Depression and Occupational Injury: Results of a Pilot Investigation

Depression symptoms reducing return to work: a meta-analysis of prospective studies

Objectives. This study was conducted to estimate the risk of return to work for people who experience symptoms of depression based on the pool of prospective data. Methods. All online articles in PubMed and Scopus which were accessible before November 2019 were searched. The odds ratios of each of the studies were pooled together to obtain an overall odds ratio. The pool of studies was with random effects. The analysis was performed based on the depression symptoms scale, type of disease and duration of follow-up. Two other aspects were examined in the analysis, one being the bias in the publication of studies and the other being the level of heterogeneity that was examined. Results. Thirty-five studies were selected for the meta-analysis. The pooled odds ratio indicates that the odds of return to work in people with depressive symptoms is 31% lower than in those without depressive symptoms. The funnel plot shows that there is asymmetry. The Egger test result was significant (p < 0.001) and there is publication bias. Conclusion. Depression symptoms after sick leave due to physical illness is a risk factor for not returning to work.

Health screening questionnaires used in the management of mental distress acquired during an injured worker’s return to work: A scoping review

BACKGROUND: Mental distress is often endured by injured workers participating in the rehabilitation or return to work process following a physical injury. Delays in detecting the onset and treating mental distress can lead to a diverse range of cognitive and behavioural changes that may precipitate psychological distress such as anxiety, depression, and posttraumatic stress. OBJECTIVE: The objective of this scoping review was to provide an overview of existing health questionnaires utilised by health care providers and affiliated researchers. It reviewed their effectiveness and suitability to detect mental distress endured by injured workers engaged in the return to work process. METHODS: A scoping review methodology was conducted using the Arksey and O’Malley framework which examined peer-reviewed articles published between 2000 and March 2020 comprising health questionnaires. Database searches included Medline, CINAHL, EMBASE and PsycINFO combining specific MeSH terms and key words. RESULTS: The full search identified 3168 articles. Following full screening a total of 164 articles reviewed the use of health questionnaires and specific criteria to determine their suitability. Most of the health questionnaires reviewed were used as screening measures for identifying both work and non-work-related psychological hazards. However, they were found to be limited in their application when considering all potential predictors of delayed return to work such as poor or stressful interactions with stakeholders, financial stress and the injured workers experience of the RTW process. CONCLUSION: Earlier identification of mental distress using an optimal MHSQ followed by appropriate intervention will reduce the risk of psychological injury becoming cumulative on a physical workplace injury. Without such complications, early return to work can be achieved with significant cost saving to the economy.

Association of work-life balance with occupational injury and work-related musculoskeletal pain among Korean workers

Background

The concept of work-life balance (WLB) has become an important issue in workers' health and safety. This study aims to investigate the relationship between WLB and occupational injury and work-related musculoskeletal pain.

Method

The study included 27,383 workers who participated in the Fifth Korean Working Conditions Survey. Participants were divided into good WLB and poor WLB groups based on their responses to the five question items which comprised two dimensions: work-on-life conflict (items, 1–3) and life-on-work conflict (items 4 and 5). Occupational injury and musculoskeletal pain were also assessed using the question items. The χ² test and multivariate logistic regression analyses were performed to examine the relationship of WLB to occupational injury and musculoskeletal pain while considering socio-demographic and occupational characteristics and ergonomic and psychological risk factors.

Results

Of the 27,383 participants, 252 (0.9%) had experienced an occupational injury and 6,408 (23.4%) had musculoskeletal pain. The poor WLB group had higher injury rates for both men (1.7%) and women (0.9%) than the good WLB group (1.1% and 0.4%, respectively). Additionally, the prevalence of musculoskeletal pain was higher for both men and women in the poor WLB group (25.2% and 28.0%, respectively) than for men and women in the good WLB group (18.7% and 23.6%, respectively). In the logistic regression analysis, the adjusted odds ratio of WLB for occupational injury was 1.37 (95% confidence interval [CI]: 1.06–1.78), and that for musculoskeletal pain was 1.14 (95% CI: 1.07–1.21), showing positive associations of WLB with both occupational injury and musculoskeletal pain.

Conclusions

Poor WLB causes an increase in occupational injury and musculoskeletal pain. Therefore, an improvement in WLB may reduce the incidence of occupational injury and musculoskeletal pain among workers. Social and policy-related initiatives are needed to improve workers' WLB to reduce occupational injury and musculoskeletal pain.

Association between job-related stress and experience of presenteeism among Korean workers stratified on the presence of depression

Background

Presenteeism refers to the phenomenon of working while sick. Its development can be attributed to not only somatic symptoms but also underlying social agreements and workplace atmosphere. In this study, we analyzed presenteeism among workers from various industries, focusing on job-related stress with stratification on the presence of depression.

Methods

We conducted the study with data from questionnaires filled in by different enterprises enrolled in the Federation of Korean Trade Unions. Workers' depressive symptoms were investigated using the Patient Health Questionnaire-2, while questions on job-related stress and presenteeism were derived from the short form of the Korean Occupational Stress Scale and the official Korean version of the Work-Productivity and Activity Impairment Questionnaire-General Health, respectively. Multilevel logistic analysis was conducted to determine the statistical differences derived from the differences between companies.

