Psychological morbidity and return to work after injury: findings from a multicentre cohort study
Being in work benefits physical and mental health, while being out of work can have financial, physical and psychological consequences. Injuries are common in working age-adults with 319,000 16-69 year olds admitted to hospital with traumatic injuries or poisoning in England in 2015. The annual NHS costs of care in the first year after such injuries is estimated at £1.53 billion. Many injuries result in a delayed return to work (RTW), and psychological morbidity may contribute to this. To date, the impact of psychological morbidity on RTW after a wide range of unintentional injuries in the UK has not been adequately quantified.
The study objective was to quantify the impact of psychological morbidity early in the recovery period (including anxiety, depression and post-traumatic distress) on RTW following unintentional injuries. A longitudinal multi-centre prospective study was undertaken in Nottingham, Bristol, Leicester and Guildford, UK. Participants were 16-69 year olds admitted to hospital following unintentional injury and in paid employment prior to injury. They were surveyed at baseline, 1, 2, 4 and 12 months following injury on demographic and injury characteristics, psychological morbidity and RTW status. Associations between demographic and injury characteristics (at baseline) and psychological factors (one month post-injury) and RTW were quantified using random effects logistic regression.
393 study participants were employed prior to injury; 273 (69%) returned 1 month questionnaires and at least one subsequent questionnaire and formed the sample for this study. Just over half the participants (53%) were aged 45-64 and 52% were male; 66% had a moderately severe injury; 43% reported single injuries; 62% had a lower limb injury; most injuries occurred at work (30%), sports facilities (15%), at home or the countryside (14% each) and were most frequently caused by falls (58%) or traffic injuries (23%). Few (13%) participants RTW at 1 month, 23% RTW at 2 months, 52% at 4 months, and two thirds at 12 months (67%). The odds of RTW reduced as depression scores one month post-injury increased (OR 0.87, 95%CI 0.79, 0.95) and as length of hospital stay increased (OR 0.91, 95%CI 0.86, 0.96). Those experiencing threatening life events following injury (OR 0.27, 95%CI 0.10, 0.72) and with higher scores on the crisis social support scale (OR 0.93, 95%CI 0.88, 0.99) had a lower odds of RTW. Multiple imputation analysis found similar results except crisis social support did not remain significant.
Depression occurring early in the recovery period, threatening life events after the injury and a longer stay in hospital significantly reduce the odds of RTW in the first year after injury. Primary care professionals can use these factors to identify patients at risk of delayed RTW, detect and manage psychological morbidity and provide support to RTW.