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Employees with mental disorders seeking support from the workers compensation system – experiences from Denmark
Abstract
Background:
In Europe it is commonly accepted that psychosocial hazards may influence the mental health of employees. However, mental disorders such as depression are generally not acknowledged as an occupational disease covered by the workers compensation system. Studies indicate that workers compensation claim processes may affect employee's health negatively due to a demanding case process. If filing a workers' compensation claim can harm the employees' health, it is highly relevant to pay attention to employees with mental health claims, as they are most likely vulnerable and face a very low chance of compensation.
Objective:
This study investigates how employees with work-related mental disorders experience the process of seeking workers compensation from the Danish Workers' Compensation System.
Method:
Interview (N = 13) and questionnaire (N = 436) data from claimants were analysed.
Results:
Analysis showed that even though many employees wished for the claim to influence the conditions at the workplace, there seemed to be a lack of preventive health and safety initiatives in the workplaces. Central stakeholders such as health and safety representatives were often not involved. Management involvement was often experienced negatively, and the Danish Working Environment Authority rarely conducted workplace inspections. Employees experienced inadequate information about the workers' compensation process and experienced a lack of coordination between stakeholders.
Conclusion:
A more supportive and coordinated approach in the Workers' Compensation System is recommendable. The processes in the system could be evaluated using the Social Insurance Literacy concept, to ensure sufficient support of the claimants and reduce potential harmful aspects of the process.
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Background:
The problem of illnesses, sick leave and the necessary return to work and permanence at work has been determining the development of different protocols and professional rehabilitation programs in different countries.
Objective:
We sought to identify articles that address programs for professional rehabilitation and the return to work of people laid off due to mental health problems, and to verify the results of professional rehabilitation programs and the follow-up processes for such return.
Method:
A systematic review was performed according to the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). The serial search of the articles was carried out in the electronic databases: Web of Science, MEDLINE/PubMed and Scopus. The variations in the descriptors served to find a greater range of significant results for the research.
Results:
In total, 2,306 articles were found. Another two articles that met the inclusion criteria were located through manual searches, adding up to a total of 2,308. Applying the exclusion criteria resulted in a final data set of 47 peer-reviewed articles.
Conclusions:
The issues involving return to work and permanence in work were complex and multifaceted in the research articles studied. Recovery from Common Mental Disorders (CMDs) is a major cause of long-term sick leave and the granting of disability benefits. Many people with these diagnoses remain employed; however, further studies are needed with women, workers with fragile relationships, and immigrants.
In the last decade, many studies have examined associations between poor psychosocial work environment and depression. We aimed to assess the evidence for a causal association between psychosocial factors at work and depressive disorders. We conducted a systematic literature search from 1980 to March 2019. For all exposures other than night and shift work and long working hours, we limited our selection of studies to those with a longitudinal design. We extracted available risk estimates for each of 19 psychosocial exposures, from which we calculated summary risk estimates with 95% confidence intervals (PROSPERO, identifier CRD42019130266). 54 studies were included, addressing 19 exposures and 11 different measures of depression. Only data on depressive episodes were sufficient for evaluation. Heterogeneity of exposure definitions and ascertainment, outcome measures, risk parameterization and effect contrasts limited the validity of meta-analyses. Summary risk estimates were above unity for all but one exposure, and below 1.60 for all but another. Outcome measures were liable to high rates of false positives, control of relevant confounding was mostly inadequate, and common method bias was likely in a large proportion of studies. The combination of resulting biases is likely to have inflated observed effect estimates. When statistical uncertainties and the potential for bias and confounding are taken into account, it is not possible to conclude with confidence that any of the psychosocial exposures at work included in this review is either likely or unlikely to cause depressive episodes or recurrent depressive disorders.
Purpose To assess employees’ experiences of the workers’ compensation claim process for psychological trauma, stress or a mental health condition sustained during the course of work in the police and emergency services sector. Methods 14,868 employees (69.4% male, response rate = 22%) from around Australia participated in Answering the Call: the Beyond Blue National Mental Health and Wellbeing Study of Police and Emergency Services, and were asked questions regarding their workers’ compensation experiences for mental health reasons. Results 14% of all employees in police and emergency services organisations had made a workers’ compensation claim for mental health reasons. Only 8.2% of employees making a claim had a positive experience (95% CI 6.6–9.8) while 70.3% had a poor experience (95% CI 67.6–73.0). Two-thirds of employees who had made a claim reported that the process was unsupportive and stressful, and over half reported that it had an overall negative impact on their recovery. Employees with poor overall support from their managers and those who perceived negative stigma about mental health in their workplace were more likely to report poor experiences. Conclusions The workers’ compensation process is perceived negatively by most police and emergency services employees who have experience with it, and a majority found that it negatively impacted on their recovery. Ways to reform the system to better support employees experiencing significant functional impairments related to mental health issues should be urgently considered.
Purpose: Sickness insurance and workers’ compensation systems decide on peoples’ eligibility for benefits, and are commonly based on medical certificates and assessments of work ability. Systems differ in the extent to which they preserve clients’ dignity and right to fair assessments. In this article, we define a new concept for studying interactions between individuals and systems: social insurance literacy, which concerns how well people understand the different procedures and regulations in social insurance systems, and how well systems communicate with clients in order to help them understand the system.
Methods: The concept was defined through a scoping literature review of related concepts, a conceptual re-analysis in relation to the social insurance field, and a following workshop.
Results: Five related concepts were reviewed for definitions and operationalizations: health literacy, financial/economic literacy, legal capability/ability, social security literacy, and insurance literacy.
Conclusions: Social insurance literacy is defined as the extent to which individuals can obtain, understand and act on information in a social insurance system, related to the comprehensibility of the information provided by the system. This definition is rooted in theories from sociology, social medicine and public health. In the next step, a measure for the concept will be developed based on this review.
• Implications for rehabilitation
• Social insurance literacy is a new concept that is based on theories in sociology, social medicine and public health.
• It provides conceptual orientation for analyzing factors that may influence different outcomes of peoples’ contacts with social insurance systems.
• The concept is of relevance for rehabilitation professionals since it focuses on how interactions between individuals and systems can influence the rehabilitation process.
• The study will in the next step develop a measure of social insurance literacy which will have practical applications for rehabilitation professionals.
Belastninger i det psykiske arbejdsmiljø er en udfordring i både dansk og europæisk kontekst, og antallet af anmeldte psykiske erhvervssygdomme er steget med 43 % over de seneste 4 år. Dog får over 95 % afvist deres sag i arbejdsskadestyrelsen (arbejdsskadestyrelsen 2015a). I denne artikel undersøges hvorfor medarbejdere vælger at anmelde en psykisk erhvervssygdom, på trods af en minimal chance for anerkendelse i arbejdsskadestyrelsen. Artiklen viser, at en væsentlig årsag til anmeldelserne er ønsket om, at arbejdsskadeanmeldelsen får en forebyggende effekt på arbejdspladsen. Imidlertid sker der ofte ingen forandringer på arbejdspladsen bla. fordi arbejdstilsynet sjældent fører tilsyn, og medarbejderne oplever en individualisering af problemerne i arbejdsmiljøet. Et stort antal sygemeldte medarbejdere går således igennem en belastende anmeldelsesprocedure og spilder dyrebare ressourcer på arbejdsskadeanmeldelser, uden hverken at få anerkendelse i arbejdsskadestyrelsen eller at opnå den ønskede forebyggende effekt på arbejdspladsen. Artiklen er baseret på analyser af interviews og spørgeskemabesvarelser fra medarbejdere med en anmeldt psykisk erhvervssygdom samt Rigsrevisionens rapport om tilsyn med det psykiske arbejdsmiljø (Statsrevisorerne 2015).
