Canadian Safety Reporter

2 Canadian HR Reporter, a Thomson Reuters business 2016 CSR | April 2016 | News dean for research and innovation at the University of Pennsylvania in Philadelphia. And those sec- ondary psychological injuries can have a critical impact on re- covery. "Over the past 20 years, I've done a series of studies that look at what contributes to recovery or sub-optimal recovery after in- jury, and particularly injuries that are not big brain injuries or spinal cord injuries — we're looking at general injuries," she said. "One of the things our early work really showed was, it wasn't really the severity of the physical injury that was driving how peo- ple recovered or did not. It really was driven by the psychological consequences. "When we first started look- ing at it, we were looking at post- traumatic stress, and indeed we found that in a pretty seriously injured group of patients, if you had high levels of post-traumatic stress, you were less likely to have a smooth recovery." And during their follow-up questions with this group, Rich- mond and her fellow researchers made another discovery. "What really came to light at that time was depression. 'I'm feeling so depressed,' or 'I can't get out of bed in the morning.' So while post-traumatic stress was an issue, what really came to light was feelings of depression were significant players in how people recovered." Research doesn't consider mental health Yet employers and even most re- searchers in this area usually do not consider mental health out- comes after occupational injury in their estimation of the burden of workplace injuries, said Abay Asfaw Getahun, a health eco- nomics researcher at the Centres for Disease Control and Preven- tion in Atlanta. "Occupational injuries are a significant source of injury to mobility in the United States, and these injuries influence workers' psychological and physical well- being, which increases their risk of suffering from depression or related illnesses. So it should be a concern for employers as well," he said. Based on previous studies in the area, Asfaw Getahun hypoth- esized injured workers would be significantly more likely to have been treated for depression, and consequently would incur more costs for the treatment of depres- sion after injury than their unin- jured counterparts. His research looked at data from 168,000 in- jured and non-injured workers from Thomson Reuters Market Scan data, and examined if there was any measurable difference between them. "Our research showed that the odds of injured workers being treated for depression was 45 per cent higher than that of non-in- jured workers. This is after con- trolling for several co-variants including age, sex, marital status, et cetera," he said. "Although more evidence should be found in this area to confirm our findings, I think employers and the occupational health community may reason- ably anticipate that injured work- ers may need mental health sup- port." Even a relatively minor injury can have a very real impact on mental health, said Richmond. That fact was supported by a Na- tional Institute of Health study she conducted in the U.S. that looked at people with minor physical injuries incurred on the job. "They weren't life-threatening injuries, they were just everyday injuries — I broke my leg, I fell off my bike, I got hit by something. And we found even in that pretty minor injury group that there was still a significant — almost one out of five people — developed significant depressive symptoms in the year after injury," she said. "And in almost every case we looked at, if people with the minor injuries had depressive symptoms, they did worse on almost every aspect of your daily life, taking care of your health and home, getting back to work, having social interactions with other people and their overall quality of life. "We tend to really focus on the physical injury as opposed to the depressive responses, and what I would say is we re- ally need to incorporate a much more holistic approach." Proactive approach The connections between physi- cal injury and mental health are certainly emerging at a quicken- ing pace, and it's a great oppor- tunity to step back and look at it from a pro-active perspective, said Alex Kelly, senior coordina- tor at Parachute Canada in To- ronto. "The research shows that in the immediate aftermath of an injury, there's often an emotional reaction, and that can often lead to depression, anxiety, PTSD and overall affect the quality of life. And that can lead to more nega- tive thoughts and behaviours, and can become almost a cycle that stems from that initial in- jury," she said. "In terms of the impact on re- turn to work — which obviously an employer wants their employ- ee to be healthy and fit for work when they come back — you're adding on a secondary issue. So you've got your physical issue, but now you're looking at a men- tal health issue, and sometimes that can be undiagnosed." It really can impact the work- place if an employee hasn't re- ceived the appropriate care by the time he comes back to work, and the mental health issue re- mains undiagnosed. It may start to manifest itself in other ways, she said. And there can be long-term effects. "When we look at something like PTSD, 42 per cent of injured parties in a recent study exhibited symptoms of PTSD six months after the injury. So it's also ac- knowledging that that timeframe post-injury may be much longer than somebody might account for in terms of a back-to-work plan," said Kelly. "In terms of education, pre- vention is always key. That's where our primary focus at Para- chute is, is on preventing those physical injuries and that's by being proactive in the workplace around any sort of systems, any sort of equipment, and really having an open and honest con- versation with employees about that, and also really encouraging your employees to be proactive in everything they do outside the workplace. So the same sort of risk management that they would employ at work, mak- ing sure that follows through to their journey to and from work, around the house, sports that they play," she said. "(It's about) really cultivating an environment of prevention and pro-activity around those areas. And of course the other side of the issue is mental health, so ensuring that mental health policies and programs and pro- cedures are in place and people are aware of them, and it's some- thing that can be talked about in a work environment." Workplace injuries < pg. 1 Recovery tied to psychological factors Credit: Shutterstock

• Cover