatic stress, and indeed we found that in a pretty seriously injured group of patients, if you had high levels of post-traumatic stress, you were less likely to have a smooth recovery.”
And during their follow-up questions with this group, Richmond and her fellow researchers made another discovery.
“What really came to light at that time was depression. ‘I’m feeling so depressed,’ or ‘I can’t get out of bed in the morning.’ So while post-traumatic stress was an issue, what really came to light was feelings of depression were significant players in how people recovered.”
Research doesn’t consider mental health
Yet employers and even most researchers in this area usually do not consider mental health outcomes after occupational injury in their estimation of the burden of workplace injuries, said Abay Asfaw Getahun, a health economics researcher at the Centres for Disease Control and Prevention in Atlanta.
“Occupational injuries are a significant source of injury to mobility in the United States, and these injuries influence workers’ psychological and physical wellbeing, which increases their risk of suffering from depression or related illnesses. So it should be a concern for employers as well,” he said.
Based on previous studies in the area, Asfaw Getahun hypothesized injured workers would be significantly more likely to have been treated for depression, and consequently would incur more costs for the treatment of depression after injury than their uninjured counterparts. His research looked at data from 168,000 injured and non-injured workers from Thomson Reuters Market Scan data, and examined if there was any measurable difference between them.
“Our research showed that the odds of injured workers being treated for depression was 45 per cent higher than that of non-injured workers. This is after controlling for several co-variants including age, sex, marital status, et cetera,” he said.
“Although more evidence should be found in this area to confirm our findings, I think employers and the occupational health community may reasonably anticipate that injured workers may need mental health support.”
Even a relatively minor injury can have a very real impact on mental health, said Richmond. That fact was supported by a National Institute of Health study she conducted in the U.S. that looked at people with minor physical injuries incurred on the job.
“They weren’t life-threatening injuries, they were just everyday injuries — I broke my leg, I fell off my bike, I got hit by something. And we found even in that pretty minor injury group that there was still a significant — almost one out of five people — developed significant depressive symptoms in the year after injury,” she said.
“And in almost every case we looked at, if people with the minor injuries had depressive symptoms, they did worse on almost every aspect of your daily life, taking care of your health and home, getting back to work, having social interactions with other people and their overall quality of life.
“We tend to really focus on the physical injury as opposed to the depressive responses, and what I would say is we really need to incorporate a much more holistic approach.”
The connections between physical injury and mental health are certainly emerging at a quickening pace, and it’s a great opportunity to step back and look at it from a pro-active perspective, said Alex Kelly, senior coordinator at Parachute Canada in Toronto.
“The research shows that in the immediate aftermath of an injury, there’s often an emotional reaction, and that can often lead to depression, anxiety, PTSD and overall affect the quality of life. And that can lead to more negative thoughts and behaviours, and can become almost a cycle that stems from that initial injury,” she said.
“In terms of the impact on return to work — which obviously an employer wants their employee to be healthy and fit for work when they come back — you’re adding on a secondary issue. So you’ve got your physical issue, but now you’re looking at a mental health issue, and sometimes that can be undiagnosed.”
It really can impact the workplace if an employee hasn’t received the appropriate care by the time he comes back to work, and the mental health issue remains undiagnosed. It may start to manifest itself in other ways, she said.
And there can be long-term effects.
“When we look at something like PTSD, 42 per cent of injured parties in a recent study exhibited symptoms of PTSD six months after the injury. So it’s also acknowledging that that timeframe post-injury may be much longer than somebody might account for in terms of a back-to-work plan,” said Kelly.
“In terms of education, prevention is always key. That’s where our primary focus at Parachute is, is on preventing those physical injuries and that’s by being proactive in the workplace around any sort of systems, any sort of equipment, and really having an open and honest conversation with employees about that, and also really encouraging your employees to be proactive in everything they do outside the workplace. So the same sort of risk management that they would employ at work, making sure that follows through to their journey to and from work, around the house, sports that they play,” she said.“(It’s about) really cultivating an environment of prevention and pro-activity around those areas. And of course the other side of the issue is mental health, so ensuring that mental health policies and programs and procedures are in place and people are aware of them, and it’s something that can be talked about in a work environment.”