Results

In total, 930 participants (753 men and 177 women) from 59 enterprises participated in the research. We conducted multilevel logistic regression to determine the association between the variables and presenteeism, with stratification by the presence of depression. Higher job demands and higher interpersonal conflict showed significantly elevated odds ratios (ORs) in univariate models and in the multivariate multilevel model. In the final model of total population, fully adjusted by general and work-related characteristics, higher job demands (OR: 3.29, 95% confidence interval [CI]: 2.08-5.21) and interpersonal conflict (OR: 1.87, 95% CI: 1.29-2.71) had significantly higher ORs-a tendency that remained in participants without depression.

Conclusions

This study reflected the factors associated with presenteeism among workers from various enterprises. The findings revealed that job-related stress was closely related to presenteeism in both the total population and in the population without depression. Thus, it emphasized interventions for managing job stress among workers to reduce presenteeism in general workers' population.

Injury and depression among 212 039 individuals in 40 low- and middle-income countries

AIMS

Although injuries have been linked to worse mental health, little is known about this association among the general population in low- and middle-income countries (LAMICs). This study examined the association between injuries and depression in 40 LAMICs that participated in the World Health Survey.

METHODS

Cross-sectional information was obtained from 212 039 community-based adults on the past 12-month experience of road traffic and other (non-traffic) injuries and depression, which was assessed using questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview. Multivariable logistic regression analysis and meta-analysis were used to examine associations.

RESULTS

The overall prevalence (95% CI) of past 12-month traffic injury, other injury, and depression was 2.8% (2.6-3.0%), 4.8% (4.6-5.0%) and 7.4% (7.1-7.8%), respectively. The prevalence of traffic injuries [range 0.1% (Ethiopia) to 5.1% (Bangladesh)], and other (non-traffic) injuries [range 0.9% (Myanmar) to 12.1% (Kenya)] varied widely across countries. After adjusting for demographic variables, alcohol consumption and smoking, the pooled OR (95%CI) for depression among individuals experiencing traffic injury based on a meta-analysis was 1.72 (1.48-1.99), and 2.04 (1.85-2.24) for those with other injuries. There was little between-country heterogeneity in the association between either form of injury and depression, although for traffic injuries, significant heterogeneity was observed between groups by country-income level (p = 0.043) where the pooled association was strongest in upper middle-income countries (OR = 2.37) and weakest in low-income countries (OR = 1.46).

CONCLUSIONS

Alerting health care providers in LAMICs to the increased risk of worse mental health among injury survivors and establishing effective trauma treatment systems to reduce the detrimental effects of injury should now be prioritised.

Physical injury and depression in six low- and middle-income countries: A nationally representative study

BACKGROUND

Studies on the association between physical injury and depression in low- and middle-income countries (LMICs) are scarce. Therefore, our goal was to analyze the association between physical injury and depression using nationally representative data from six LMICs.

METHODS

Cross-sectional data from the Study on Global Ageing and Adult Health (SAGE) survey (2007-2010) were analyzed (N = 42,489). Questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview were used for the endorsement of past 12-month DSM-IV depression. Any injury in our analysis referred to having experienced traffic injury or other injury in the past 12 months. Multivariable logistic regression analysis and meta-analyses were used to assess associations.

RESULTS

Overall, the prevalence of depression was higher among those who had any injury compared to those without injuries (9.0% vs. 3.7%). Compared to having no injury, any injury without disability was associated with a 1.72 (95%CI=1.18-2.50) times higher odds for depression, while the odds for injury with disability was much higher (OR =3.81; 95%CI=2.16-6.73). The pooled estimate (OR) for the association between any injury and depression based on a meta-analysis using country-wise estimates was 3.28 (95%CI = 1.71-6.31) and a moderate level of between-country heterogeneity was observed (I² = 63.1%).

LIMITATIONS

Causality or temporal associations cannot be established due to the cross-sectional nature of the study.

CONCLUSIONS

Personalized mental health care to victims of physical injury may reduce risk for depression. Treating disability as the result of injuries may also be effective in the prevention of depressive disorders.

Occupational Injury Among Janitors: Injury Incidence, Severity, and Associated Risk Factors

OBJECTIVE

Determine injury incidence and severity and potential associated risk factors for injury, among janitors.

METHODS

Questionnaires were disseminated to 1200 full-time janitors in the Service Employees International Union (SEIU) Local 26 union; 390 responded and provided information on their injury experiences and exposures, based on personal characteristics and work-related activities. Multivariable analyses, including bias adjustment, were implemented using directed acyclic graphs to determine potential risk.

RESULTS

Among the janitors, 34% reported experiencing at least one injury; 16% of cases resulted in hospital admittance. Significantly increased risks were identified for age, ethnicity, shift start time, and physician-diagnosed depression.

CONCLUSIONS

Knowledge of specific risk and protective factors is valuable, and can serve as a basis for further in-depth studies and inform the development of targeted intervention strategies aimed to reduce occurrence of these injuries.

