Psychosocial conditions after occupational injury

Transcription

1 Psychosocial conditions after occupational injury Leon Guo, Judith Shiao, Weishan Chin National Institute of Environmental Health Sciences, NHRI, Taiwan EOM, National Taiwan University and NTU Hospital Nursing, NTU and NTU Hospital

2 Estimated work related injury in the world Prof. Takala, President International Commission of Occupational Health (ICOH) (3.0%) (18.5%) (2.8%) (12.2%) (8.5%) (13.5%) (13.5%) (10.6%) ~300 M out of ~3,000 M workers are injured per year (10.6%) (Takala et al., Journal of Occupational and Environmental Hygiene 2014)

3 A worker suffered from crushing injury due to collapse of soil while working underground: LeFort II and LeFort III facial bone fracture, months after the injury, posttraumatic stress disorder (PTSD) and major depression were diagnosed by psychiatrists Cannot go back to work due to fear Compensated for 15 days of hospitalization, and 30 days off work NOT compensated for treatments for mental diseases (not considered occupational) Lost his job because unable to return-towork PTSD in DSM5: Emotional distress after exposure to traumatic reminders

4 Follow-up study OI in 2009 N=4,403 3 months Psychological symptoms Return to work 12 months Psychological symptoms Return to work 6 years Psychological symptoms Work condition Quality of life

5 3 months after OI 12 months after OI 6 years after OI Injured workers hospitalized for 3 days or longer, Feb 1 ~ Aug 31, 2009 Injured workers who completed the questionnaire survey in 2009 Tier 1 Brief symptoms Rating Scale (BSRS) 50, posttraumatic Symptom Checklist (PTSC) High score in BSRS or PTSC Brief symptoms Rating Scale (BSRS) 5, posttraumatic Symptom Checklist (PTSC) WHO Quality of life (WHOQoL) High score in BSRS or PTSC Tier 2 Mini International Neuropsychiatric Interview (MINI) Mini International Neuropsychiatric Interview (MINI) Estimated % of psychiatric conditions Estimated % of psychiatric conditions 5

6 Psychiatric conditions at 3 months, 12 months, and 6 years after occupational injury 3mo 12 mo 6yr Taiwan survey Major depression 3.0% 2.0% 9.2% 1.2% PTSD or partial PTSD 6.8% 5.1% 7.2% Anxiety disorder 6.9% Alcohol dependence or abuse 5.4% Social phobia 2.9% (Lin et al. J Occup Health 2012; Lin et al. J Occup Rehabil 2013; Liao et al., Psychological Medicine 2012) 6

7 Policy impact Psychiatric disorders after occupational injury were included into compensable occupational diseases in late 2009 Ministry of Labor support screening and early intervention in injured workers seen in any occupational health clinic 7

8 Psychiatric conditions at 3 months, 12 months, and 6 years after occupational injury 3mo 12 mo 6yr Taiwan survey Major depression 3.0% 2.0% 9.2% 1.2% PTSD or partial PTSD 6.8% 5.1% 7.2% Anxiety disorder 6.9% Alcohol dependence or abuse 5.4% Social phobia 2.9% (Lin et al. J Occup Health 2012; Lin et al. J Occup Rehabil 2013; Liao et al., Psychological Medicine 2012; Chin et al., Eur Arch Psychiat Clin Neurosci 2017) 8

9 Psychiatric conditions after occupational injury adding suicidality 3mo 12 mo 6yr Taiwan survey Major depression 3.0% 2.0% 9.2% 1.2% PTSD or partial PTSD 6.8% 5.1% 7.2% Anxiety disorder 6.9% Alcohol dependence or abuse 5.4% Social phobia 2.9% Suicidality 5.6% 5.9% 10.2% (Chin et al., J Clin Psychiat, accepted) 9

