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Investigating trends in mental disorders among a cohort of health care workers [poster presentation] Dufton, J.A.; Koehoorn, M.; Cole, D.C.; Hertzman, C.; Ibrahim, S.; Ostry, A. 2003

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Investigating Trends in Mental Disorders among a Cohort of Health Care Workers Dufton JA 1, Koehoorn M1, 2, Cole DC2 3, Hertzman C1, Ibrahim S2,3, Ostry A1 1 Department  of Health Care & Epidemiology, University of British Columbia, Vancouver Canada; 2 Institute for Work & Health, Toronto Canada; 3 Department of Public Health Sciences, University of Toronto, Toronto Canada  Figure 1: A Comparison of EHB Utilization and LTD in Workers with and without Depression  INTRODUCTION •  Preliminary findings from private insurance data indicate that mental disorders may be surpassing other disorders as the major source of long term disability among health care workers.  •  Evidence suggests that individuals with depressive symptoms have increased health care utilization, absenteeism and disability.  •  In Canada, both the universal health care system and private health plans play an important role the in the management of these conditions.  •  Study Purpose: To investigate patterns of extended health benefits (EHB) and long term disability (LTD) utilization for mental disorders among a cohort of health care workers and to investigate differences in rates of utilization over a five-year follow-up period.  Overall Rate of EHB Utilization (All Claims Per Worker)  Comparison of LTD Claims Rates per 1000 Workers  25  60  50  20  40  15  No Depression Depression  30  10 20  5  METHODS  10  •  This was a retrospective cohort study (1995-1999) of 46,254 health care workers from acute care hospitals in British Columbia, Canada.  •  Employee records for workers eligible for private insurance benefits were linked with extended health benefits (EHB) and long term disability (LTD) claims to create a person-specific longitudinal database.  •  Overall rates of EHB and LTD utilization, and rates of depression (as defined by at least one pharmaceutical claim for an antidepression medication per year) were calculated and compared per year of follow-up.  •  An exploratory comparison of EHB and LTD utilization between individuals taking anti-depression medication and those not taking medication was conducted.  0 1995  1996  1997  1998  0  1999  1995  1996  18  Percentage of Workers Remaining on LTD for Each Year After Incident Year 1997  12  10  Table 1: Cohort Characteristics, and Rates of Extended Health Utilization, Long Term Disability Claims, and Depression  Number of workers Gender - % female Age – mean yrs (SD) Years experience – mean yrs (SD) Extended health claims / worker Total no. of claims Medication claims Depression medication Depression rate* / 100 workers Long term disability rate / per 1000 employees All causes LTD Mental health LTD  1997 34,749 86.5 44.9 (9.3) 13.3 (6.9)  1998 35,994 86.5 45.3 (9.3) 12.8 (7.0)  1999 33,752 85.6 45.4 (9.2) 12.4 (7.1)  5.66 3.46 0.31 7.0  6.05 3.66 0.34 7.9  6.47 3.82 0.37 8.8  6.62 4.11 0.41 9.3  7.14 4.49 0.49 10.6  14.5 2.4  15.7 2.6  *Defined by the presence of at least one pharmaceutical claim for depression  15.4 2.4  17.6 2.9  18.5 2.7  1999  Incident LTD Claim  16  RESULTS  1996 34,787 86.4 44.4 (9.4) 13.5 (7.0)  1998  Figure 2: Yearly EHB Utilization, Pharmaceutical Claims, and Depression Medication Claims for Workers with an Incident LTD Claim in 1997 (Utilization Two Years Before and Two Years After LTD Claim)  14  1995 34,265 86.6 43.9 (9.6) 13.7 (7.0)  1997  Depression Medication Claims per Worker All Pharmaceutical Claims per Worker EHB Utilization (All Services) per Worker  8  1997 - 100% 1998 - 94% 1999 - 82%  6  4  2  0 1995  1996  1997  1998  1999  DISCUSSION •  The findings from this exploratory work indicate that mental disorders are a major source of disability among health care workers and have been increasing over the past decade.  •  Depressed workers have increased EHB utilization and LTD claim rates in comparison to non-depressed workers.  •  In the year preceding an incident LTD claim, significant increases in EHB utilization are apparent, and elevated levels of utilization remain for at least two years after an LTD claim.  •  These descriptive findings have generated some potentially important hypotheses about the relationship between claims experience for mental disorders among health care workers and a number of explanatory factors.  This research was supported by a grant through the Canadian Institute of Health Research and by a Research Trainee Award from the Michael Smith Foundation for Health Research.  

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