Patients with Psychiatric Disorders Require Greater Health-Care Resources after Injury

The objective of this study was to assess whether patients with comorbid psychiatric conditions admitted after traumatic injury require greater health-care resource utilization. The trauma registry of a Level 1 trauma center was used to identify all adult trauma patients presenting from 2012 to 2015. Patients with psychiatric needs, identified as having either an ICD-9 code corresponding to a psychiatric disorder or requiring inpatient psychiatric consultation, were compared with controls, using propensity score matching. Patients with psychiatric disorders were more than three times more likely to present with penetrating injuries (odds ratio [OR] 3.5, P < 0.005). They had longer length of hospital stay (median 5 [IQR 2.5–11] vs. three days [IQR 1–7], P < 0.01), were approximately 70 per cent more likely to require ICU-level care (OR 1.68, P = 0.08), and were 80 per cent less likely to be discharged home (OR 0.18, P < 0.005). Trauma patients with psychiatric illness or need consume greater health-care resources.

Satisfaction with life and the risk of occupational injury

Background

Occupational injuries increase burden on society as well as personal health. Low satisfaction with life may not only increases the risk of occupational injuries directly, but also influences other factors that increase the risk of occupational injury. Along with previous studies on the risk of occupational injury, we sought to explore the relationship between satisfaction with life and occupational injury.

Methods

The study participants were 6234workers health screened at a university hospital in Incheon. Information on occupational injury and satisfaction with life scale (SWLS) was obtained in a self-report format. Participants were allocated to one of four SWLS groups; the dissatisfied group, the slightly dissatisfied group, the slightly satisfied group, and the satisfied group. The analysis was performed using the chi-square test primarily and by logistic regression adjusted for potential confounders.

Results

In men, the un-adjusted and adjusted odds ratios (ORs) of low satisfaction with life (SWLS< 20) were 1.98(CI1.55-2.53) and 1.81(CI 1.41-2.32), respectively. When the SWLS were divided into four groups, the adjusted ORs of the slightly satisfied (20-25), slightly dissatisfied(15-19), and dissatisfied(≤14) groups were 1.21, 1.72, and 2.70, respectively. That is ORs tended to increase linearly with decreasing SWLS score (p for trend < 0.001). In women, this relation was of borderline significance at best.When subjects were dichotomized based on SWLS scores, for males, the cured and adjusted RRs of occupational injury in the low satisfaction with life group were1.91 (95% CI: 1.50-2.42) and 1.66 (95% CI: 1.30-2.13), and for females, the adjusted-RR was marginally significant (1.67; 95% CI: 0.93-2.99).When subjects were divided into four groups by SWLS scores, adjusted RRs tended to increase linearly with decreasing SWLS score for males (slightly satisfied: 1.18, 95% CI: 0.77-1.82; slightly dissatisfied: 1.65, 95% CI: 1.08-2.52; dissatisfied: 2.22, 95% CI: 1.44-3.42; p for trend < 0.001) and for females (slightly satisfied: 1.17, 95% CI: 0.42-3.30; slightly dissatisfied: 1.56, 95% CI: 0.56-4.36; dissatisfied: 2.38, 95% CI: 0.84-6.74; p for trend = 0.040).

Conclusions

This study suggests that the risk of occupational injury was higher in workers not satisfied with life, and indicates attention to satisfaction with life may promote the health of workers.

Diagnosed Chronic Health Conditions Among Injured Workers With Permanent Impairments and the General Population

OBJECTIVE

To profile chronic health conditions of an injured worker sample before and after workplace injury and compare injured workers to a matched community sample.

METHODS

Logistic regression analyses compared risk of certain chronic health conditions for permanently disabled injured workers in the pre- and post-injury periods to comparator subsamples from the Canadian Community Health Surveys 2003 and 2009/2010.

RESULTS

There were notable health differences between the injured worker and comparator samples for the post-injury period. Injured men and women were more likely to report arthritis, hypertension, ulcers, depression, and back problems than the comparator sample. Injured women were also more likely to report migraine headaches and asthma.

CONCLUSIONS

The observed differences suggest that permanently impaired injured workers experience more rapidly accelerated health declines than other aging workers, and this outcome is gendered.

Psychosocial employment characteristics and postpartum maternal mental health symptoms

INTRODUCTION

For new mothers returning to work, the role of the workplace psychosocial environment on maternal mental health has not been fully described.

OBJECTIVES

The purpose of this study was to identify the relationship between psychosocial employment characteristics and mothers' postpartum depression, anxiety, and stress symptoms.

METHODS

Ninety-seven women answered survey questions regarding employment, job demand, control, and support, and postpartum depression, anxiety, and stress symptoms soon after live birth and 6 months later.

RESULTS

Working and nonworking mothers reported similar mental health symptoms. Psychological characteristics of employment were not associated with increased odds of mental health symptoms. Increased social support provided by coworkers, supervisors, and the organization was associated with reduced odds of anxiety symptoms.

CONCLUSION

Our findings identified lack of workplace social support as a modifiable risk factor for postpartum anxiety. Future evaluations of workplace social support interventions may be explored to improve postpartum mental health symptoms. Am. J. Ind. Med. 60:109-120, 2017. © 2016 Wiley Periodicals, Inc.