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11 Occupational Injury Raises Long Term Suicidality Risk, Study Finds Thursday, September 6, 2018 Occupational injury, particularly an injury which leaves workers severely harmed or results in work instability, may increase the long term risk of suicidality, according to study in the Journal of Clinical Psychiatry. For the study, Wei Shan Chin, Ph.D., a postdoctoral research fellow at the National Institute of Environmental Health Sciences in Taiwan, and colleagues recruited workers from Taiwan who sustained occupational injuries requiring hospitalization for three days or longer. Some 2,300 workers responded to questionnaires sent by mail at three months and 12 months after the injury; the questionnaires collected information on the workers demographics, work instability, injury severity, psychological symptoms (Brief Symptom Rating Scale [BSRS 5] and the Posttraumatic Symptom Checklist [PTSC]), and suicidal ideation. Workers with a high score on the BSRS 5 or PTSC were asked to take an in depth psychiatric evaluation administered by psychiatrists or trained nurses who used a structured clinical interview (a Chinese version of the Mini International Neuropsychiatric Interview [MINI]). Six years later, 1,715 of these workers completed a similar assessment. The estimated MINI diagnosed suicidality rates were 5.4%, 4.8%, and 9.5% at three months, 12 months, and six years after occupational injury, respectively, the authors reported. At six years, participants with an injury that had a major negative impact on their physical appearance had a 1.7 times greater risk of suicidal ideation; those with unstable employment had a 1.5 times greater risk; and those with reduced income within the past year compared with before the injury had a 1.6 higher risk. These results suggest that suicidality does not improve with time but remains a vital issue after occupational injury, the

12 PTSD among residents after Chi Chi earthquake, 1999, Taiwan % PTSD 20 Different! month (Chen et al., 1999; Hsu et al., 2004; Kuo et al., 2003; Yang et al., 2003; Chang et al., 2003; Chou et al., 2005; Lai et al., 2004; Chang et al., 2004; Wu et al., 2006) 12

13 Although many cases remit within months, PTSD symptoms typically are quite persistent WHO Mental Health Surveys in 24 countries (n = 68,894) (Kessler et al., European Journal of Psychotraumatology 2017) 13

14 Chronic Probable PTSD in Police Responders in the World Trade Center Health Registry Years After 9/11 Half of police with probable PTSD in continued to have probable PTSD in Women had higher prevalence of PTSD than men (15.5% vs. 10.3%, P=0.008). Risk factors: decreased social support unemployment 2+ life stressors in last 12 months 2+ life-threatening events since 9/11 2+ injuries during the 9/11 attacks unmet mental health needs. (Cone et al., Am J Ind Med 2015) 14

15 Depression as a psychosocial consequence of occupational injury in the US working population 4 5 mo after an injury 8 10 mo after an injury mo after an injury (Kim, BMC public health, 2013)

16 Diagnosed Chronic Health Conditions Comparing Injured Workers to CCHS Respondents (Reference Group), Canada (~4 yr) (Casey and Ballantyne, JOEM 2017)

17 The authors views: (Casey and Ballantyne, JOEM 2017) Navigating the compensation system and fighting for the right to a claim could result in increased stress and depression among injured workers, suggesting that dealing with an adversarial compensation system may account for increases in stress and depression that is reported by some injured workers. (Lippel 2007; Storey 2009) Depression is common for individuals who report musculoskeletal pain a common outcome of workplace injury. (Alcantara et al., 2013)

18 Whom should we be worried about? Identifying risk factors will allow identifying susceptible people, for early intervention and prevention of poor outcomes 18

19 Mental conditions 3 months after occupational trauma, Taiwan Mental condition % PTSD 2.7% partial PTSD 4.1% major depression 3.0% PTSD/PPTSD and major depression 2.3% PTSD/PPTSD or major depression 7.5% (Lin et al., JOH 2012) PTSD/PPTSD or major depression Nature of trauma % intracranial injury 10.4% fracture 6.9% burn 5.9% crushing injury 5.8% open wound of upper limbs 0%

20 Mental conditions 12 months after occupational trauma, Taiwan Mental condition % PTSD 3.2% partial PTSD 1.9% major depression 2.0% PTSD/PPTSD and major depression 2.0% PTSD/PPTSD or major depression 5.1% (Lin et al., 2014) PTSD/PPTSD or major depression Nature of trauma % intracranial injury 9.6% burn 7.4% fracture 4.8% open wound of 1.6% upper limbs crushing injury 0%

21 Factors psychological symptoms scores, 6 yr after OI Family condition Injury severity Job status (Chin et al., Eur Arch Psychiatry Clin Neurosci 2016)