AIM: To explore what happens when employees become ill with a work-related mental disorder. This thesis focuses on the Workplace System, the Workers’ Compensation System, and the interaction between the two systems, applying the perspectives of employees and line managers.
KEY QUESTIONS: Study I explores how line managers experience and handle situations in which employees are sick-listed for a work-related mental disorder. Study II analyses what happens in the workplace when an employee develops a work-related disease: who is involved? Is work-related mental disorders handled differently from other types of work-related conditions? Study III explores the experiences of employees with notified work-related mental disorder in the workplace and Workers’ Compensation System. It compares the responses of employees with rejected and recognised claims and those of employees with different diagnoses, such as PTSD, depression, or stress related illness. Study IV examined if workers compensation claims of mental disorders are associated with changes in health, income, or long-term sickness absence.
Purpose:
To examine how line managers experience and manage the return to work process of employees on sick leave due to work-related stress and to identify supportive and inhibiting factors.
Materials and methods:
Semi-structured interviews with 15 line managers who have had employees on sick leave due to work-related stress. The grounded theory approach was employed.
Results:
Even though managers may accept the overall concept of work-related stress, they focus on personality and individual circumstances when an employee is sick-listed due to work-related stress. The lack of a common understanding of stress creates room for this focus. Line managers experience cross-pressure, discrepancies between strategic and human-relationship perspectives and a lack of organizational support in the return to work process.
Conclusion:
Organizations should aim to provide support for line managers. Research-based knowledge and guidelines on work-related stress and return to work process are essential, as is the involvement of coworkers. A commonly accepted definition of stress and a systematic risk assessment is also important. Cross-pressure on line managers should be minimized and room for adequate preventive actions should be provided as such an approach could support both the return to work process and the implementation of important interventions in the work environment. Implication for rehabilitation Organizations should aim to provide support for line managers handling the return to work process. Cross-pressure on line managers should be minimized and adequate preventive actions should be provided in relation to the return to work process. Research-based knowledge and guidelines on work-related stress and return to work are essential. A common and formal definition of stress should be emphasized in the workplace.
In spite of many years efforts it is difficult to prove substantial improvements of the work envi-ronment and policymakers are continuously searching for new efficient strategies. This paper ex-amines the concept of orchestration of work environment programs, based on an empirical analy-sis of recent Danish policy. Orchestration is a strategy where different stakeholders and activities are integrated into a unified program aimed at a specific target group. The analysis includes three policy cases, supplemented with two company case studies. The research shows a move towards a more governance type of regulation which is not only emerging in network, but also includes more explicitly orchestrated policy programs. The stakeholders participate in the network with different interests and the orchestration of work environment policies is therefore built on a platform of regulation, as it is especially important for employers and unions as key stakeholders in order to accept these shared policies.
Objectives This study aimed to evaluate the effect of a stress management intervention (SMI) on lasting return to work (RTW) among patients with work-related stress complaints. Methods Sickness benefit departments from three local municipalities referred patients on sick leave with work-related adjustment disorders or mild depression to the Department of Occupational Medicine, Regional Hospital West Jutland. A 2× randomization procedure allocated patients into one of three groups: intervention (N=58), control A (which received a clinical assessment; N=56), or control B (no assessment; N=49). Treatment comprised individual work-focused cognitive behavioral therapy (CBT) with an optional workplace intervention. The outcome was time until lasting RTW (16 and 44 weeks follow-up) using register data. Results Median number of weeks until lasting RTW was 15, 19, and 32 for the intervention group, control A, and control B respectively. However, for group B, clinical assessment was not part of the inclusion process, which may have introduced selection bias. In the fully-adjusted Cox regression model, the intervention group exhibited significantly faster lasting RTW at 44 weeks; hazard ratio (HR) 1.57 [95% confidence interval (95% CI) 1.01-2.44] relative to control group A, with a non-significant trend evident at 16 weeks; HR 1.70 (95% CI 0.94-3.10), when controlling for age, gender, occupation, sick leave during previous year, full or partial sick leave, and diagnosis. Unadjusted analyses remained directionally consistent but were reduced to marginal significance. Conclusions There was a tendency towards faster lasting RTW in the intervention group compared to control A, which received clinical assessment, in all analyses. The intervention group returned to work about 4 weeks earlier than control A, which could translate into substantial financial gains.
Objective The aim of this review was to determine whether employees exposed to effort-reward imbalance (ERI) at work have a higher risk of depressive disorders than non-exposed employees. Methods We conducted a systematic review and meta-analysis of published prospective cohort studies examining the association of ERI at baseline with onset of depressive disorders at follow-up. The work was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and a detailed study protocol was registered before literature search commenced (Registration number: CRD42016047581). We obtained a summary estimate for the association of ERI with risk of depressive disorders by pooling the study-specific estimates in a meta-analysis. We further conducted pre-defined sensitivity analyses. Results We identified eight eligible cohort studies, encompassing 84 963 employees and 2897 (3.4%) new cases of depressive disorders. Seven of the eight studies suggested an increased risk of depressive disorders among employees exposed to ERI. The pooled random-effects estimate was 1.49 [95% confidence interval (95% CI) 1.12-1.80, P<0.001], indicating that ERI predicts risk of depressive disorders. The estimate was robust in sensitivity analyses stratified by study quality, type of ERI ascertainment and type depressive disorder ascertainment, respectively. Conclusions Employees exposed to ERI were at increased risk of depressive disorder. Future studies on ERI and depressive disorders should examine if this association is stronger or weaker when ERI is measured repeatedly during follow-up and with other methods than self-report or when depressive disorders are ascertained with clinical diagnostic interviews.
Background
Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among employees, but evidence on clinically diagnosed depression is scarce. We examined job strain as a risk factor for clinical depression.
Method
We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individual-level data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium. Summary estimates of the association were obtained using random-effects models. Individual-level data analyses were based on a pre-published study protocol.
Results
We included six published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression. Job strain was associated with an increased risk of clinical depression in both published [relative risk (RR) = 1.77, 95% confidence interval (CI) 1.47–2.13] and unpublished datasets (RR = 1.27, 95% CI 1.04–1.55). Further individual participant analyses showed a similar association across sociodemographic subgroups and after excluding individuals with baseline somatic disease. The association was unchanged when excluding individuals with baseline depressive symptoms (RR = 1.25, 95% CI 0.94–1.65), but attenuated on adjustment for a continuous depressive symptoms score (RR = 1.03, 95% CI 0.81–1.32).
