Course, diagnosis, and treatment of depressive symptomatology in workers following a workplace injury: a prospective cohort study.
OBJECTIVE
To estimate prevalence, incidence, and course of depressive symptoms and prevalence of mental health treatment following a workplace injury, and to estimate the association between depressive symptoms and return-to-work (RTW) trajectories.


METHODS
In a prospective cohort study, workers filing a lost-time compensation claim for a work-related musculoskeletal disorder of the back or upper extremity were interviewed 1 month (n = 599) and 6 months (n = 430) postinjury. A high level of depressive symptoms was defined as 16 or more on the self-reported Center for Epidemiologic Studies-Depression (CES-D) Scale. The following estimates are reported: prevalence of high depressive symptom levels at 1 and 6 months postinjury; incidence, resolution, and persistence of high depressive symptom levels between 1 and 6 months; and prevalence of self-reported mental health treatment and depression diagnosis at 6 months postinjury.


RESULTS
Prevalence of high depressive symptom levels at 1 month and 6 months postinjury were 42.9% (95% CI 38.9% to 46.9%) and 26.5% (95% CI 22.3% to 30.7%), respectively. Among participants reporting high depressive symptom levels at 1 month postinjury, 47.2% (95% CI 39.9% to 54.5%) experienced a persistence of symptoms 6 months postinjury. By 6 months, 38.6% of workers who never returned to work or had work disability recurrences had high depressive symptom levels, compared with 17.7% of those with a sustained RTW trajectory. At 6-month follow-up, 12.9% (95% CI 5.8% to 20.1%) of participants with persistently high depressive symptom levels self-reported a depression diagnosis since injury and 23.8% (95% CI 14.7% to 32.9%) were receiving depression treatment.


CONCLUSIONS
Depressive symptoms are pervasive in workers with musculoskeletal injuries, but transient for some, and seldom diagnosed as depression or treated.
Franche
Renée-Louise
RL
Occupational Health and Safety Agency for Healthcare in British Columbia, Vancouver, British Columbia. renee-louisef@ohsah.bc.ca
Carnide
Nancy
N
Hogg-Johnson
Sheilah
S
Côté
Pierre
P
Breslin
F Curtis
FC
Bültmann
Ute
U
Severin
Colette N
CN
Krause
Niklas
N
D000062:Accidents, Occupational / Q000523:psychology* / Q000706:statistics & numerical data; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D001134:Arm Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D019567:Back Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D002170:Canada; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D011446:Prospective Studies; D012050:Rehabilitation, Vocational / Q000523:psychology; D013223:Statistics as Topic; D014942:Workers' Compensation
D000928:Antidepressive Agents