Gender Differences in the Longitudinal Association between Work-Related Injury and Depression

Little is known about gender differences in the association between occupational injury and depression. We investigated the bidirectional association and gender differences between work-related injury and depression using the same cohort in the US Medical Expenditure Panel Survey (MEPS). In Analysis 1, the association of occupational injury and subsequent depression was investigated from 35,155 employees without depression. Analysis 2 included 32,355 participants without previous injury and examined the association of depression and work-related injury. The multivariable-adjusted odds ratio was estimated using a discrete time-proportional odds model. Male workers who had experienced workplace injury were more vulnerable to post-injury depression than non-injured male workers (OR = 2.35, 95% CI: 1.52, 3.65). Female workers with depression were more prone to get injured at the workplace than the non-depressed female workers (OR = 1.44, 95% CI: 1.07, 1.96). These results did not hold in the reverse direction for both genders. Workers compensation benefit was positively associated with the risk of post-injury depression among males, whereas anti-depressant medication and duration of depression were related to workplace injury among females. Gender differences in the direction and associated factors of the relationship between occupational injury and depression highlight the need for gender-specific intervention to the vicious cycle of workplace injury and depression.

The role of mental health problems and common psychotropic drug treatments in accidental injury at work: a case-control study

OBJECTIVES

Mental illness and psychotropic drugs have been linked with workplace injury, but few studies have measured exposures and outcomes independently or established their relative timings. To address this shortcoming, we conducted a case-control study nested within a database prospectively recording injury consultations, diagnoses and drug prescriptions.

METHODS

The Clinical Practice Research Datalink logs primary care data for 6% of the British population, coding all consultations (by the Read system) and drug prescriptions. We identified 1348 patients aged 16-64 years from this database who had consulted a family doctor or hospital over a 20-year period for workplace injury (cases, 479 diagnostic codes) and 6652 age, sex and practice-matched controls with no such consultation. Groups were compared in terms of consultations for mental health problems (1328 codes) and prescription of psychotropic drugs prior to the case's injury consultation using conditional logistic regression.

RESULTS

In total, 1846 (23%) subjects had at least one psychiatric consultation before the index date and 1682 (21%) had been prescribed a psychotropic drug. The OR for prior mental health consultation was 1.44 (p<0.001) and that for psychotropic drug treatment was 1.57 (p<0.001). Risks were significantly elevated for several subclasses of mental health diagnosis (eg, psychosis, neurosis) and for each of the drug classes analysed. Assuming causal relationships, about 9-10% of all workplace injuries leading to medical consultation were attributable to mental illness or psychotropic medication.

CONCLUSIONS

Mental health problems and psychotropic treatments may account for an important minority of workplace injuries.

Development of uncertainty-based work injury model using Bayesian structural equation modelling

This paper proposed a Bayesian method-based structural equation model (SEM) of miners' work injury for an underground coal mine in India. The environmental and behavioural variables for work injury were identified and causal relationships were developed. For Bayesian modelling, prior distributions of SEM parameters are necessary to develop the model. In this paper, two approaches were adopted to obtain prior distribution for factor loading parameters and structural parameters of SEM. In the first approach, the prior distributions were considered as a fixed distribution function with specific parameter values, whereas, in the second approach, prior distributions of the parameters were generated from experts' opinions. The posterior distributions of these parameters were obtained by applying Bayesian rule. The Markov Chain Monte Carlo sampling in the form Gibbs sampling was applied for sampling from the posterior distribution. The results revealed that all coefficients of structural and measurement model parameters are statistically significant in experts' opinion-based priors, whereas, two coefficients are not statistically significant when fixed prior-based distributions are applied. The error statistics reveals that Bayesian structural model provides reasonably good fit of work injury with high coefficient of determination (0.91) and less mean squared error as compared to traditional SEM.

A structural equation modeling approach to fatigue-related risk factors for occupational injury

Occupational injury is associated with numerous individual and work-related risk factors, including long working hours and short sleep duration; however, the complex mechanisms causing such injuries are not yet fully understood. The authors used structural equation modeling (SEM) as a novel approach to examine fatigue-related direct and indirect potential risk factors for occupational injury. The study sample contained 89,366 employed workers from the National Health Interview Survey (pooled across 6 years, 2004-2009), an annual survey of a representative cross-sectional sample of the US population. Direct and indirect effects of weekly hours worked and usual sleep duration on occupational injuries were modeled using SEM procedures for dichotomous outcomes and a complex sampling design. Confounding and mediating effects of gender, age, race/ethnicity, occupation, industry, type of pay, body mass index (BMI), and psychological distress were simultaneously examined. Long working hours and short sleep duration independently increased the risk of injury. Additional direct risk factors were gender, occupation, type of pay, and BMI. At the same time, sleep duration mediated the adverse relations of long working hours, high psychological distress, and high BMI with injury. These findings indicate that SEM is a useful approach with which to examine dichotomous outcomes and indirect effects in complex samples, and it offers a comprehensive new model of injury prediction.

Unintentional injury, psychological distress and depressive symptoms: is there an association for rural Australians?

PURPOSE

To investigate the association between unintentional injury and mental health in Australian rural communities.