Conclusions
Job strain may precipitate clinical depression among employees. Future intervention studies should test whether job strain is a modifiable risk factor for depression.
Background:
Depressive symptoms are potential outcomes of poorly functioning work environments. Such symptoms are frequent and cause considerable suffering for the employees as well as financial loss for the employers. Accordingly good prospective studies of psychosocial working conditions and depressive symptoms are valuable. Scientific reviews of such studies have pointed at methodological difficulties but still established a few job risk factors. Those reviews were published some years ago. There is need for an updated systematic review using the GRADE system. In addition, gender related questions have been insufficiently reviewed.
Method:
Inclusion criteria for the studies published 1990 to June 2013: 1. European and English speaking countries. 2. Quantified results describing the relationship between exposure (psychosocial or physical/chemical) and outcome (standardized questionnaire assessment of depressive symptoms or interview-based clinical depression). 3. Prospective or comparable case-control design with at least 100 participants. 4. Assessments of exposure (working conditions) and outcome at baseline and outcome (depressive symptoms) once again after follow-up 1-5 years later. 5. Adjustment for age and adjustment or stratification for gender. Studies filling inclusion criteria were subjected to assessment of 1.) relevance and 2.) quality using predefined criteria. Systematic review of the evidence was made using the GRADE system. When applicable, meta-analysis of the magnitude of associations was made. Consistency of findings was examined for a number of possible confounders and publication bias was discussed.
Results:
Fifty-nine articles of high or medium high scientific quality were included. Moderately strong evidence (grade three out of four) was found for job strain (high psychological demands and low decision latitude), low decision latitude and bullying having significant impact on development of depressive symptoms. Limited evidence (grade two) was shown for psychological demands, effort reward imbalance, low support, unfavorable social climate, lack of work justice, conflicts, limited skill discretion, job insecurity and long working hours. There was no differential gender effect of adverse job conditions on depressive symptoms
Conclusion:
There is substantial empirical evidence that employees, both men and women, who report lack of decision latitude, job strain and bullying, will experience increasing depressive symptoms over time. These conditions are amenable to organizational interventions.
Proper working conditions and successful occupational health and safety (OHS) management help organizations achieve their targets and support the quality of working life and performance. Work-related stress, conflicts, work ability issues, ill health, and other challenging OHS situations in the workplace may impede the well-being and productivity of employees. According to OHS legislation, employers are responsible for managing risks and solving problems in the work community. Challenging situations can be viewed from the perspective of efficiency, since their economic effects may be remarkable. The objective of this study is to describe the challenging OHS situations managers encounter and the support they require in these situations. The results are based on thematic interviews and inquiries with top, middle, and front-line managers in three Finnish public sector service organizations. The most challenging OHS management situations are related to the administration of work under high economic pressure and constant changes in the work community, managing employee workload and time pressures, providing feedback, facilitating collaboration, and managing conflict. The managers’ own understandings, competences, and resources, as well as organizational supports, have an effect on successful resolutions of challenging OHS management situations.
Introduction:
Healthcare providers (HCPs) are influential in the injured worker's recovery process and fulfil many roles in the delivery of health services. Interactions between HCPs and insurers can also affect injured workers' engagement in rehabilitation and subsequently their recovery and return to work. Consideration of the injured workers' perceptions and experiences as consumers of medical and compensation services can provide vital information about the quality, efficacy and impact of such systems. The aim of this systematic review was to identify and synthesize published qualitative research that focused on the interactions between injured workers, HCPs and insurers in workers' compensation systems in order to identify processes or interactions which impact injured worker recovery.
Method:
A search of six electronic databases for literature published between 1985 and 2012 revealed 1,006 articles. Screening for relevance identified 27 studies which were assessed for quality against set criteria. A final 13 articles of medium and high quality were retained for data extraction.
Results:
Findings were synthesized using a meta-ethnographic approach. Injured workers reported that HCPs could play both healing and harming roles in their recovery. Supportive patient-centred interaction with HCPs is important for injured workers. Difficult interactions between HCPs and insurers were highlighted in themes of adversarial relations and organisational pressures. Insurer and compensation system processes exerted an influence on the therapeutic relationship. Recommendations to improve relationships included streamlining administrative demands and increasing education and communication between the parties.
Conclusion:
Injured workers with long term complex injuries experience difficulties with healthcare in the workers' compensation context. Changes in insurer administrative demands and compensation processes could increase HCP participation and job satisfaction. This in turn may improve injured worker recovery. Further research into experiences of distinct healthcare professions with workers' compensation systems is warranted.
Introduction:
Work-related injury is a major public health problem and a worker's recovery can be shaped by their interactions with employers, healthcare providers and the workers' compensation system. Most research on the effects of compensation has concentrated on examining outcomes rather than considering the compensation process itself. There has been little attention paid to the interactions between stakeholders and only recently has the client's view been considered as worthy of investigation. This systematic review aimed to identify and synthesize findings from peer reviewed qualitative studies that investigated injured workers interactions with insurers in workers' compensation systems.
Method:
A search of six electronic library databases revealed 1,006 articles. After screening for relevance, 18 articles were read in full and a search of those bibliographies revealed a further nine relevant articles. Quality assessment of the 27 studies resulted in a final 13 articles of medium and high quality being retained for data extraction.
Results:
Included studies focused mainly on experiences of injured workers, many of whom had long term claims. Findings were synthesized using a meta-ethnographic approach. Six themes were identified which characterised the interactions between insurers and injured workers. The majority of interactions were negative and resulted in considerable psychosocial consequences for injured workers. Positive interactions were less frequently reported and included respectful, understanding and supportive communication and efficient service from insurers.
Conclusion:
Findings from this synthesis support the growing consensus that involvement in compensation systems contributes to poorer outcomes for claimants. Interactions between insurers and injured workers were interwoven in cyclical and pathogenic relationships, which influence the development of secondary injury in the form of psychosocial consequences instead of fostering recovery of injured workers. This review suggests that further research is required to investigate positive interactions and identify mechanisms to better support and prevent secondary psychosocial harm to injured workers.
Purpose:
Long-term sick leave due to common mental disorders (CMD) is an increasing problem in many countries. Recent reviews indicate that return to work (RTW) interventions have limited effect on reducing sickness absence among this group of sick-listed. The aims of this study were to investigate how sick-listed persons with CMD experienced participating in an RTW intervention and how workability assessments and RTW activities influenced their RTW-process, and to examine the working mechanisms of the intervention. The gained knowledge can help improve future RTW intervention design and implementation.
Methods:
In-depth interviews were conducted with 17 participants on sick leave due to CMD who participated in an RTW intervention. Interviews were conducted at three time points with each participant. Principles of interpretative phenomenological analyses guided the analysis.
Results:
The workability assessment consultations and RTW activities such as psychoeducative group sessions and individual sessions with psychologist could result in both motivation and frustration depending on the extent to which the RTW professionals practiced what we have termed an individual approach to the sick-listed person.
Conclusions:
The individual approach seems necessary for the realization of the positive potential in the RTW intervention. However, the fact that RTW professionals are both the facilitators and the controllers of the sick-listed persons' RTW process is an inherent paradox in the intervention, which can impede the necessary establishment of a high-quality relationship between the sick-listed persons and RTW professionals.
