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Investigating the epidemiology and work disability impacts of anxiety and depression disorders after musculoskeletal injury using linked health data Jones, Andrea


Anxiety and depression disorders are common after lost-time musculoskeletal work injury, and may be a modifiable determinant of work disability. Despite this, little evidence exists on the epidemiology or impacts of mental health in the work injury population. This dissertation generated new information on the descriptive epidemiology and work disability impacts of anxiety and depression disorders among workers with lost-time musculoskeletal work injury. Accepted lost-time claims for spine or upper limb strain or sprain work injury were extracted for workers in the Canadian province of British Columbia from 2000 to 2013. Anxiety and depression diagnoses and physician mental health services were identified using physician billing, hospital discharge and prescription data. Analytic approaches included prevalence estimates; multinomial, Cox, and instrumental variable regression models; direct adjusted survival curves; and model stratification by gender. Approximately 1 in 10 men and 3 in 10 women had a recent or current anxiety or depression disorder at the time of injury. Both pre-existing and new onset anxiety and depression disorders were associated with a lower probability of sustained return to work, and pre-existing anxiety was associated with a higher probability of lost-time recurrence after initial return to work. The effect size of the association between pre-existing anxiety and sustained return to work was greater for men than for women, and pre-existing depression was associated with a lower probability of sustained return to work for men but not women. Lastly, instrumental variable methods offer a promising analytic approach to estimate the effects of mental health treatment, based on physician treatment preference, on work disability outcomes for workers with a mental disorder. These findings offer important and novel contributions to our understanding of the prevalence, impacts, and management of anxiety and depression disorders in a lost-time musculoskeletal work injury context. Workers’ compensation benefits and programs intended to improve return to work after musculoskeletal injury should take pre-existing anxiety and depression disorders into consideration, in addition to new onset disorders attributable to the injury; and, gender specific strategies may be warranted to optimize return-to-work outcomes.

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