Psychosocial factors are strong predictors of delayed recovery and other adverse outcomes in patients with work-related injuries.
A recent white paper from the Workers’ Compensation Research Institute (WCRI) examines the correlations between a worker’s mental health and the time it takes to recover from a physical workplace injury.
The paper, A Primer on Behavioral Health Care in Workers’ Compensation, uses information obtained from open-ended interviews with mental health care professionals, health care providers, employers, employment attorneys, and workers’ compensation insurers. It also derives from a review of selected national and state occupational health treatment guidelines.
Studies have shown that early identification and treatment of pre-existing behavioral risk factors and those caused by a work-related injury will result in improved outcomes.
The Colorado Division of Workers’ Compensation suggests that 3 to 10 percent of all injured workers may experience delayed recovery related to behavioral health issues.
Behavioral health barriers
Concerns about the impact of behavioral health problems on work-related injuries have increased in recent years as studies estimate that 30% to 50% of adults experience a mental illness in their lifetime.
Common psychosocial issues that hinder recovery may include:
- Poor recovery expectations after injury,
- Fear of new pain and injury
- Perceived injustice
- Dissatisfaction at work
- Low motivation
- Lack of family and community support
For some workers, poor recovery expectations become a self-fulfilling prophecy. Fear of pain may be more disabling than pain itself, consistent with chronic pain and dysfunction.
Job satisfaction before the injury also comes into play. About one in four workers surveyed reported that they were not at all or somewhat satisfied with their job at the time of the injury, and 27% said they feared being fired after a work-related injury. Having a lower level of confidence in the workplace makes employees recover more slowly and possibly even less likely to work after an injury.
The cycle of pain and mental health issues
Some studies show that poor behavioral health increases the likelihood of developing physical conditions and vice versa.
Up to 85% of patients with chronic pain are affected by major depression. They show a poorer prognosis than those with chronic pain alone. Workers may report feeling depressed, stressed, and anxious about a new injury.
Depression and stress disorders, whether stemming from workplace injury or existing, can contribute to chronic pain, which slows or masks healing.
The first steps
Workers’ compensation stakeholders recognize the importance of unaddressed behavioral health issues and how they can delay a worker’s recovery, return to work and medical costs after an injury.
Early identification of mental health factors is important to assess how they may affect an employee’s recovery. Early mental health intervention can be key to minimizing the time an employee needs to recover.
For example, the Washington State Department of Labor and Industry Guidelines recommend risk factor screening at two to six weeks of lost time after an injury. The Colorado back pain guidelines recommend behavioral health screenings as a routine part of care or when psychosocial factors appear to be influencing recovery.
The WCRI study describes and references specific testing protocols that can help identify specific issues and put employees on a course for recovery.
Help can come in the form of educating patients, teaching them self-management strategies, and referring them to behavioral health specialists.
An evaluation is recommended during follow-up care if the expected improvement is not observed within six weeks after the injury and if the validity of the symptoms cannot be determined by objective data.
A Primer on Behavioral Health Care in Workers’ Compensation by Vennela Thumula and Sebastian Negrusa is available for download at https://www.wcrinet.org/reports/a-primer-on-behavioral-health-care-in-workers -compensation. A fee is required for non-members.
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