Post hoc and planned comparison procedures for interpreting chi-square contingency-table test results, not currently discussed in most standard textbooks, are presented. A planned comparison procedure that simplifies the tedious process of partitioning a contingency table by creating single-degree-of-freedom contrasts through a regression-based approach is proposed. Importantly, these post hoc methods supplement the analysis of standardized residuals by reporting the percentage contribution for each cell to the overall chi-square statistic (relative contribution) and to the percentage of variance shared by the two factors (absolute contribution). Both methods can be readily incorporated into existing statistical packages such as SAS or SPSS. The equivalence of the percentage contribution method to the more common standardized residual method is also presented along with an example of a typical application.
The Nordic countries have a long tradition of research studying the impact of the psychosocial work environment on health (1, 2). Fittingly, the Scandinavian Journal of Work, Environment and Health has been a key place for the presentation and discussion of studies examining the complex relations between working conditions, psychological processes, and health and illness. Chances are high that this will continue in the foreseeable future as an increasing proportion of the workforce, particularly – but not exclusively – in high-income countries, is facing potentially health-affecting psychosocial working conditions, such as working with people in need, team work, demands for high flexibility, job insecurity, international competition, or working with tight deadlines – to name just a few examples (3). Additionally, mental ill-health, which is known to be caused to a substantial extent by adverse psychosocial circumstances in life (4), is on the rise to become the leading cause of disability-adjusted life years lost in high-income countries (5). Examining whether and how psychosocial working conditions contribute to mental ill-health, and ultimately how this knowledge can be used for preventive efforts, is an important task for occupational health research (6, 7). Over the last decade, major improvements have been made in the designs of psychosocial work environment studies. Earlier research has often been hampered by an over reliance on cross-sectional data, with the immanent limitations in establishing temporality of exposure and outcome and drawing causal inference (8). Today, however, data from several large-scale cohort studies are available, not least in the Nordic countries. The number of cohort studies has grown to such an extent that a European Research Consortium recently launched a project on an “Individual-participant-data meta-analysis of working populations” (IPD-Work), aiming to synthesize the data from the numerous European psychosocial work environment cohort studies (9). Despite this progress, there are still important methodological challenges that need to be tackled. A major concern is how the psychosocial work environment can be assessed in the most precise and unbiased way. Self-administered questionnaires. By far, the most widely-used method for assessing the psychosocial work environment is the self-administered questionnaire. Several instruments with good psychometric properties have been developed, both for testing specific theoretical models (10, 11) and assessing the psychosocial work environment in all its broadness (12–14). Using self-reported data has many advantages. First, it is a convenient and cost-effective way to collect a lot of information from a large number of people, the latter being necessary when the aim is to investigate incident of disease. Second, workers are the obvious experts of their own workplaces; they are likely those who know most about their work environment. Third, questionnaires enable researchers to enquire about typical or average working conditions and are not restricted to the work environment of a specific day. These important advantages must be balanced against one major disadvantage. The response in self-administered questionnaires is in all likelihood not only driven by characteristics of the work environment (ie, the entity that is intended to be measured) but also by other factors, such as personal dispositions, mood, expectations, previous experiences, or health. This might cause both non-differential and differential misclassification, resulting in under- and overestimations of effects. For researchers mainly focused on how individual differences shape the perception and appraisal process of the person (15), the precise measurement of psychosocial working conditions might be of lesser concern. However, for researchers interested in the characteristics of the work environment that harm, protect or promote workers’ health, the most accurate and valid assessment of psychosocial working conditions is a major concern. This concern is, of course, not new. In the 1980s, scholars such as Kasl, Frese, and Zapf already warned against the naive use of self-reported exposure data in studies on psychosocial work environment and health (16, 17). Thus, the problem is not that the research community is unaware of the limitations of self-administered questionnaires; the problem is to find the right solutions. There are, for example, alternatives to self-administered questionnaires, but, not surprisingly, each alternative has its own challenges. Workplace aggregation of self-reported data. The purpose of aggregating individual responses to group levels in the workplace (eg, departments or work groups) is that the influence of individual factors can be reduced and the shared work environment can be carved out. The method has been used in some studies (18–20), but has also been discussed controversially (21). Particular challenging is the identification of the organizational level at which individuals have a sufficient amount of shared work environment. Also, whereas certain workplace characteristics (eg, organizational justice) appear well-suited for workplace aggregation, other characteristics (eg, decision authority) might be better suited for aggregation at the job title instead of at the workplace level. To complicate things further, sometimes the non-shared work environment could be the most important exposure. Imagine a workplace where a high level of social coherence is achieved by the social exclusion of some selected employees. Whereas the social cohesion score of the workplace is likely high, the score of these selected employees is likely low. This might lead investigators to conclude that the scores of these employees are biased by individual characteristics, such as negative affectivity, whereas in fact the contrast between the high social cohesion score at the group level and the low score for these selected employees is the pivotal workplace exposure in this example. Observer-based assessments. One of the most advanced methods for observer-based assessments of the psychosocial work environment is the RHIA/VERA method, which is a German acronym for “Regulationshindernisse in der Arbeitswelt/Verfahren zur Ermittlung von Regulationserfordernissen”. The method, which is based on action-regulation theory, was developed by work and organizational psychologists in Germany in the 1980s (22, 23) and has been tested in several countries (24–26). A major advantage is that the objective of interest, the working conditions, are directly observed. A major disadvantage is that the assessment is time-consuming and costly. Moreover, psychosocial exposures, such as bullying, threats, or violence at work, which are important predictors of mental ill-health (27–29), are unlikely to surface in the presence of an observer. Further, although the method avoids bias resulting from employees’ individual characteristics, bias resulting from observers’ individual characteristics is possible. Assessment by register data. Recently, Virtanen et al (30) used register data on hospital ward overcrowding as an indicator of high workload among hospital staff. The authors found a clear dose–response pattern between the level of ward overcrowding and risk of antidepressant treatment among the employees at these wards. In this issue of the Scandinavian Journal of Work Environment and Health, Ervasti and colleagues (31) present a register-linkage study that examined the effect of the psychosocial work environment in schools on risk of sickness absence of teachers. This topic is highly relevant. Sickness absence has evolved as a major research theme, in particular in the Nordic countries (32, 33). Although sickness absence is a complex phenomenon, influenced not only by health but by other factors as well (34), it is nevertheless an excellent indicator of both physical and mental ill-health (35, 36). Human service work, including teaching, and the emotional demands associated with working with people, is suspected to increase risk of mental ill-health of employees and subsequent sickness absence (37, 38). Investigating this association is, however, difficult, because pre-clinical conditions of ill-health at baseline might cause participants to overestimate quantitative and emotional demands when working conditions are assessed by self-report. Ervasti et al used register data on the proportion of pupils with special educational needs (SEN) at the schools as a measure of psychosocial working conditions. They found that risk of sickness absence increased with the percentage of SEN pupils, and that this association was stronger in schools with a high pupil–teacher ratio. Thus, the authors identified a prospective association between a specific working condition and risk of sickness absence. Their analyses also suggested a clear solution: increase teaching staff