The Influence of Psychological Comorbidity on Return-to-Work Following a Multidisciplinary Rehabilitation Program
Creators: Krebs, Brandon
Publisher: name: University of Alberta Library
Year: 2022

<p>Background: Posttraumatic Stress Injury (PTSI) encompasses a range of trauma, mood, anxiety, and somatoform disorders. PTSI have been shown to have adverse effects on both physical and psychological health. Workers with PTSI demonstrate decreased work performance, functional capability, and ability to return-to-work (RTW). Comorbid injuries such as co-occurring physical and psychological conditions often exacerbate these adverse effects. However, the impact of psychological comorbidity (i.e., PTSI in conjunction with another mental health diagnosis like depression or anxiety) on RTW outcomes has not been examined. Objectives: The current study aimed to 1) describe workers with comorbid psychological diagnoses compared to those with only a trauma-related psychological diagnosis, and 2) examine whether comorbid psychological diagnoses are associated with RTW in workers with PTSI. Methods: We conducted a population-based cohort study using data from injured workers with PTSI admitted to the Workers&#39; Compensation Board of Alberta&#39;s Traumatic Psychological Injury Program. Demographic, administrative, and psychological variables were obtained to examine differences between those with and without comorbid psychological diagnoses. Comorbid psychological diagnoses were defined as having multiple psychological diagnoses identified in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5; n=146) rather than only one diagnosis (n=627). We also obtained data on RTW status at discharge from rehabilitation. The psychological comorbidity variable was entered into a multivariable logistic regression model predicting RTW using a risk-factor modelling strategy. A p-value of 0.05 was used to establish significance.Results: Workers with psychological comorbidity were more likely to be employed as public safety personnel (42.5% versus 31.6%, p = 0.05), had a longer duration between accident and program admission (155.5 versus 76.0 days, p = 0.003), increased substance abuse issues (30.1% versus 18.2%, p &lt; 0.001), and elevated scores on psychological measures of depression, anxiety, and posttraumatic stress. Psychological comorbidities identified were primarily trauma and comorbid depression (59.6%), trauma and multiple comorbid psychological diagnoses (17.1%), and trauma and comorbid anxiety (13.0%). The final logistic regression model indicated higher odds of RTW if workers had a single psychological diagnosis (OR 2.05, 95% CI 1.28 - 3.29, p = 0.003). Other variables remaining in the final model indicating higher odds of RTW included initially having a physical International Classification of Diseases, ninth revision (ICD-9) diagnosis (OR 1.90, 95% CI 1.13 – 3.19, p = 0.02), non-elevated scores on the Trauma Symptom Inventory-2 (TSI-2) trauma factor (OR 1.71, 95% CI 0.92 - 2.29, p = 0.01), and a higher readiness to RTW (OR 1.23, 95% CI 1.16 – 2.51, p &lt; 0.001). Finally, RTW odds were lower for individuals working in education, law and social, community, and government (OR 0.54, 95% CI 0.34 – 0.85, p = 0.01), which included public safety personnel. Conclusions: In workers with PTSI, being diagnosed with more than one psychological disorder appears to be associated with worse RTW outcomes following rehabilitation. Future research with larger samples is needed to identify if some diagnostic combinations impair return-to-work more than others.</p>