METHODS

Using cross-sectional baseline data for a longitudinal study from randomly selected adults in nonmetropolitan Australia, we fitted logistic regression models for the outcomes of domestic or public setting injury and injury in high-risk settings, using prior depression and demographic factors. OR and 99% CI were reported and also calculated for current mental health including psychological distress, depressive symptoms and risky alcohol consumption, comparing those injured with those not.

FINDINGS

Of 2,639 participants who completed the injury component, 364 (13.8%) reported injury requiring treatment from a doctor or a hospitalization in the previous 12 months. Of those requiring treatment or hospitalization, 147 (40.4%) reported being injured in a domestic or public setting and 207 (56.9%) in a high-risk setting. The most common types and mechanisms of injury were sprains and strains, and falls, trips and slips, respectively. Preinjury depression was independently associated with unintentional injury in a domestic or public setting. Being injured in this setting was associated with double the odds of experiencing current depressive symptoms. The likelihood of a high-risk setting injury was significantly associated with male gender. High-risk setting injury was associated with current psychological distress and higher levels of alcohol usage.

CONCLUSIONS

This study supports the hypothesis that pre-existing depression is associated with unintentional injury in a rural sample and indicates the important role of prior depression in management of injury, given the high rate of injury in rural communities. Mechanisms by which prior depression increases likelihood of unintentional injury will be further investigated using longitudinal data.

Asian Student Depression in American High Schools

There are inconsistent findings about depression in Asians. This study examined risk factors for depression in Asian and Caucasian adolescents. Stratified bivariate secondary analyses of risk indicators and depressed mood were performed in this cross-sectional study of high school survey data (9th to 12th grades) from 2,542 students (198 Asian). Asians had a higher prevalence of depressed symptoms, but similar risk factors as Caucasians. Smoking and injury at work were major risk factors for depressed mood among Asians. Asian-specific risk factors for depression were being foreign-born and having a work-related injury. Asian and Caucasian teens have similar risk factors for depressed mood, though being foreign born and having a work-related injury are risk factors specific to Asian youth, possibly related to social–economic status. Providers of care in school, such as school nurses, can be important primary screeners of depression for Asian students in particular.

Evaluating the association of workplace psychosocial stressors with occupational injury, illness, and assault

This research project characterizes occupational injuries, illnesses, and assaults (OIIAs) as a negative outcome associated with worker exposure to generalized workplace abuse/harassment, sexual harassment, and job threat and pressure. Data were collected in a nationwide random-digit-dial telephone survey conducted during 2003-2004. There were 2151 study interviews conducted in English and Spanish. Analyses included cross tabulation with Pearson's Chi-Square and logistic regression analyses. Three hundred and fifty-one study participants reported having an OIIA during the 12 months preceding the study. Occurrences of generalized workplace harassment (OR = 1.53; CI = 1.33-1.75, p ≤ 0.05); sexual harassment (OR = 1. 18; CI = 1.04-.34, p ≤ 0.05); and job pressure and threat (OR = 1.26; CI = 1.10-1.45, p ≤ 0.05) were significantly associated with reporting an OIIA. The psychosocial environment is significantly associated with an increased risk of OIIA. Further research is needed to understand causal pathways and to explore potential interventions.

Associations between psychological distress, workplace accidents, workplace failures and workplace successes

PURPOSE

This study investigates associations between psychological distress and workplace accidents, workplace failures and workplace successes.

METHODS

The Health and Work Performance Questionnaire (HPQ) was distributed to employees of 58 large employers. A total of 60,556 full-time employees were eligible for analysis. The HPQ probed whether the respondent had, in the past 30-days, a workplace accident, success or failure ("yes" or "no"). Psychological distress was quantified using the Kessler 6 (K6) scale and categorised into low, moderate and high psychological distress. Three binomial logistic regressions were performed with the dependent variables being workplace accident, success or failure. Covariates in the models were K6 category, gender, age, marital status, education level, job category, physical health and employment sector.

RESULTS

Accounting for all other variables, moderate and high psychological distress significantly (P < 0.0001) increased the odds ratio (OR) for a workplace accident to 1.4 for both levels of distress. Moderate and high psychological distress significantly (P < 0.0001) increased the OR (OR = 2.3 and 2.6, respectively) for a workplace failure and significantly (P < 0.0001) decreased the OR for a workplace success (OR = 0.8 and 0.7, respectively).

CONCLUSIONS

Moderate and high psychological distress increase the OR's for workplace accidents work failures and decrease the OR of workplace successes at similar levels. As the prevalence of moderate psychological distress is approximately double that of high psychological distress moderate distress consequentially has a greater workplace impact.

Major depression and injury risk

OBJECTIVE

Cross-sectional epidemiologic studies have inconsistently reported associations between injuries and depressive symptoms. The significance of these findings remains unclear. Major depressive episodes (MDEs) may increase the risk of injury and injuries may increase the risk of MDEs. Longitudinal data are needed to distinguish between these possibilities.

METHOD

Data from the Canadian National Population Health Survey (NPHS) were used in this analysis. The NPHS is a prospective study based on a representative sample of household residents in Canada. Injuries were evaluated using self-report items. MDE was assessed using the Composite International Diagnostic Interview-Short Form for major depression.

