Quantifying social consequences of occupational injuries and illnesses: state of the art and research agenda

Depression as a psychosocial consequence of occupational injury in the US working population: findings from the medical expenditure panel survey

BACKGROUND

Empirical evidence describing the psychosocial consequences of occupational injury is still limited. The effect of occupational injury on depression might pose unique challenges in workers compared with other kinds of injury. This study aimed to assess the differential impact of workplace injury compared with non-workplace injury on depression over time, and to identify the potential risk factors associated with post-injury depression in the US working population.

METHODS

Using pooled panel data from the Medical Expenditure Panel Survey 2000-2006, a total of 35,155 workers aged 18-64 years who had been followed for about 18 months in each panel were analyzed. Injuries in the 4-5 months before baseline, and subsequent depression incidence during follow-up, were identified using ICD-9 codes for the medical conditions captured in personal interviews. A discrete time-proportional odds model was used.

RESULTS

A total of 5.5% of workers with occupational injury at baseline reported depression at follow-up, compared with 4.7% of workers with non-occupational injury and 3.1% of workers without injuries. Those with occupational injuries had more severe injuries and required longer treatment, compared with those with non-occupational injuries. Only 39% of workers with workplace injuries were paid Workers' Compensation (WC). The association between injury and depression appeared to be stronger for workplace injury, and the adjusted odds ratio for depression was 1.72 for those with occupational injury (95% CI: 1.27-2.32), and 1.36 for those with non-occupational injury (95% CI: 1.07-1.65) compared with the no-injury group, after controlling for relevant covariates. Occupational injury was associated with higher odds of developing depression over time. WC as a source of medical payment was associated with 33% higher odds of developing depression (95% CI: 1.01-1.74). Part-time work, shorter job tenure, and long working hours were independently associated with post-injury depression risk.

CONCLUSIONS

Workers with occupational injury were more likely to become depressed than those with non-occupational injury. The psychosocial consequences of occupational injury, including depression, deserve further exploration to adequately support those injured at work. This finding also emphasizes a need for early intervention to reduce the burden of depression associated with occupational injury.

Psychosocial precursors and physical consequences of workplace violence towards nurses: a longitudinal examination with naturally occurring groups in hospital settings

BACKGROUND

Workplace violence towards nurses is prevalent and consequential, contributing to nurses' reduced health and safety, worsened job attitudes, and compromised productivity.

OBJECTIVES

To examine if organizational violence prevention climate as perceived by nurses predicts nurses' physical violence exposure and if physical violence exposure predicts nurses' somatic symptoms and musculoskeletal disorder symptoms.

DESIGN

A two-wave longitudinal design with naturally occurring groups, with a 6-month interval.

METHODS

Analysis of covariance and logistic regression were applied to test the proposed hypotheses among 176 nurses from two hospitals in the U.S. who participated in both surveys required by this study. All nurses from the two hospitals were recruited to participate voluntarily. The response rate was 30% for the first survey and 36% for the follow-up survey. Among the subjects, only 8 were male. On average, the subjects were about 45 years old, had a job tenure of about 17 years, and worked approximately 37 h per week.

RESULTS

Violence prevention climate, specifically the dimension of perceived pressure against violence prevention, predicted nurses' chance of being exposed to physical violence over six months (odds ratio 1.69), with no evidence found that violence exposure affected change in climate reports. In addition, results supported that nurses' physical violence exposure had effects on somatic symptoms, and upper body, lower extremity, and low back pain over six months.

CONCLUSIONS

Findings of this study suggest that reducing organizational pressure against violence prevention will help decrease the chance of nurses' physical violence exposure and benefit their health and safety.

The lived experience of patients with uncertain medical diagnosis following a serious injury: a qualitative study

PURPOSE

This paper examines the lived experience of uncertain medical diagnosis in patients with a serious injury.

METHOD

Data reported in this article are from the qualitative component of a multi-method study. Nineteen participants were purposively selected from a longitudinal quantitative study (n = 2856) undertaken in five regions of New Zealand, investigating the outcomes of injury. This article reports results from qualitative interviews taking place approximately 6 months after the injury event.

RESULTS

The results section focuses on the lived experience of the injured patient who does not have a definite diagnosis. It describes the difficulty of persuading both health professionals and the workplace to take ongoing injury effects seriously, when the diagnosis cannot be clearly articulated. Issues associated with health professionals as gatekeepers to resources are raised, and also the potential for extended uncertainty to stigmatise the patient. Finally, the emotional impact of injury is discussed as an issue that is not often recognised.

