Getting back on the horse: Return to work has beneficial effect on health

Returning to work after an injury is good for people, both physically and mentally, according to a new systematic review.

Published: April 23, 2012

Getting back to work after an injury or illness can improve the health of workers, says a recent systematic review—just the ticket for return-to-work programs.

This systematic review is a rigorous study that fills an important gap and provides key evidence to support return-to-work programs, says Institute for Work & Health President and Senior Scientist Dr. Cameron Mustard, who was on the committee that supervised this research. The research was led by Dr. Sergio Rueda, scientist and director of Health Research Initiatives at the Ontario HIV Treatment Network.

Which comes first: Good health or employment status?

Most research to date has focused on the chicken-egg question of which comes first: good health or employment status. One theory says that employment leads to health benefits, while another says that health shapes people’s employment status. (Likely, both mechanisms reinforce each other.) Considerably less research has explored the impact of return to work (RTW) on health.

That’s where this systematic review comes in, the aim of which was to review the literature on the effects of gaining or returning to employment on the health of working-age adults. Researchers combed six electronic databases looking for controlled trials, cohort studies and case-control studies that documented a transition from unemployment to employment and included a comparison group. A total of 18 studies met inclusion criteria, including one randomized controlled trial.

Studies tell unified story of health benefits

The studies that met the criteria varied in population and setting. Sixteen of the 18 studies examined mental health outcomes, including depression, anxiety and substance use, while five studies also included physical health outcomes. Some focused on women, others on men, the elderly, people with mental illness, people with HIV, refugees and the unemployed.

But despite the variety, the vast majority of these studies told a single, cohesive story: the health benefits of returning to employment.

Fifteen of the 18 studies demonstrated a beneficial effect of RTW on health, either showing a significant improvement in health after re-employment or a significant decline in health attributed to continued unemployment. The overall weight of the RTW/health benefits link was “moderate evidence,” according to the review. Researchers also found evidence that poor health interferes with people’s ability to go back to work, as well as some evidence suggesting that earlier re-employment may be associated with better health.

Although researchers were unable to figure out the underlying connection between RTW and health, this doesn’t worry them. The absence of proof on causality seems inconsequential, says Rueda. The final aim of research shouldn’t be to find a unique and ultimate cause when it comes to social determinants of health. We would expect that a web of causation is more likely where multiple factors interact. These findings resonate with the IWH Issue Briefing on unemployment and mental health, released in August 2009 (see:

This research was published in the March 2012 issue of the American Journal of Public Health (vol. 102, no. 3).