in schools with a high percentage of SEN pupils. Moreover, Ervasti et al (31) adjusted their analyses for average income level of residents in the school neighborhood, thereby addressing another important issue: the role of contextual factors in studies on psychosocial work environment and health (39). Despite its merits, the article by Ervasti et al also illustrates the limitations of register-linkage studies. As the authors themselves point out, the study does not provide insight into the specific mechanism that links the proportion of SEN pupils to risk of sickness absence. A high proportion of SEN pupils might add to the quantitative workload of teachers, it might qualitatively change the teachers’ work environment, for example by increasing social conflicts and decreasing social cohesion in the class, or it might generally cause a feeling of insufficiency among teachers who were not adequately trained to teach SEN pupils. Important effect modifiers might be the attitude and reactions of the other students and their parents towards SEN pupils and the school’s written or unwritten policy of social inclusiveness. To investigate these and other potential mechanisms and explanations requires information beyond that available in registers. Thus register data might be most useful to assess quantitative and emotional demands at work, but they appear to be limited for the assessment of social relations, interactions, and conflicts. Towards a more comprehensive assessment of working conditions. An object of research as complex as the psychosocial work environment requires thoughtful and comprehensive assessments. Because each assessment method has its advantages and disadvantages, combining methods might be a promising strategy. A few studies have used multi-method assessments. In a study with urban transit operators, Greiner and colleagues (25) found that observer-based but not self-reported stressors were associated with hypertension. When the authors analyzed interactions between observer-based and self-reported stressors, they found that hypertension was high among participants who had high levels of observer-based and low levels of self-reported stressors. Greiner et al (25) point out that this could indicate that adverse psychosocial working conditions might be particularly harmful when employees are unaware or in denial of the exposure. In the study on hospital ward overcrowding and antidepressant treatment by Virtanen et al (30), job demands were also measured by self-report. In a further analysis, Kivimäki et al (40) showed that the part of the variation of self-reported job demands that was explained by ward overcrowding predicted sickness absence with psychiatric disorder, leading the authors to conclude that there was a prospective association between self-reported job demands and sickness absence that could not be explained by reporting bias. These two examples illustrate some of the potential benefits of multi-method assessments of the psychosocial work environment. In the first example, the discrepancy in the results generated a new hypothesis on the potential role of unawareness and denial. In the second example, the concordance in the results provided important information on the validity of a self-administered questionnaire. In our endeavor to better understand how the psychosocial work environment can affect health and illness, we need more such studies. Acknowledgement. Many thanks to the members of the “PIWA Research Group” at the National Research Centre for the Working Environment for valuable comments on an earlier draft of this editorial.
Work disability prevention has evolved from being a component of disease outcomes studies, to a separate and growing research discipline. In part, this is due to recognition that work outcomes often do not correlate with other health outcomes; the causes of work disability are multiple, complex, and often distinct from associated health conditions or treatments; and that work disability creates an important personal, economic and social burden that is often preventable. Conceptual frameworks, measures, research methods and interventions specific to this area have been developed, many have been validated across different contexts, and an international community of researchers and trainees in work disability prevention has formed. The articles included in this special section exemplify the breadth of current research in this field, and future opportunities for greater cross- disciplinary collaboration and translation of research to practical implementation and policy interventions.
The aim was to combat occurrence of chronic occupational back pain.
A multidisciplinary model to manage back pain that includes both clinical and ergonomic approaches has been developed. Early detection, early clinical and ergonomic evaluations, and early active treatment make up the cornerstone of management. Detection of cases starts after four weeks of absence from work. An ergonomic intervention is implemented at six weeks. A medical specialist is involved at eight weeks. If return to work is not possible after 12 weeks, a functional recovery therapy followed by a therapeutic return to work is implemented. A multidisciplinary team decides if return to original or modified work is possible or if vocational rehabilitation is necessary. This model has been implemented by the investigators in the Sherbrooke (Quebec, Canada) area, and is presently being evaluated through a randomised trial in 31 industrial settlements (about 20,000 workers). A cluster randomisation of industries and workers will allow separate testing of ergonomic and clinical interventions.
One year after implementation, 31 of 35 of the eligible industrial sites participated in the study and 79 of 88 of the eligible workers affected by recent back pain had agreed to participate. Ergonomic and clinical interventions have been implemented as planned. Only three workers dropped out. Hence this global clinical and ergonomic management programme has been shown to be feasible in a general population.
A global management programme of back pain joining ergonomic and clinical intervention with a multidisciplinary approach has not been tested yet. Linking these two strategies in a same multidisciplinary team represents a systemic approach to this multifactorial ailment. During the first year of this trial we did not find any conflict between these two interventions from the employer's or worker's point of view.
Health and safety legislation now requires organizations to undertake risk assessments for psychosocial hazards in the workplace. Despite this, there is relatively little guidance on what constitutes a psychosocial risk assessment and how one should be conducted. The approaches that do exist are not without problems. This paper examines some of the difficulties with current approaches and looks at possible areas for development to improve understanding and performance in this important area of health and safety management.
This study measured work limitations and work adjustments among chronically ill employees with regard to three distinct job characteristics: physical work demands, cognitive work demands and social work demands. The study presents findings from an organizational-based survey, from which 610 respondents reported managing employees with a chronic illness. These included arthritis, musculoskeletal pain, diabetes, asthma, migraine, heart disease, irritable bowel syndrome and depression. The results indicate that depression had the largest impact in all three work demand categories, while musculoskeletal pain principally affected physical work demands and migraine and diabetes largely affected cognitive work demands. For other chronic illnesses, it was the generic symptoms of the illness (for example, fatigue) that resulted in a work limitation, rather than the specific nature of the illness itself. Employer work adjustments were available to those people with illnesses that required a physical work adjustment (for example, musculoskeletal pain). For other chronic illnesses, with the exception of depression, disclosing an illness was the strongest predictor for work adjustments in cognitive tasks and the provision of social support. Those with depression were least likely to receive a cognitive work adjustment, indicating either a low disclosure rate in this group or that employers' perceptions of depression may be a barrier to providing suitable work adjustments.
A systematic review was conducted to review the effectiveness of workplace-based return-to-work (RTW) interventions.
Seven databases were searched, in English and French, between January 1990 and December 2003 for peer-reviewed studies of RTW interventions provided at the workplace to workers with work disability associated with musculoskeletal or other pain-related conditions. Methodological quality appraisal and data extraction were conducted by pairs of reviewers.
Of a total of 4124 papers identified by the search, 10 studies were of sufficient quality to be included in the review. There was strong evidence that work disability duration is significantly reduced by work accommodation offers and contact between healthcare provider and workplace; and moderate evidence that it is reduced by interventions which include early contact with worker by workplace, ergonomic work site visits, and presence of a RTW coordinator. For these five intervention components, there was moderate evidence that they reduce costs associated with work disability duration. Evidence for sustainability of these effects was insufficient or limited. Evidence regarding the impact of supernumerary replacements was insufficient. Evidence levels regarding the impact of the intervention components on quality-of-life was insufficient or mixed.
