Access to mental health treatment among workers with physical injuries

• In a sample of 600 workers’ compensation claimants with musculoskeletal injuries in Victoria, Australia, one in three experienced a serious mental illness, yet only 40 per cent of them accessed mental health services.
• Claimants who had returned to work and older claimants were less likely to access mental health services.

Research evidence shows that people who are physically injured at work are also prone to experiencing mental health problems. A previous study in Ontario shows that only one in three workers’ compensation claimants with musculoskeletal injuries who also experience depressive symptoms get treatment for their mental health issues in the first year after injury. In the general population, research has shown that men, people with low socioeconomic status, and those who are married, older or a visible minority are more likely to have mental health symptoms that go untreated.

A group of nearly 900 workers’ compensation claimants in the Australian state of Victoria 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.

This study focused on the subset of 678 claimants who had a musculoskeletal disorder (MSD) of the back or upper extremities. Participants were asked about a broad range of personal and post-injury factors and experiences.

This analysis focused on participants’ responses to questions about their mental health, as measured by the six-item Kessler Screening Scale for Psychological Distress. (In each of the three interviews, participants were asked how often in the previous 30 days they felt nervous, hopeless, restless, worthless, so depressed that nothing cheers them up and like everything is an effort.) According to this scale, participants who scored 13 (out of a possible 24) were considered to have a serious mental health issue. The study team also drew on WorkSafe Victoria’s administrative data to determine participants’ use of mental health services (i.e. psychological counselling, psychiatry services, anti-depressant medication and anxiety-reducing medication).

About 30 per cent of the MSD claimants had a serious mental issue at any one point. Of these, only 40 per cent had accessed a mental health service during the study’s 18-month timeframe. Older participants were less likely to get treatment. Participants who had returned to work for 28 days or more were also less likely (by 27 per cent) to get treatment. Respondents who were born in Australia were more than twice as likely as immigrants to access mental health services; however, due to the small number of immigrants in the sample, this estimate was imprecise. No statistically significant link was found for the other factors examined, including sex, hourly wage, injury severity, quality of interaction with claim agent or case manager, or quality of interaction with health-care provider.

A substantial proportion of workers with compensation claims for a work-related musculoskeletal injury also experience a serious mental condition. However, a minority of these workers receive treatment for their mental health conditions. More research is needed to understand why. The findings suggest a need for better mental health screening, referral and treatment for injured workers.

A strength of this study was its long follow-up time. Another was its use of administrative data as a source of information about injured workers’ access to mental health services. A weakness of this study was the lack of information about participants’ use of mental health services outside of the workers’ compensation system or prior to the work-related injury. Another weakness was its small sample size.