RESULTS

During each round of interviews, an association between MDE and injuries was evident. In longitudinal analyses a bidirectional association was found. MDEs increased the risk of injury (adjusted hazard ratio [HR] 1.6, 95% CI 1.3 to 2.0) and injury increased the risk of MDEs (adjusted HR 1.4, 95% CI 1.1 to 1.8).

CONCLUSIONS

Injury prevention efforts may benefit from consideration of MDE as an injury determinant. For example, particular occupational or recreational activities may have a higher risk of injury during depressive episodes. Improved access to mental health resources in clinical settings where injuries are treated may also be valuable. However, additional studies are necessary to confirm these observations and to develop evidence-based interventions.

Health, medication use, and agricultural injury: A review

BACKGROUND

Agricultural work in the United States and Canada continues to be one of the most dangerous vocations. Surveillance evidence suggests that older farmers (>60 years of age) are at greater risk of serious injury than their younger counterparts. The purpose of this article was to outline illnesses and medications that may contribute to older farmers' increased risk of agricultural injury and to determine a minimum set of health-related covariates that could be used in farm injury studies.

METHODS

A review of English language literature in Medline, CINAHL, and NIOSH databases was conducted examining disease and medication factors related to farm injury.

RESULTS

Health- and disease-related factors most commonly reported as significantly contributing to agricultural injury included previous injury, hearing problems, depression, arthritis, and sleep deprivation. The use of "any medication" was identified as a significant risk factor for injury in a number of studies. The use of sleep medication was significantly related to injury in two studies.

CONCLUSIONS

Based on the findings, it is recommended that at a minimum, researchers collect information on the prevalence of previous injury, hearing problems, depression, arthritis/muscular-skeletal problems and sleep disturbance as these have been identified as significant risk factors in a number of studies. In addition, where subjects that identify any of these afflictions, further information should be sought on any medications used in their treatment which can add data on disease severity. More research and surveillance activities need to be focused on the older farm worker. This population is critical to the maintenance of the agricultural base in North America and health and safety research initiatives need to address this. By integrating research from the fields of gerontology, occupational health and safety, and injury prevention, innovative interventions could be constructed to assist the aging farmer in the continuation of safe farming.

Chronic health problems and risk of accidental injury in the workplace: a systematic literature review

OBJECTIVES

To investigate whether common important health conditions and their treatments increase risks of occupational injury.

METHODS

A systematic search was conducted of MEDLINE, EMBASE and PsycINFO databases from inception to November 2006 employing terms for occupational injury, medications, and a broad range of diseases and impairments. Papers related solely to driving, alcohol, or substance abuse were excluded, as were studies that did not allow analysis of injury risk. For each paper that was retrieved we abstracted standard information on the population, design, exposure(s), outcome(s), response rates, confounders and effect estimates; and rated the quality of information provided.

RESULTS

We found 38 relevant papers (33 study populations): 16 studies were of cross-sectional design, 13 were case-control and 4 were prospective. The overall quality was rated as excellent for only two studies. Most commonly investigated were problems of hearing (15 studies), mental health (11 studies) and vision (10 studies). For impaired hearing, neurotic illness, diabetes, epilepsy and use of sedating medication there were moderate positive associations with occupational injury (odds ratios 1.5-2.0), but there were major gaps in the evidence base. Studies covering vision did not present risks by category of eye disease; no evidence was found on psychotic illness; for diabetes, epilepsy and cardiovascular disease there were remarkably few papers; studies seldom distinguished risks by sub-category of external cause or anatomical site and nature of injury; and exposures and outcomes were mostly ascertained by self-report at a single time point, with a lack of clarity about exposure timings.

CONCLUSION

Improved research is needed to define the risks of occupational injury arising from common health complaints and treatments. Such research should delineate exposures and outcomes in more detail, and ensure by design that the former precede the latter.

Depressive symptoms and self-reported occupational injury in small and medium-sized companies

OBJECTIVES

This survey was designed to determine whether depressive symptoms had an effect on the risk of self-reported occupational injury in South Korea.

METHODS

We conducted a prospective follow-up survey of workers at 44 small- to medium-sized companies classified into manufacturing or service businesses; 1,350 questionnaires were used in the final analysis. The first survey requested information regarding personal characteristics, work characteristics, and depressive symptoms (CES-D); the second survey queried participants in the first survey about self-reported occupational injuries (including minor scratches or cuts) experienced in the previous 4 months. Risk ratios (RRs) were calculated through Poisson regression analysis. The number of occupational injuries during the previous 4 months served as the dependent variable, and depressive symptoms served as the independent variable.

RESULTS

After adjustment for demographic factors, the RRs were 1.75 (95% CI: 1.41-2.18) and 2.68 (95% CI: 1.98-3.64) in male and female, respectively. Additional adjustment for work-related variables did not alter the RR considerably in females (2.65; 95% CI: 1.95-3.59). Among the male workers, however, the RR was not significant (1.21; 95% CI: 0.95-1.55). On the other hand, when the analysis was limited to blue-collar workers, after adjustment for demographic and work-related factors, the RRs remained significant in both genders (male: 1.34; 95% CI: 1.03-1.74; female: 2.04; 95% CI: 1.41-2.95).