Our systematic review provides the evidence base supporting that workplace-based RTW interventions can reduce work disability duration and associated costs, however the evidence regarding their impact on quality-of-life outcomes was much weaker.
To examine the association of mental and physical disorders with multiple domains of functioning and compare the two.
Data were derived from the European Study of the Epidemiology of Mental Disorders, a general population study in which adults (n > 21,000) from Belgium, France, Germany, Italy, the Netherlands and Spain were assessed using the Composite International Diagnostic Interview (mental disorders), World Health Organization Disability Assessment Schedule second edition (functional disability) and self-report (physical disorders). Means in different groups were compared using the Mann-Whitney U-test and multiple regression analyses.
Mental disorders were related to disability in all domains of functioning: anxiety disorders the most, followed by mood disorders, and finally alcohol disorders. The findings suggest that mental disorders are associated with similar or higher levels of disability in all domains, except getting around, than arthritis and heart disease.
Mental disorders are associated with a similar or higher negative impact on daily functioning than arthritis and heart disease.
To determine the relationship between compensable status in a "no-fault" compensation scheme and long-term outcomes after orthopaedic trauma.
Prospective cohort study within two adult Level 1 trauma centres in Victoria, Australia.
Blunt trauma patients aged 18-64 years, admitted between September 2003 and August 2004 with orthopaedic injuries and funded by the no-fault compensation scheme for transport-related injury, or deemed non-compensable.
12-item Short Form Health Survey (SF-12) and return to work or study at 12 months after injury.
Of 1033 eligible patients, 707 (68.8%) provided follow-up data; 450 compensable and 247 non-compensable patients completed the study. After adjusting for differences across the groups (age, injury severity, head injury status, injury group, and discharge destination) using multivariate analyses, compensable patients were more likely than non-compensable patients to report moderate to severe disability at follow-up for the physical (adjusted odds ratio [AOR], 2.0; 95% CI, 1.3-2.9), and mental (AOR, 1.6; 95% CI, 1.1-2.5) summary scores of the SF-12. Compensable patients were less likely than non-compensable patients to have returned to work or study, even after adjusting for injury severity, age, head injury status and discharge destination (AOR, 0.6; 95% CI, 0.3-0.9).
Patients covered by the no-fault compensation system for transport-related injuries in Victoria had worse outcomes than non-compensable patients.
Poor mental health is responsible for a large percentage of long term work absence, and only 50% of those who are off work for 6 months or more return to work.
We aimed to describe the factors which predict or restrict return to work for people suffering episodes of poor mental health. A literature review was conducted to identify all papers relating to long term mental illness absence.
Fourteen papers of varying methodological quality considered mental health in relation to psychiatric morbidity, depression, stress, and body weight. Successful return to work is predicted by factors related to work, family history, health risk behaviours, social status, and medical condition.
This study identifies a range of factors which are important in preventing return to work for people with mental health conditions. The factors affecting RTW after a period of sickness absence due to poor mental health are wide ranging and in some cases studies have produced opposing results (particularly in the case of demographic factors). Further research is required to describe the factors which delay return to work for people experiencing episodes of poor mental health.
Background:
Workers who suffered a workplace injury and submitted a claim with the compensation board in Ontario often faced economic and non-economic costs that provoked depressive feelings, family strain, financial strain, and feelings of diminished self-worth.
Objective:
This qualitative descriptive study aimed to understand the perceived gaps and failures associated with the support systems (e.g., union, compensation and employer) that were in place to assist some male underground workers in Sudbury, Ontario, Canada who had suffered a workplace injury and had a compensation claim.
Methods:
Twelve in-depth, in-person, individual, semi-structured interviews were conducted and data were transcribed verbatim and anonymized at the time of transcription. Data analysis followed Braun and Clarke's guidelines for thematic analysis.
Results:
Themes that emerged include: unfair and inadequate recognition of an injury; limited communication with stakeholders involved with their claim, including claim adjudicators, challenges when returning to work, and compensation claim system barriers.
Conclusions:
Cooperation, collaboration, knowledge transfer, and decreased power imbalances could help to reduce the economic and non-economic strain felt by a worker with an injury. Additionally, a government-funded third-party advocate who knows the medical system, union contracts, the workers' compensation system, and employer policies and practices could act on behalf of an injured worker.
Patients on sick leave due to work-related stress often present with cognitive complaints. The primary aim of this prospective cohort study was to examine potential long-term consequences of previous ongoing work-related stress in terms of cognitive functioning four years after initial professional care seeking. We tested a group of patients with work-related stress complaints with a comprehensive neuropsychological test battery. Patients were examined at a department of occupational medicine and tested at baseline, one-year follow-up and four-year follow-up. At each time point, we compared the performance of patients with healthy controls matched pairwise on sex, age and length of education. This paper presents the results from the four-year follow-up. Patients improved on their neuropsychological test performance during the four years but the main improvements took place during the first year. At baseline, the main impairments in the patient group concerned executive function and mental speed. At four-year follow-up, patients displayed slightly lower scores on the neuropsychological tests relative to controls but only the difference on immediate memory was significant corresponding to a small effect size (Cohen’s d). More than half of the patients who participated in the four-year follow-up reported that they felt only slightly or partially recovered. The level of work participation among the former patients improved considerably during the four-year follow-up period.
• Lay Summary
• This study examines the long-term consequences of work-related stress in terms of cognitive functioning and recovery four years after initial professional care seeking. After four years, patients continued to display significantly lower memory scores than controls but no other significant differences between the groups were found on neuropsychological tests. Levels of work participation among patients improved considerably over time, yet, more than half of the former patients who participated in the four-year follow-up did not feel completely recovered.
Objective The aim of this scoping review was to map the literature on the lived experiences of injured workers in Australia in order to better understand the factors that inhibit the transition back to work and improved health. The ultimate aim of the study was to identify areas for further research into workers' compensation systems and practices that are associated with improved occupational rehabilitation outcomes.Methods PubMed, ProQuest, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for eligible articles published in English in peer-reviewed journals from 2001 to 2017. Narrative data synthesis was used to analyse the data collected from included articles.Results Twelve articles examining injured workers' experiences within Australian workers' compensation systems were identified. Injured workers reported similar experiences across states and territories in Australia. Four common themes and three subthemes were noted, namely: (1) relationships and interactions; (2) injured workers' perceptions (subthemes: mental health effects, social effects and financial effects); (3) the workers' compensation process; and (4) independent medical evaluations.Conclusions There are common difficulties that injured workers experience within Australian workers' compensation systems that are reported to impede rehabilitation and return to work. A less harmful, more cooperative approach to worker rehabilitation and compensation is needed.What is known about the topic? Different workers' compensation systems exist throughout Australia. Little is known about injured workers' perceptions of their experiences within these systems in Australia and whether these experiences are similar or different across systems.What does this paper add? This scoping review synthesises available evidence showing that injured workers report negative experiences of workers' compensation systems, and that this experience is similar across the different systems. This review also identified a clear need for future research on workers' compensation systems in order to promote evidence-based approaches to best support the occupational rehabilitation of injured workers.What are the implications for practitioners? Evidence suggests a more holistic, biopsychosocial approach is required by practitioners when facilitating an injured worker's recovery and return to work. This approach is also vital when considering legislative reforms, such as workers' compensation systems, processes and practices.
