Behavioral health related to worker recovery: A survey

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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 injury in the workforce.

The paper, A Primer in Behavioral Health Care in Workers’ Compensation, uses information taken from open-ended interviews with mental health professionals, health care providers, employers, labor advocates and workers’ compensation insurers. It is also based on a review of selected national and state guidelines for occupational medical treatment.

Studies show that early identification and treatment of both pre-existing behavioral health risk factors and those triggered by a work-related injury will lead to 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 associated with work injuries have increased in recent years, as studies show that 30% to 50% of adults experience a mental illness in their lifetime.

Common psychosocial issues impeding recovery may include:

  • Low expectations for recovery after injury,
  • Fear of pain and re-injury
  • Perceived injustice
  • Dissatisfaction with work
  • Pessimism
  • Fear
  • 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.

Pre-injury job satisfaction also comes into play. About one in four workers surveyed reported that they were not at all or somewhat dissatisfied with their job at the time of the injury, and 27% said they feared being fired after a work-related injury. A lower level of confidence in the workplace makes employees recover more slowly and perhaps even less likely to work after an injury.

Cycle of pain and mental health problems

Several studies have shown that poor behavioral health increases the likelihood of developing physical conditions and vice versa.

Up to 85% of chronic pain patients are affected by major depression. They show a worse prognosis than those with chronic pain. Workers may report feeling discouraged, stressed, and anxious about re-injury.

Depression and stress disorders, whether stemming from a workplace injury or pre-existing, can contribute to chronic pain that delays or masks recovery.

First steps

Workers’ compensation stakeholders recognize the importance of unresolved 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 a worker’s recovery. Early mental health intervention can be key to minimizing the time a worker needs to recover.

For example, guidelines from the Washington State Department of Labor and Industries recommend risk factor screening at two to six weeks lost time after injury. The Colorado Low Back Pain Guidelines recommend behavioral health screenings as a routine part of care or when psychosocial factors appear to impact recovery.

The WCRI study outlines and references specific testing protocols that can help identify specific problems and guide workers toward recovery.

Help can come in the form of patient education, teaching self-management strategies, and referrals to behavioral health professionals.

Evaluation during follow-up care is recommended if expected progress is not observed within six weeks of injury and if symptom validity 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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