Abstract
Objective
Each year, approximately 31,000 Canadian injured worker claimants are certified to have permanent impairments associated with the initial workplace incident. Permanent impairments are characterized by ongoing pain, and limitations in physical function and activity participation — all predisposing factors to mental health problems. Here we examine the post-accident mental health status of a sample of Ontario injured workers with permanent impairments.
Methods
We analyze data from a cross-sectional telephone survey of 494 injured workers. Mental health status is examined using nine dichotomous diagnostic, symptomatic and functional mental health indicators identified by survey respondents as non-present, or having pre- or post-injury onset, and the CES-D. We describe the relationship of these indicators and work injury, demographic and socio-economic factors.
Results
Post-injury onset mental health problems are elevated compared to pre-injury onset in seven of nine indicators. Diagnosed depression, medication abuse, inability to concentrate, and sleep problems are elevated compared to general Canadian population prevalence. Diagnosed depression is elevated compared to populations with pain and chronic health conditions. Higher education and pre-injury income are associated with lower depressive symptoms. Men and older individuals are less likely to report a diagnosis of depression. Older individuals are less likely to report concentration problems.
Conclusion
These data paint a troubling mental health picture among injured workers with permanent impairments. Implications for return-to-work and income recovery, health service access and rehabilitation within and outside the compensation system are discussed.
Key words: Mental health, injured workers, work injury, chronic illness
Résumé
Objectif
Chaque année, environ 31 000 Canadiens ayant demandé une indemnisation à la suite d’un accident de travail ont des déficiences permanentes attestées, associées à l’incident initial survenu sur le lieu de travail. Ces déficiences permanentes se caractérisent par des douleurs chroniques, des limitations des fonctions physiques et des contraintes à la participation aux activités — tous facteurs qui prédisposent aux problèmes de santé mentale. Nous examinons ici l’état de santé mentale post-accident d’un échantillon de travailleurs accidentés ontariens ayant des déficiences permanentes.
Méthode
Nous analysons les données d’une enquête téléphonique transversale menée auprès de 494 travailleurs accidentés. Leur état de santé mentale est examiné à l’aide de l’échelle CES-D et de neuf indicateurs dichotomiques (diagnostiques, symptomatiques et fonctionnels) de la santé mentale, définis par les répondants de l’enquête comme étant absents, apparus avant ou apparus après l’accident. Nous décrivons les liens entre ces indicateurs et les facteurs démographiques, socioéconomiques et de l’accident.
Résultats
Selon sept indicateurs sur neuf, l’apparition de problèmes de santé mentale est plus élevée après qu’avant l’accident. La dépression diagnostiquée, l’abus de médicaments, l’incapacité de se concentrer et les troubles du sommeil sont élevés par rapport à leur prévalence dans la population générale au Canada. La dépression diagnostiquée est plus élevée que dans les populations souffrant de douleurs et de troubles de santé chroniques. Les études supérieures et le revenu avant l’accident sont associés à des symptômes dépressifs moins prononcés. Les hommes et les personnes âgées sont moins susceptibles de faire état d’un diagnostic de dépression. Les personnes âgées sont moins susceptibles de faire état de difficultés à se concentrer.
Conclusion
Ces données dépeignent une image troublante de la santé mentale chez les travailleurs accidentés ayant des déficiences permanentes. Nous en expliquons les conséquences pour le retour au travail et le recouvrement des revenus, l’accès aux services de santé et la réadaptation à l’intérieur et à l’extérieur du système d’indemnisation.
Mots clés: santé mentale, travailleurs accidentés, accidents du travail, maladie chronique
Footnotes
Source of funding: Funding provided by the Social Science and Humanities Research Council of Canada under the Community-University Research Alliance funding envelope (Grant 833-2005-1012).
Acknowledgements: We thank E. Tompa, M. Endicot, S. Mantis, and anonymous injured worker participants in the Research Action Alliance on the Consequences of Work Injury (RAACWI) for their assistance in developing the survey instrument; several student research assistants from Trent University for participant recruitment and database management; K. Schultz for data cleaning; B. Cater for analytic advice; and the injured workers for agreement to give so much of themselves as participants in the study. We gratefully acknowledge the tremendous support of staff from the Ontario WSIB, Intelligence and Innovation Branch, who through the laborious work of building a sampling frame and verifying participant eligibility, assisted us to enhance the sample representativeness and credibility of the findings. F. O’Hagan thanks RAACWI for postdoctoral support in conducting the research.
Conflict of Interest: None to declare.
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