Background:
Little is known about how healthcare providers (HCPs) in Canada manage mental health claims and the return to work (RTW) of injured workersOBJECTIVE:To examine HCPs' experience and challenges on the treatment of mental health conditions (MHCs) in the context of Workers' Compensation (WC) processes and their involvement in RTW.
Methods:
Ninety-seven interviews with HCPs (general practitioners, n = 59; allied HCPs, n = 19; specialists, n = 19) were conducted in British Columbia, Manitoba, Ontario and Newfoundland. A thematic content analysis was used to analyze interviews.
Results:
HCPs reported that while RTW is extolled at virtually all costs by WC boards, they did not always see it as beneficial. Most HCPs were convinced that successful recovery and RTW depend on being aware of how mental and physical health is intertwined and treating both issues. Organizational barriers within WC processes and adversarial relationships between injured workers (IWs) and WC boards made it difficult for HCPs to adequately treat patients and facilitate RTW. Dealing with IWs' MHCs and their emotional distress due to 'going through WC systems' was challenging.
Conclusions:
WC boards must identify how policies can be modified to mitigate compensation processes and RTW for WC claimants with MHC.
Background:
Insurance workers and physiotherapists are important stakeholders in the rehabilitation of workers with an injury and subsequent musculoskeletal pain. Understanding perceptions of roles may facilitate communication between these stakeholders.
Objective:
Increase knowledge around, (i) the self-perception of and (ii) the external perception of the insurance workers and physiotherapists roles in the management of a worker with an injury in an Australian workers' compensation environment.
Methods:
A cross-sectional study assessed the perceptions of insurance workers and physiotherapists related to the roles of these two professions in managing a worker with an injury via questionnaire. Respondents were also asked about potential communication barriers.
Results:
Insurance workers (n = 48) and physiotherapists (n = 80) reported contrasting role perceptions, with their perception of the other profession leaning towards negative attributes. There was greater alignment of their beliefs of roles in the 'ideal' situation. The perception of barriers to communication also differed between the two professions. Effective and efficient communication was identified as a central component of mismatched role perceptions between stakeholders, but recognised as a critical attribute of 'ideal' stakeholder roles.
Conclusion:
Insurance workers and physiotherapists self-perception of their roles differs from external perceptions. This information highlights the importance of a shared understanding of stakeholder roles in the management of a worker with an injury.
Objectives:
The aim of this study was to analyze if notification of an occupational disease increases the risk of work disability.
Methods:
We included 2304 patients examined at the Department of Occupational Medicine, Aarhus University Hospital, 1998-2005 and followed them for two years. A total of 564 patients were notified of an occupational disease when they were examined at baseline and 1740 patients were not. We obtained weekly information on sick payment, unemployment payment, disability pension, rehabilitation benefit, and other social benefits during the two years of follow-up from a national register. Using Cox regression models, we analyzed notification and adjusted hazard ratios (HRadj) of work disability (defined as >12 weeks of social benefits during the first or second year of follow-up).
Results:
Prior to notification, notified patients had higher levels of clinical, occupational, and social characteristics that predict poorer vocational prognosis. Analyses that adjusted for these differences showed an increased risk of work disability following notification for patients who were working when notified at baseline (HRadj 1.46, 95% CI 1.17-1.82). No effect was seen for patients who were not working.
Conclusions:
Notification of an occupational disease may, as an unintended side effect, increase the risk of work disability. A cautious interpretation is warranted because data analyses may not fully have accounted for the poorer vocational prognosis already present at baseline.
Social desirability is one of the most common sources of bias affecting the validity of experimental and survey research findings. From a self-presentational perspective, social desirability can be regarded as the resultant of two separate factors: self-deception and other-deception. Two main modes of coping with social desirability bias are distinguished. The first mode comprises two methods aimed at the detection and measurement of social desirability bias: the use of social desirability scales, and the rating of item desirability. A second category comprises seven methods to prevent or reduce social desirability bias, including the use of forced-choice items, the randomized response technique, the bogus pipeline, self-administration of the questionnaire, the selection of interviewers, and the use of proxy subjects. Not one method was found to excel completely and under all conditions in coping with both other-deceptive and self-deceptive social desirability bias. A combination of prevention and detection methods offers the best choice available.
Background:
Victims who are involved in a compensation processes generally have more health complaints compared to victims who are not involved in a compensation process. Previous research regarding the effect of compensation processes has concentrated on the effect on physical health. This meta-analysis focuses on the effect of compensation processes on mental health.
Method:
Prospective cohort studies addressing compensation and mental health after traffic accidents, occupational accidents or medical errors were identified using PubMed, EMBASE, PsycInfo, CINAHL, and the Cochrane Library. Relevant studies published between January 1966 and 10 June 2011 were selected for inclusion.
Results:
Ten studies were included. The first finding was that the compensation group already had higher mental health complaints at baseline compared to the non-compensation group (standardised mean difference (SMD)=-0.38; 95% confidence interval (CI) -0.66 to -0.10; p=.01). The second finding was that mental health between baseline and post measurement improved less in the compensation group compared to the non-compensation group (SMD=-0.35; 95% CI -0.70 to -0.01; p=.05). However, the quality of evidence was limited, mainly because of low quality study design and heterogeneity.
Discussion:
Being involved in a compensation process is associated with higher mental health complaints but three-quarters of the difference appeared to be already present at baseline. The findings of this study should be interpreted with caution because of the limited quality of evidence. The difference at baseline may be explained by a selection bias or more anger and blame about the accident in the compensation group. The difference between baseline and follow-up may be explained by secondary gain and secondary victimisation. Future research should involve assessment of exposure to compensation processes, should analyse and correct for baseline differences, and could examine the effect of time, compensation scheme design, and claim settlement on (mental) health.
Previous research has documented various psychosocial risk factors with influence on outcome in low back pain (LBP) patients, but the value of clinical predictors has been less well documented.
To identify clinical and psychosocial risk factors at baseline influencing disability and pain at 1 year in LBP patients sick-listed 3 to 16 weeks, and to look for differences between nonspecific LBP and radiculopathy.
Cohort study with 1-year follow-up based on a randomized clinical trial.
Disability and change of disability, pain and change in pain at 1 year.
In a randomized clinical study evaluating multidisciplinary versus brief intervention, 325 patients were followed for 1 year. At baseline, they completed a questionnaire and went through a clinical low back examination, including measure of forward flexion and side flexion as well as tender point examination, a method to estimate diffuse tenderness. Furthermore, degenerative changes on plain X-rays of the lumbar spine were quantified, and sciatica was investigated by magnetic resonance imaging.