22 Adjusted RR for suicidal ideation at different time point Factors 3 months 6 years Marriage, Divorced/separated/widowed vs. 2.4 ** ( ) others Injury type, intracranial vs. others 2.0 ** ( ) Self-rated injury severity, serious vs. less 1.9 ** ( ) Hospital stay, 8 days vs. <8 days 1.5 * ( ) Change in physical appearance, major vs. 1.8 ** ( ) 1.7 ** ( ) others Additional OI vs. no 1.4 * ( ) Employment status, unstable vs. 1.5 * ( ) stable/retired Reduced salary vs. unreduced 1.6 ** ( ) (Kuo et al., J Psychiat Res 2012; Chin et al., J Clin Psychiat 2018)

23 Non_injury DAFW NDAFW DAFW: days away from work National Longitudinal Survey of Youth, 1979 cohort (n=12,686) by the U.S. Bureau of Labor Statistics ( Dong et al., American Journal of Industrial Medicine, 2016 )

24 What likely happened? Lost wages and disability following injury contributed to income loss for injured workers (Dong et al., 2016) Some injured workers had lowered capability of work after OI, and had to take lower wages, or whatever is available (observed in clinical patients)

25 Salary compared to that before OI, among those currently employed, yr after OI (Chin et al., in preparation)

26 Do psychosocial conditions after OI affect work capability?

27 With higher GSI score of BSRS 50 (more severe symptoms), injured workers were less likely return to work 0.80 likely RTW compared to those with less severe symptoms, adjusted for gender, age, education, total hospital days, and affected physical appearance (Lin et al., J Occup Rehabil 2013) 27

28 Injured workers with higher GSI score of BSRS 5 (more severe symptoms) with 1 yr after injury were less likely return to work 0.70 likely RTW compared to those with less severe symptoms, adjusted for gender, age, education, total hospital days, and affected physical appearance (Chu et al.,submitted)

29 A vicious cycle The injured workers with more psychological/psychiatric problems had more difficulty in return to work Those who did not return to work became more prone to psychological conditions

30 Looks like People who are injured had higher risk of having psychiatric diseases People who are injured at work (probably) had even higher risk of having psychiatric diseases

31 Some bottom lines

32 ILO List of occupational diseases (revised 2010) 2. Occupational diseases by target organ systems 2.1. Respiratory diseases 2.2. Skin diseases 2.3. Musculoskeletal disorders 2.4. Mental and behavioural disorders Post-traumatic stress disorder Other mental or behavioural disorders not mentioned in the preceding item where a direct link is established scientifically, or determined by methods appropriate to national conditions and practice, between the exposure to risk factors arising from work activities and the mental and behavioural disorder(s) contracted by the worker. Psychiatric diseases after OI are not clearly included, especially major depression

33 DALY (disability adjusted life years) loss due to occupational injuries 21.9 M globally in M globally in 2016 Basically unchanged! (GBD 2016 Risk Factors Collaborators. Lancet 2017)

34 Estimated work related injury in the world Prof. Takala, President International Commission of Occupational Health (ICOH) (3.0%) (18.5%) (2.8%) (12.2%) (8.5%) (13.5%) (13.5%) (10.6%) ~300 M out of ~3,000 M workers are injured per year (10.6%) A few M will suffer from psychiatric diseases after OI (Takala et al., Journal of Occupational and Environmental Hygiene 2014)

35 Global DALYs attributable to Level 2 risk factors for men in 2015 (DALYs=disability adjusted life years) (GBD 2015 Risk Factors Collaborators, Lancet 2016)

36 Global DALYs attributable to Level 2 risk factors for women in 2015 (DALYs=disability adjusted life years) (GBD 2015 Risk Factors Collaborators, Lancet 2016)

37 Recommendations For countries where psychiatric diseases are not compensable as occupational diseases establish PTSD/major depression (and other diseases) as compensable diseases after OI Adding psychiatric diseases into occupational risks in the estimate of global burden of diseases Strategy for identifying high risk workers for psychiatric diseases, early detecting the conditions, and preventing psychiatric conditions after OI Longer term assessment and care of psychiatric and psychological conditions after OI Primary prevention against OI is still needed, and cannot be overly emphasized!

38 Acknowledgment Dr. WS Chin, Dr. Judith Shiao, Dr. SC Liao, Dr. Tammy Lin, Dr. NW Guo, Dr. CY Kuo, Dr. SC Pan, Grants: Institute of Occupational Safety and Health, Taiwan (IOSH98 M315) Ministry of Science and Technology, Taiwan (MOST B )