CONCLUSIONS

We found that the risk of self-reported occupational injury experience was higher in workers who reported depressive symptoms. Additional study using objective data is required to confirm our results.

Integrated management of depression: improving system quality and creating effective interfaces

Depression is a chronic recurrent condition and is a leading cause of work disability. Improving occupational outcomes for depression will require an integrated approach that incorporates best practices from the clinical, community, and workplace systems. This article briefly reviews recent quality improvement initiatives and promising practices in each system and then shifts to the importance of systems integration. An integrated chronic care model uses a sophisticated case management process to support essential relationships, facilitate key plans, and efficiently link the three systems to optimize clinical, economic, and occupational outcomes. An expanded role for employers and their agents in the management of depression and other chronic diseases is seen as fundamental to maintaining a healthy and productive workforce.

OBJECTIVE

To improve occupational outcomes for depression by integrating best practices from the clinical, community, and workplace systems.

METHODS

After a brief review of quality improvement initiatives and promising practices in each system, an integrated chronic care model is introduced.

RESULTS

A case management process that links critical systems, supports essential relationships, and facilitates key plans is expected to result in improvements in clinical, economic, and occupational outcomes.

CONCLUSIONS

Employers should be more engaged with clinical and community partners in the prevention and control of depression in affected employees.

Factors associated with depression symptoms in high school students in São Paulo, Brazil

OBJECTIVE

To assess factors associated with depression symptoms in high school students.

METHODS

A cross-sectional study involving high school students was conducted in the city of São Paulo, Brazil, 2001. A total of 724 students aged 14-18 years answered questionnaires on life and health conditions. Another questionnaire was applied to working (44.8%) and unemployed (22.9%) students to collect information on working conditions. Factors associated to depressive disorders were analyzed using multiple logistic regression controlled for occupational status.

RESULTS

Overall prevalence rate of depression was 7.5%. Rates according to gender were 39 (10.3%) in females and 15 (4.3%) in males. The multiple logistic regression analysis showed that factors associated with depressive disorders were: poor self-perception of health (OR=5.78), being female (OR = 2.45), and alcohol consumption (OR=2.35).

CONCLUSIONS

The study results showed that sociodemographic, lifestyle and health variables were associated with symptoms of depression in this population. These findings suggest that it is important to have mental health professionals available in high schools for early detection of mental conditions and student counseling.

Measuring job characteristics and mental health among Latino farmworkers: results from cognitive testing

BACKGROUND

Few research instruments used in occupational stress research have been evaluated for acceptability and validity among immigrant Latino farmworkers.

METHODS

Cognitive testing was completed with 40 migrant and seasonal farmworkers (21 women, 19 men) through two focus groups and 16 one-on-one interviews conducted in Texas and Florida. Participants responded to the K-6, a short form instrument designed to measure psychological distress, selected items from the Job Content Questionnaire (JCQ) and standard health items.

RESULTS

The K-6 items were characterized as too long and using a higher "class" language than farmworkers use. Further, the cultural connotation of several items in the K-6 was viewed as inappropriate by farmworkers. Demand items from the JCQ were interpreted inconsistently, whereas decision latitude items were consistently understood but viewed as irrelevant to farmworkers.

CONCLUSIONS

The results highlight the difficulties involved in conducting research with immigrant farmworkers, and they suggest that researchers interested in studying antecedents and consequences of farmworker mental health need to select instruments cautiously.

The association of needlestick injury with depressive symptoms among first-year medical residents in Japan

Depressive symptoms among medical residents are common. The objective of this study was to determine the association of depressive symptoms with needlestick injury among first-year medical residents (so-called "intern"). We conducted a prospective cohort study among 107 medical residents in 14 training hospitals. The baseline survey was conducted in August 2005 and the follow-up survey was conducted in March 2006. Depressive symptoms were based on the Center for Epidemiological Study of Depression. Factors associated with depressive symptoms were examined using logistic regression analysis. For medical residents without depressive symptoms at the baseline survey, needlestick injury events were associated with depressive symptoms at the follow-up survey (corrected odds ratio [cOR]=2.98; 95% confidence interval [CI], 1.16-3.70). Because it was not possible to determine when the medical residents developed depressive symptoms, it is not possible to definitely determine causality between needlestick injury and depressive symptoms, although these findings are suggestive. Therefore, it would seem prudent to suggest the provision of mental health services to medical residents sustaining a needlestick injury since this may be helpful in identifying and treating depression.

Mental illness as an independent risk factor for unintentional injury and injury recidivism

BACKGROUND

Twelve percent of Americans are diagnosed and treated for mental illness annually. The relationship between mental illness and intentional injuries such as assault and suicide has previously been described. However, unintentional injury among mentally ill adults has not been characterized. The purpose of this study was to identify relationships between mental illness diagnosis and unintentional injury. We hypothesized that diagnosed mental illness is an independent risk factor for unintentional injury and it increases the risk of recidivism.