Radiculopathy was verified by magnetic resonance imaging in 111 (34%) patients. At 1 year, questions of disability in daily life activities and pain were answered by 60% and 67%, respectively. The intensity of back+leg pain and disability was closely correlated. Statistically significant predictors for both disability and back+leg pain at 1 year were intensity of back+leg pain, worrying and health anxiety, many tender points, and little or moderate exercise in leisure time. Two additional risk factors were identified in patients with radiculopathy: older age and "drinking alcohol less than once per month." Furthermore, disability at 1 year was associated with initial disability and compensation claim, and back+leg pain at 1 year was associated with fear avoidance about physical activity and the duration of pain. Change in disability was more closely associated with return to work than change in pain. Disc degeneration was not associated with disability or pain at 1 year. General health was not statistically significantly associated with outcome when adjusted for back+leg pain, disability, and worrying and health anxiety.
Disability and pain at 1 year were associated with baseline disability and pain, diffuse tenderness, worrying and health anxiety, compensation claim, fear avoidance, and baseline exercise habits. Only in patients with verified nerve root affection, older age, and restrained alcohol seemed to play a role. The multivariate models were insufficient in predicting disability and pain, partly because disability and pain were also strongly associated with return to work.
There is a common perception that injury compensation has a negative impact on health status, and systematic reviews supporting this thesis have been used to influence policy and practice decisions. This study evaluates the quality of the empirical evidence of a negative correlation between injury compensation and health outcomes, based on systematic reviews involving both verifiable and non-verifiable injuries.
Systematic meta-review (a "review of reviews").
PubMED, CINAHL, EMBASE, PEDro, PsycInfo, EconLit, Lexis, ABI/INFORM, The Cochrane Library, and the AHRQ EPC were searched from the date of their inception to August 2008, and hand searches were conducted.
Selection criteria were established a priori. Included systematic reviews examined the impact of compensation on health, involved adults, were published in English and used a range of outcome measures. Two investigators independently applied standard instruments to evaluate the methodological quality of the included reviews. Data on compensation scheme design (i.e., the intervention) and outcome measures were also extracted.
Eleven systematic reviews involving verifiable and non-verifiable injuries met the inclusion criteria. Nine reviews reported an association between compensation and poor health outcomes. All of them were affected by the generally low quality of the primary (observational) research in this field, the heterogeneous nature of compensation laws (schemes) and legal processes for seeking compensation, and the difficulties in measuring compensation in relation to health.
Notwithstanding the limitations of the research in this field, one higher quality review examining a single compensation process and relying on primary studies using health outcome (rather than proxy) measures found strong evidence of no association between litigation and poor health following whiplash, challenging the general belief that legal processes have a negative impact on health status. Moves to alter scheme design and limit access to compensation on the basis that it is "bad for health" are therefore premature, as evidence of such an association is unclear.
To investigate whether poor outcome after spinal pain episodes is linked with the claim process and, if so, whether this link is independent of other potential risk factors of chronic pain and disability in patients with spine-related leg or arm pain.
A 1-year prospective outcome study with internal control groups in two Danish secondary care, public, multidisciplinary, non-surgical spine clinics. Patients with low back pain (LBP) radiating to the leg (n = 1243) or with neck and arm pain thought to emanate from the neck (n = 202) were referred to the clinics by their general practitioners. Rheumatologists, physiotherapists, and nurses examined, treated, and informed the patients based on cognitive principles. Follow-up data were collected with a postal questionnaire. Claim, defined as seeking some sort of financial compensation or filing any sort of financial claim, such as workers' compensation, was the main independent variable. Potential confounders examined were: age, sex, social class, smoking, duration and severity of pain and disability. The main outcome measures were: global assessment (main outcome variable), pain, disability, and intake of analgesics.
Financial claims were registered by 31% of patients. After adjustment for covariates, the odds ratio for claim and no improvement was calculated to be 4.2 (95% CI 2.8-6.2) for the LBP/leg patients and 17.4 (95% CI 5.1-60.1) for the neck/arm patients.
A claim for financial compensation is strongly and independently linked with a poor prognosis for Danish patients with pain radiating from the low-back or neck.
The literature contains many different viewpoints on the impact of compensation on recovery from chronic pain.
What is the role of compensation in chronic pain and/or chronic pain disability?
The literature search identified 11 observational studies to provide evidence about this question.
There is a paucity of high-quality data on the subject of the impact of compensation on chronic pain. This subject was reviewed under the headings of (1) injury claim rate and duration; (2) recovery; and (3) rehabilitation treatment programs. The studies were of subjects with musculoskeletal pain, mainly low back pain.
Filing a compensation claim for costs, retaining a lawyer, or higher pain intensities were limited predictors of longer claims (level 3). As the ratio of compensation to preinjury wage increases, there is moderate evidence (level 2) that the duration of the claim increases and that disability is more likely. Compensation status, particularly combined with higher pain intensities, is associated with poorer prognosis after rehabilitation treatment programs (level 3).
Job loss may be attributed to a number of causes. The medical profession is often involved in counselling or case work when citizens are excluded from work for health reasons. The aim of this study was to identify predictors of health related job loss (HRJL) in a cohort of Danish employees.
A total of 39 workplaces with 5,604 employees aged from 18 to 67 years participated. Questionnaires were obtained at baseline and follow up. Participants reported reason for job loss whilst employers' information provided the date. Hazard Ratios (HR) for HRJL with 95% confidence intervals (CI) were analysed.
4006 responses were obtained at baseline (71.5%), and 3,276 (81.8%) at follow up. About 567 (17.3%) had lost their job, and 135 (23.8%) reported HRJL. 51.5% of HRJL was related to pain, disease, or discomfort in the neck, the back, arms, or legs, and another 23% to stress or stress related symptoms. HRJL involved low reemployment rate compared to non-HRJL. After multiple mutual adjustments, HRJL among females was associated with reports of a work compensation claim within the year previous to baseline (HR 3.0; 95% CI 1.6-5.1), high level of health anxiety (3.7; 2.1-6.6), one or more contacts to the general practitioner in the year previous to baseline (2.2;1.4-3.6), and reported poor leadership quality at work (1.8;1.2-2.9). Among males, HRJL was associated with high levels of health anxiety (2.5; 1.0-6.2) and repetitive work (2.7; 1.4-5.4).
About 4% of employees experienced HRJL, which was associated with care seeking and high levels of health anxiety. Further studies of gender differences in HRJL are warranted.
The Mental Health Impacts of Compensation Claim Assessment Processes
- P A Collie
Handbook of Work Disability - Prevention and Management
- Anema Loisel
Handbook of Return to Work - From Research to Practice
- I Z Schultz
- R J Gatchel
Hvidbog om mentalt helbred, sygefravær og tilbagevenden til arbejde. København: Det Nationale Forskningscenter for Arbejdsmiljø
- V Borg
- M A Nexø
- I V Kolte
- M F Andersen
Psychological damages - a preventive perpective on the legal regulations impact on company’s behavior (Psykisk arbejdsskade - juridiske virkemidler i et forebyggelsesperspektiv med fokus på virksomhedens adfærd)
- Mlb Andersen
Obligatory work environment education fails [Obligatorisk arbejdsmiljøuddannelse svigter det psykiske arbejdsmiljø]
- Ladegaard