Poor interactions with case managers linked with risk of mental illness later on

New Ontario study finds claimants who report poor treatment by case managers face higher risk of serious psychological distress 18 months post-injury

Published: March 9, 2022

Injured workers who report having poor interactions with case managers during their workers’ compensation claims face a higher risk of developing serious or elevated psychological distress later on, according to a recent study by the Institute for Work & Health (IWH).

The study, conducted in Ontario, found Workplace Safety and Insurance Board (WSIB) claimants who said they were not treated politely or with dignity and respect were 3.6 times more likely to develop symptoms of depression and anxiety disorders 18 months post-injury, compared to those who said they were treated well. Claimants who said they were not given the information they needed from their case managers were 2.6 times more likely to develop such symptoms, compared with those who said they received the needed information.

The findings have strong implications for the handling of workers’ compensation claims, says Christa Orchard, research associate at IWH and lead author of the study, published in March 2021 in the Journal of Occupational Rehabilitation (doi: 10.1007/s10926-021-09974-7).

Given the high prevalence of mental illness following physical workplace injuries, it’s important to understand what aspects of the claims process can be improved, she adds. While parties may disagree over the outcome of a claim, the quality of case manager interactions is one thing that compensation systems can change, through policies and training programs.

The study findings dovetailed with those of another IWH study conducted in the Australian state of Victoria, of which Orchard was also the lead author. Both examined case manager interactions along two dimensions: the quality of the interpersonal interaction (as measured by questions about being treated with respect and dignity), and the quality of the information received (as measured by questions about getting needed information in a timely manner).

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Like the earlier study, this Ontario study also found a large majority of claimants (an average of 82 per cent) reported positive interpersonal interactions with their case managers. However, the risk of mental illness among the minority who did not report positive interactions was substantial, justifying efforts to improve on this front, notes Orchard.

A smaller majority of claimants (about 66 per cent) reported adequate communication of information from their case manager. The impact of inadequate information may be smaller, but it’s more commonly reported by claimants. This makes it an important target area for improvement as well, adds Orchard.

Unlike the Victoria study, the Ontario study was able to account for a mental health diagnosis before the work-related injury or illness. As such, this is the first study we know of that establishes a link between case manager communications and elevated psychological distress, independent of poor mental health prior to the injury or illness, says Orchard.

How the study was conducted

The study was conducted as part of a larger IWH study, called the Ontario Life After Work Injury Study (OLAWIS), set up to follow about 1,100 WSIB claimants for three years after a work injury or illness. Although most WSIB claimants (86 per cent) typically return to work within three months, the research team focused its recruitment efforts on injured workers with longer claims. The study sample consisted of three similar-sized groups: those with short-term claims (between five days and three months), those with medium-duration claims (of three to 12 months) and those who continued to receive services from the WSIB 12 to 18 months following injury. Only claimants with a work-related physical injury or illness—not psychological illness—were eligible to take part.

See other findings from the project

In interviews conducted 18 months after their injury or illness, study participants were asked about a wide range of topics, including return-to-work and work status, sources of income, function, recovery, interactions with case managers and health-care providers, and workplace accommodations provided. To assess mental health, the survey asked claimants how often in the previous four weeks they experienced six symptoms associated with psychological distress (i.e. feeling nervous, hopeless, restless, worthless, so depressed that nothing cheers them up and like everything is an effort). These questions came from the Kessler psychological distress scale, which provides a five-point range for each item—from 0 for none of the time to 4 for all of the time. The Kessler scale considers a total score of 13 or more as indication of a elevated psychological distress, a cutoff that has been validated against gold-standard diagnostic measures used to detect anxiety and depressive disorders.

With respect to interactions with case managers, claimants were asked to indicate, on a five-point scale, the degree to which they agreed or disagreed with seven statements.

The first two statements were related to the interpersonal quality of their communications with case managers, and the last five related to the quality of the information communicated to them. Participants were asked whether their case managers:

  • treated them in a polite manner;
  • treated them with respect and dignity;
  • provided the information needed;
  • were open and truthful in communications;
  • explained the return-to-work process carefully and completely;
  • communicated details at appropriate times; and
  • understood their individual needs.

Results showed 16 per cent of study participants had met the Kessler criteria for elevated psychological distress at the time of the interview. Of this group, more than half had received a mental health diagnosis from a physician or other professional; 15 per cent were diagnosed pre-injury and 39 per cent were diagnosed post-injury.

About 14 per cent of claimants gave their case manager interactions low scores with regard to the quality of information received. In terms of being treated with dignity and respect, nine per cent of claimants had low perceptions of their case managers and 44 per cent had moderate perceptions of their case managers.