CONCLUSION

Vague diagnostic labels attached to serious but invisible injury potentially reduce legitimate access to rehabilitation and the sick role. The socio-cultural context within which medicine is administered produces specific tensions in the clinical encounter. It is hypothesised that patients with uncertain diagnosis may be particularly at risk of the emergence of disability.

Managing pain in the workplace: a focus group study of challenges, strategies and what matters most to workers with low back pain

PURPOSE

Most working adults with low back pain (LBP) continue to work despite pain, but few studies have assessed self-management strategies in this at-work population. The purpose of this study was to identify workplace challenges and self-management strategies reported by workers remaining at work despite recurrent or persistent LBP, to be used as a framework for the development of a workplace group intervention to prevent back disability.

METHOD

Workers with LBP (n = 38) participated in five focus groups, and audio recordings of sessions were analysed to assemble lists of common challenges and coping strategies. A separate analysis provided a general categorisation of major themes.

RESULTS

Workplace pain challenges fell within four domains: activity interference, negative self-perceptions, interpersonal challenges and inflexibility of work. Self-management strategies consisted of modifying work activities and routines, reducing pain symptoms, using cognitive strategies and communicating pain effectively. Theme extraction identified six predominant themes: knowing your work setting, talking about pain, being prepared for a bad day, thoughts and emotions, keeping moving and finding leeway.

CONCLUSIONS

To retain workers with LBP, this qualitative investigation suggests future intervention efforts should focus on worker communication and cognitions related to pain, pacing of work and employer efforts to provide leeway for altered job routines.

Healthcare use before and after a workplace injury in British Columbia, Canada

OBJECTIVES

There is growing evidence that occupational injuries influence workers' emotional and physical wellbeing, extending healthcare use beyond what is covered by the Workers' Compensation Board (WCB).

METHODS

The authors used an administrative database that links individual publicly funded healthcare and WCB data for the population of British Columbia (BC), Canada. They examined change in service use, relative to one year before the injury, for workers who required time off for their injuries (lost time = LT) and compared them to other injured workers (no lost time = NLT) and individuals in the population who were not injured (non-injured = NI).

RESULTS

LT workers increased physician visits (22%), hospital days (50%), and mental healthcare use (43% physician visits; and 70% hospital days) five years after the injury, relative to the year before the injury, at a higher rate than the NI group. For the NLT workers, the level of increased use following the injury was between that of these two groups. These patterns persisted when adjusting for registration in the BC Medical Service Plan (MSP) and several workplace characteristics.

CONCLUSIONS

Although the WCB system is the primary mechanism for processing claims and providing information about workplace injury, it is clear that the consequences of workplace injury extend beyond what is covered by the WCB into the publicly funded healthcare system.

Prevention of injuries at work: the role of the occupational physician

OBJECTIVES

To highlight the role of occupational physician (OP) in occupational injuries (OI) prevention and management. To suggest an approach beyond traditional focus on descriptive epidemiology, engineering interventions, administrative aspects of OI prevention. To promote a person- and enterprise-tailored approach, entailing greater attention to human factors and to practical problems of the specific workplace, with a call to a leading role played by OP.

METHODS AND RESULTS

Analysis of the literature on the broader topic of OI prevention revealed thousands of publications; however, only a handful of them mention or describe the participation of OP in OI prevention. While recognizing that literature search is not the proper and only way to appreciate the current role of OP in this field, therefore, it seems necessary to call OP to a stronger effort in prevention and management of OI, through the context of a comprehensive intervention in cooperation with managers, supervisors, safety personnel and workers, focusing on specific needs of each enterprise. The following areas of OP intervention were examined: risk assessment, health surveillance, management, scientific research and health education. Within each of these topics, possible contributions, methodologies, instruments available for the OP were discussed, taking into account the relevant literature. Pathways for practical applications were illustrated, e.g., OI data generation and analyses, predictors of OI, fitness for work, case management, team work, educational issues, first aid, suggestion for OP contribution in specific research questions.

CONCLUSIONS

OI continue to take a remarkable toll from individuals and society. New multidisciplinary interventions are needed to prevent OI. Focused activities at the single worksite with a central role from OP are definite options. OP is an effective interface between workforce and management and may offer, through a proactive approach, valuable practical and cultural contributions, while respecting technical and ethical guidelines of occupational health professionals.