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 an injury to the physical workforce.
The paper, A Primer in Behavioral Health Care in Workers ‘Compensation, uses information drawn from open-ended interviews with mental health professionals, healthcare professionals, employers, labor advocates, and workers’ compensation insurers. It also draws from a review of selected national and state guidelines for the treatment of occupational medicine.
Studies have shown that early identification and treatment of both pre-existing behavioral health risk factors and those triggered by an injury at work will result in better outcomes.
The Colorado Division of Workers’ Compensation suggests that 3 to 10 percent of all workers with injuries could experience delayed recovery related to behavioral health issues.
Behavioral Health Barriers
Concerns about the impact of behavioral health problems of work-related injuries have increased in recent years as studies estimate that 30% to 50% of adults have mental illness in their lifetime.
Common psychosocial problems that inhibit recovery can include:
- Low expectations of recovery after injury,
- Fear of pain and re-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 can 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 in some way satisfied with their job at the time of the injury, and 27% said they feared being fired after an injury at work. Having a lower level of confidence in the workplace causes employees to recover more slowly and perhaps even less likely to work after an injury.
Cycle of pain and mental health problems
Several studies show that poor behavioral health increases the likelihood of developing physical conditions and vice versa.
Up to 85% of chronic pain patients have severe depression. They have a worse prognosis than those with chronic pain alone. Workers may report feeling discouraged, stressed and anxious about the new injury.
Depression and stress-related disorders, whether they are derived from work-related or pre-existing injuries, can contribute to chronic pain, which slows or masks healing.
Workers’ compensation stakeholders recognize the importance of unaddressed behavioral health issues and how they could delay a worker’s recovery, return to work, and medical bills after an injury.
Early identification of mental health factors is important in assessing how they can affect a worker’s recovery. Early mental health intervention may be the key to minimizing the time a worker needs to recover.
For example, guidelines from the Washington State Department of Labor and Industries recommend screening for the risk factor two to six weeks of lost time after an injury. The Colorado low back pain guidelines recommend behavioral health screening as a routine part of care or when psychosocial factors appear to be impacting recovery.
The WCRI study outlines and references specific testing protocols that can help identify specific problems and direct workers towards recovery.
Assistance can come in the form of educating patients, teaching self-management strategies, and referring them to behavioral health specialists.
Evaluation during follow-up care is recommended if expected progress is not observed within six weeks of injury and if the validity of symptoms cannot be established with objective data.
A Primer of Behavioral Health Care in Worker’s 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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