METHODS

In this retrospective cohort study, trauma registry data, medical records, and outpatient mental health care data from the San Francisco Department of Public Health Billing Information System (BIS) were used to identify patients admitted with unintentional injury at a Level I urban trauma center in 2003 and 2004. Data collected included mechanism of injury, patient outcome and disposition, mental health diagnoses, substance abuse history, presence of homelessness, number of repeat injury events, and outpatient mental health treatment history. The incidence of unintentional injury requiring admission to a trauma center and the risk of intentional injury recidivism in subjects with a mental illness diagnosis were compared with those in subjects without a mental illness diagnosis. The risk of recidivism in those who had received publicly funded outpatient treatment before their injury was also evaluated.

RESULTS

Of the 1,709 patients admitted for unintentional injury, 20% had a diagnosis of mental illness. Individuals with mental illness had twice the rate of unintentional injury requiring admission (2.2-2.4 people in 1,000 vs. 1.0-1.1 in 1,000) and 4.5 times the odds of injury recidivism (odds ratio [OR] = 4.5, 95% confidence interval [CI] 3.3-6.1) as those who did not have a mental illness diagnosis. Mental illness was a more robust predictor of injury recidivism than substance abuse (OR = 3.2, 95% CI 2.3-4.3) or homelessness (OR = 2.3, 95% CI 1.5-3.4). Compared with the nonmentally ill group, subjects with mental illness had a longer hospital stay and were less likely to be discharged home. Also, their injuries were more likely the result of falling or being hit by cars, and less likely the result of motor vehicle collisions than subjects without mental illness.

CONCLUSIONS

Mental illness is an independent risk factor for unintentional injury and injury recidivism. Individuals with mental illness also have a different pattern of injury and hospitalization. They tended to suffer from different mechanisms of injury, stayed in the hospital longer, and were more likely to be discharged to a skilled nursing facility. Recognition of mental illness as a risk factor for injury may prompt re-examination of resource allocation for mental health and injury prevention and highlights the mentally ill as a prime target population for unintentional injury prevention efforts.

Reducing the societal burden of depression: a review of economic costs, quality of care and effects of treatment

Depression is a highly prevalent condition that results in substantial functional impairment. Advocates have attempted in recent years to make the 'business case' for investing in quality improvement efforts in depression care, particularly in primary care settings. The business case suggests that the costs of depression treatment may be offset by gains in worker productivity and/or reductions in other healthcare spending. In this paper, we review the evidence in support of this argument for improving the quality of depression treatment. We examined the impact of depression on two of the primary drivers of the societal burden of depression: healthcare utilisation and worker productivity. Depression leads to higher healthcare utilisation and spending, most of which is not the result of depression treatment costs. Depression is also a leading cause of absenteeism and reduced productivity at work. It is clear that the economic burden of depression is substantial; however, critical gaps in the literature remain and need to be addressed. For instance, we do not know the economic burden of untreated and/or inappropriately treated versus appropriately treated depression. There remain considerable problems with access to and quality of depression treatment. Progress has been made in terms of access to care, but quality of care is seldom consistent with national treatment guidelines. A wide range of effective treatments and care programmes for depression are available, yet rigorously tested clinical models to improve depression care have not been widely adopted by healthcare systems. Barriers to improving depression care exist at the patient, healthcare provider, practice, plan and purchaser levels, and may be both economic and non-economic. Studies evaluating interventions to improve the quality of depression treatment have found that the cost per QALY associated with improved depression care ranges from a low of 2519 US dollars to a high of 49,500 US dollars. We conclude from our review of the literature that effective treatment of depression is cost effective, but that evidence of a medical or productivity cost offset for depression treatment remains equivocal, and this points to the need for further research in this area.

Impact of psychosocial job stress on non-fatal occupational injuries in small and medium-sized manufacturing enterprises

BACKGROUND

Workers involved in manufacturing are known to comprise a high-risk population for occupational injury, and this risk is greater in small and medium-sized enterprises (SMEs). The purpose of this study was to examine the association between psychosocial job stress and occupational injuries among workers in SMEs.

METHODS

One thousand forty-nine men and 721 women from 244 SMEs participated in this study. Perceived job stress was evaluated with the Japanese version of the generic job stress questionnaire, which covered 14 job stress variables. Occupational injury was assessed by self-report during the last 1-year period.

RESULTS

Workers with high quantitative workload (odds ratio [OR] = 1.55 for men, 1.62 for women), high cognitive demands (OR = 1.70 for men, 1.53 for women), and low job satisfaction (OR = 1.33 for men, 1.93 for women) had a significantly increased risk of occupational injury in the multivariate model. High variance in workload (OR = 1.70) and high job future ambiguity (OR = 1.35) in men, and low job control (OR = 2.04) and high intragroup conflict (OR = 1.66) in women were significantly associated with occupational injury. In manufacturing/production workers, high quantitative workload (OR = 1.91), high variance in workload (OR = 2.02), and high depressive symptoms (OR = 1.55) were significantly associated with injury in men, while low social support from colleagues (OR = 2.36) or family (OR = 2.51) was related to injury in women.

CONCLUSIONS

These data point to an independent relationship between psychosocial job stress and self-reported occupational injury in SMEs.