Compensation seeking and disability after injury: the role of compensation-related stress and mental health.
OBJECTIVE
Claiming for compensation after injury is associated with poor health outcomes. This study examined the degree to which compensation-related stress predicts long-term disability and the mental health factors that contribute to this relationship.


METHODS
In a longitudinal, multisite cohort study, 332 injury patients (who claimed for compensation) recruited from April 2004 to February 2006 were assessed during hospitalization and at 3 and 72 months after injury. Posttraumatic stress, depression, and anxiety symptoms (using the Mini-International Neuropsychiatric Interview) were assessed at 3 months; compensation-related stress and disability levels (using the World Health Organization Disability Assessment Schedule II) were assessed at 72 months.


RESULTS
A significant direct relationship was found between levels of compensation-related stress and levels of long-term disability (β = 0.35, P < .001). Three-month posttraumatic stress symptoms had a significant relationship with compensation-related stress (β = 0.29, P < .001) as did 3-month depression symptoms (β = 0.39, P < .001), but 3-month anxiety symptoms did not. A significant indirect relationship was found for posttraumatic stress symptoms and disability via compensation stress (β = 0.099, P = .001) and for depression and disability via compensation stress (β = 0.136, P < .001).


CONCLUSIONS
Stress associated with seeking compensation is significantly related to long-term disability. Posttraumatic stress and depression symptoms increase the perception of stress associated with the claims process, which in turn is related to higher levels of long-term disability. Early interventions targeting those at risk for compensation-related stress may decrease long-term costs for compensation schemes.
Australian Centre for Posttraumatic Mental Health, Level 3, Alan Gilbert St, 161 Barry St, Carlton, VIC, 3053, Australia mod@unimelb.edu.au.
Meaghan L
ML
O'Donnell
Genevieve
G
Grant
Nathan
N
Alkemade
Matthew
M
Spittal
Mark
M
Creamer
Derrick
D
Silove
Alexander
A
McFarlane
Richard A
RA
Bryant
David
D
Forbes
David M
DM
Studdert
D000328:Adult; D001007:Anxiety / Q000523:psychology; D035881:Compensation and Redress; D003863:Depression / Q000523:psychology*; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*; D014947:Wounds and Injuries / Q000191:economics* / Q000523:psychology*