Workers with a physical injury on the job represent a segment of our workforce that is vulnerable to experiencing poor mental health. On top of the physically disabling injury, they may experience pain, financial worries, difficulty performing their social roles, and social disconnection, while they are away from work—all of which may potentially impact their mental health.
An Institute for Work & Health (IWH) study has found, the risks of poor mental health among injured workers run beyond the risks of diagnosed conditions. The study examined the mental health of a group of Ontario injured workers who required time away from work—both through the lens of mental disorders and psychological wellbeing.
It found poorer return-to-work outcomes—such as longer disability claim times—not only among injured workers with a diagnosed condition such as depression or anxiety, but also among injured workers who felt poorly in their emotional wellbeing, their sense of social belonging and other dimensions of psychological wellbeing.
The absence of a mental illness alone doesn’t necessarily mean someone is happy and flourishing,
says Dr. Kathleen Dobson, IWH associate scientist and lead on the study, which has been published in the Journal of Occupational Rehabilitation (doi:10.1007/s10926-024-10254-3).
Other aspects like people’s emotional states, their outlook on life and their social circles can have a positive or negative impact on their overall mental health,
says Dobson. Viewing mental health as a combination of mental illness and mental wellbeing can help us learn about different experiences, and how these experiences may impact injured workers’ ability to work,
adds Dobson, noting that the study draws on a concept called the dual continuum model of mental health
.
The study was based on a sample of Ontario workers interviewed 18 months after a work-related injury. It found that on indicators including social, psychological and emotional wellbeing, 14 per cent reported the lowest levels of mental wellbeing—what the researchers call languishing
mental health. Another 25 per cent scored moderately, and 61 per cent scored the highest—what the researchers call flourishing
mental health.
The good news is that a large proportion of workers in our study reported flourishing or moderate wellbeing after their injury,
says Dobson. These groups had fairly positive responses to questions about whether they were happy, interested in life, felt calm and peaceful, or felt a sense of belonging to their community.
But among the 18 per cent of injured workers reporting a mental illness, 50 to 60 per cent also had languishing mental wellbeing. For this group, the study found heightened return-to-work challenges, with these workers being more likely to:
- report financial difficulties during their disability claim
- have other health conditions, and
- have longer and more expensive loss of earning disability claims
By studying mental illness and mental well being more generally, we can try to tailor supports to what injured workers need,
says Dobson. For the injured workers who have mental illness diagnoses, providing access to resources for things like therapy or medication coverage could be very helpful, she explains.
But there are injured workers without a diagnosed condition who have low mental wellbeing. These workers are also facing more challenges returning to work than those with generally good mental health,
notes Dobson. She adds that more research is needed on targeted return-to-work interventions to improve the overall emotional well-being of injured workers.
Identifying different mental health experiences
The research team interviewed 1,132 Ontario workers with a physical work-related injury or illness about their mental health 18 months after the injury occurred. This group of workers was part of an existing study group called the Ontario Life After Work Injury Study (OLAWIS) cohort, who had a physical work injury or illness and received lost-time claim benefits from the Workplace Safety and Insurance Board.
Participants were asked about whether they had a mood (e.g., depression) or anxiety disorder diagnosed before or after their injury occurred—these are the mental health conditions most commonly seen among adults. They were also asked about other aspects of their mental health including self-rated overall mental health, emotional wellbeing (happiness, interest in life and life satisfaction), psychological wellbeing (feeling peaceful, having lots of energy and feeling downhearted or depressed), and social wellbeing or sense of belonging.
The researchers then used a statistical technique called latent profile analysis to find different subgroups within the sample that responded similarly on mental illness questions and wellbeing questions in the survey. They found four distinct profiles of mental illness, and three profiles of mental wellbeing.
Mental illness classes:
- Class 1 (eight per cent): Highest prevalence of mental illness after the injury
- Class 2 (10 per cent): Highest prevalence of mental illness before the injury
- Classes 3 and 4 (82 per cent): Low prevalence of mental illness
Mental wellbeing classes:
- Class 1 (14 per cent): Languishing, or poor mental wellbeing
- Class 2 (25 per cent): Moderate mental wellbeing
- Class 3 (61 per cent): Flourishing, or good mental wellbeing
The researchers also examined how mental wellbeing scores overlapped with mental illness diagnoses. Many of the individuals in the groups with high prevalence of mental illness diagnoses before or after their injury reported the poorest levels of mental wellbeing, but many also reported moderate mental wellbeing. Most, but not all, of those with a low prevalence of mental illness reported good mental wellbeing.
Return-to-work differences between groups
The study found differences in symptoms and return-to-work outcomes between mental illness classes:
- The group with the highest prevalence of post-injury mental illness diagnosis were almost twice as likely to report having financial concerns during their claim compared to those with a low prevalence of mental illness.
- The groups with the highest level of mental illness symptoms before or after a work injury reported more trouble sleeping, pain, migraines and opioid use.
The study also found differences between mental wellbeing classes. Compared to the moderate and flourishing mental wellbeing groups, the languishing group was:
- 1.2 times more likely to report financial concerns during their disability claim
- 1.7 times less likely to have returned to work 18 months after their injury
- 1.3 times more likely to still be receiving healthcare for their injury 18 months after their injury
- 1.3 times more likely to report high pain interference
- 1.5 times more likely to report using an oxycodone product in the past year
We found distinct mental health profiles in our study, which suggests that injured workers’ mental health isn’t a ‘one-size-fits-all’. This is important to recognize as we saw that even if an injured worker did not have a diagnosed mental health condition, their mental wellbeing was linked to the duration and cost of their disability claim,
says Dobson.