Poorer post-injury experiences lead to worse RTW outcomes for psychological claimants

IWH’s 12-month follow-up study of injured workers in Australia found many interconnected differences in return-to-work process for physical and psychological claimants

Published: February 26, 2020

Workers disabled by work-related psychological injuries have less desirable return-to-work (RTW) experiences than workers with musculoskeletal disorders (MSDs), and these experiences are associated with poorer RTW outcomes during their first eight to 11 months on workers’ compensation leave, according to a study by researchers at the Institute for Work & Health (IWH). What’s more, the study shows, these poorer experiences are interconnected.

We observed different self-reported experiences at the personal, workplace, health-care provider and workers’ compensation levels, which suggests approaches to address differences in RTW for psychological and musculoskeletal conditions need to be integrated, says Dr. Peter Smith, a senior scientist and scientific co-director at the Institute and study lead author.

As reported in a previous article based on early findings from this same study, workers’ compensation claimants with psychological injuries have lower expectations than claimants with MSDs that they will return to their previous jobs. They’re also less likely to be contacted by their workplace’s RTW coordinator, to be offered modified duties and to accept modified duties. They face more negative reactions in response to their injury from supervisors and co-workers, and experience more stressful interactions with health-care providers, RTW coordinators and workers’ compensation case managers.

Now, further analysis of these findings shows that many of the differences are interconnected—that is, one is associated with another. Notably, supervisors’ reactions to injury are associated with several other experiences in the RTW process that also affect outcomes. We found that claimants with psychological injuries were much less likely to receive a positive supervisor response to their injury, says Smith.

This poor response was also associated with more stressful interactions with claim agents or case managers, lower likelihood of having consultative return-to-work plans or modified duties, and less positive recovery expectations. Overall, these factors were associated with a reduced likelihood of sustained return to work within six months.

The study was based on a group of 869 workers’ compensation claimants in the Australian state of Victoria, where chronic work-related mental stress is recognized as a compensable injury. The study sample was recruited such that one-fifth of the claimants had psychological injuries; the remainder had MSDs of the back or upper extremities. The claimants were interviewed three times over a 12-month period. The first interview took place about two to five months after their first day off work. The second and third interviews were conducted at six months and 12 months, respectively, after the initial interview.

The claimants in the study were asked about a broad range of factors in four areas: personal (recovery expectations and mental health status in the previous month); workplace (supervisor reaction to injury, co-worker reaction to injury, workplace offers of modified duty and/or consultative RTW plan); health care (contact between providers and the workplace); and workers’ compensation system (interactions with case managers). They were also asked about attempted or sustained work returns. (Sustained RTW was defined as being back at work for 28 days or more.)

The findings revealed that, at the first interview two to five months after the injury, claimants with MSDs were 69 per cent more likely than psychological claimants to have a sustained return to work. At the second interview six months later, MSD claimants were 24 per cent more likely to have a sustained RTW. At the third interview a year after the first, no difference remained between psychological and MSD claimants with respect to their return to work.

That says to us that, if you’re trying to reduce the inequalities in the return-to-work outcomes of psychological and MSD claimants, you should act early, says Smith. The further you get post-injury, the less it matters what type of injury the respondent has. Rather, what matters more is whether the respondent has been able to make a return-to-work attempt, and how successful that attempt was, says Smith.

According to the study, three factors explain much of the difference in RTW outcomes among claimants with psychological injuries compared to those with MSDs: their poorer mental health symptoms, greater likelihood of lacking a consultative RTW plan or being offered modified duties, and poorer supervisor responses to injury.

While treating and preventing further exacerbation of mental health symptoms should remain an important part of the rehabilitation process for claimants with psychological injuries, other modifiable factors—in particular, supervisor response to injury and consultative RTW planning and modified duties—account for a sizeable proportion of differences in sustained RTW across injury types, says Smith.

Our study suggests these should be prioritized to reduce inequalities in return to work for psychological injuries compared to MSDs.

One of the unique things about this study is that it examined how factors in the RTW process relate to each other. In that context, we did see that a positive supervisor response is itself related to a number of key factors, such as mental health symptoms and offer of modified duties, says Smith.

Yet he cautions against interventions that focus singularly on supervisors’ response to injury. A supervisor’s reaction to an injury is likely shaped by the same workplace culture that gave rise to a worker’s psychological injury to begin with, he notes.

The study has been published in February 2020 in the journal Social Psychiatry and Psychiatric Epidemiology (doi: 10.1007/s00127-020-01839-3).