Comparing time off work after work-related mental health conditions across Australian workers' compensation systems: a retrospective cohort study

Incidence, trends and factors associated with psychological injury among health and social care workers in New South Wales, Australia: a retrospective cohort study of workers' compensation claims

OBJECTIVES

To describe and compare the incidence and trends of workers' compensation (WC) claims for psychological injury: (1) between health and social care (HSC) industry and other industries; (2) among specific occupations in the HSC industry; and (3) to determine if psychological injury claim rates differ by age and gender in the HSC industry and among specific occupations.

METHODS

A retrospective cohort study was conducted using data from the New South Wales WC system. Workers with accepted psychological injury claims between July 2012 and June 2021 were included. Negative binomial regression models were employed to estimate incidence rate ratios and 95% CIs.

RESULTS

The HSC industry had a higher incidence (2.4 per 1000 workers) than all other industries combined (1.1 per 1000 workers). In the HSC industry, the incidence increased from 1.8 in 2013-2015 to 3.4 in 2019-2021. Ambulance officers had the highest incidence (24.9 per 1000 workers) and the highest growth rate. Nurses and midwives, and aged and disability care workers also had fast-growing incidence over the 9 years. Risk of psychological injury claims was highest among female workers and older adults.

CONCLUSIONS

The increasing incidence and trend of psychological injury claims among HSC workers in New South Wales signify a growing public health issue. Greater efforts are needed to prevent work-related psychological injury in the HSC industry and support affected workers. The different patterns of psychological injury claims across occupations suggest that interventions should be tailored to each occupational group.

The burden of working time lost to compensable occupational injury and disease in Australia, 2012-17: a retrospective population-based study

OBJECTIVES

To determine the national burden of working time lost to occupational injury and disease in Australia compensable by workers' compensation schemes; to characterise the distribution of time lost by age, sex, and injury and disease type.

STUDY DESIGN

Retrospective population-based study; analysis of National Dataset for Compensation-based Statistics (NDS) data.

SETTING, PARTICIPANTS

Granted workers' compensation claims by people aged 15-100 years including payment of wage replacement benefits for time off work lodged in Australia, 1 July 2012 - 30 June 2017.

MAIN OUTCOME MEASURES

Working years lost (WYL) per annum (total number of years of wage replacement benefits paid to injured and ill workers), overall and by sex, age, and injury and disease type; WYL per 10 000 fulltime equivalent (FTE) years worked.

RESULTS

A total of 755 330 eligible claims with complete data for analysis variables by people aged 15-100 years were identified, for compensable injuries and disease that led to 41 194 (95% confidence interval [CI], 41 020-41 368) WYL/year. The annual WYL number and rate were each higher for men (25 367 [95% CI, 25 230-25 503] WYL/year; 42.6 [95% CI, 42.1-43.1] WYL/10 000 FTE years) than for women (15 827 [95% CI, 15 720-15 935] WYL/year; 38.8 [95% CI, 38.2-39.4] WYL/10 000 FTE years). Workers aged 45-100 years made 66 742 claims per year (44.1% of all claims) but incurred 21 763 WYL/year (52.8% of all WYL). Traumatic joint and muscle injuries led to 16 494 WYL/year (40.0% of all WYL), musculoskeletal disorders to 8547 WYL/year (20.7%), mental health conditions to 5361 WYL/year (13.0%), fractures to 4276 WYL/year (10.4%), and wounds and lacerations to 3449 WYL/year (8.4%).

CONCLUSIONS

Occupational injury and disease covered by workers' compensation result in lost working time in Australia equivalent to more than 41 000 fulltime jobs. Distribution of the burden reflects the greater labour force participation of men, slower recovery of older workers, and the impact of common occupational injuries and diseases. Population-based monitoring of lost working time could support effective occupational health surveillance and allocation of resources for protecting the health of Australian workers.

Determinants of psychological injury among health and social care workers in community settings: A systematic review

BACKGROUND

Health and Social Care (HSC) workers face psychological health risks in the workplace. While many studies have described psychological injuries in HSC workers, few have examined the determinants. Previous research has primarily focused on hospitals, lacking systematic reviews of community-based settings.

OBJECTIVE

To systematically identify and appraise current evidence on the determinants of psychological injuries among HSC workers in community settings.

METHODS

Searches were conducted in three bibliographic databases, supplemented by citation searches. Included studies focused on community-based HSC workers, reporting statistical associations between psychological injury and personal, health, occupational, or organizational factors. Quantitative studies published in English between January 1, 2000 and August 15, 2023 were included. Quality appraisal was undertaken using the JBI critical appraisal checklist.

RESULTS

Sixty-six studies were included. Study quality was highly variable, and all studies were cross-sectional. Twenty-three studies linked psychological injury with occupational factors (e.g. low job control, high job demands and low job satisfaction). Thirteen studies observed an association between work environment and psychological injury, and a further eleven between workplace social support and psychological injury. Fewer studies have examined the relationship between psychological injury and personal/individual factors.

CONCLUSION

Occupational and organisational factors are significantly associated with psychological health among HSA workers, in community settings. These aspects of job design, work environment and workplace relationships are modifiable, suggesting an opportunity for work design interventions to improve workers' psychological health and reduce the prevalence of psychological injury in this sector.

Time off work following psychological injury among health and social care workers: a population-based retrospective cohort study in New South Wales, Australia

OBJECTIVE

This study aimed to determine the disability duration and burden of compensated time loss in the health and social care (HSC) sector following psychological injury.

METHODS

A retrospective cohort study was conducted using data from the New South Wales workers' compensation system. The median weeks disability duration and total weeks of working time lost (WWL) per 1000 workers were compared between the HSC sector and all other industries, and between specific occupational groups in the HSC sector, using accelerated failure time models.

RESULTS

HSC workers had a median (IQR) disability duration of 12.4 (3.3-40.0) weeks, which was less than the 15.3 (4.3-48.3) weeks observed in other industries. Within the HSC sector, ambulance officers had the longest disability duration at 31.1 (6.1-104.0) weeks and highest WWL at 15 734 weeks per 1000 workers. Conversely, nurses and midwives had the shortest disability duration at 8.0 (2.0-25.8) weeks, while other healthcare workers had the lowest WWL (17.0). Controlling for other determinants, ambulance officers had the highest likelihood of longer disability duration (time ratio (TR) 2.14; 95% CI 1.64 to 2.78), followed by social workers (TR 1.46; 95% CI 1.20 to 1.79) and administrators and managers (TR 1.41; 95% CI 1.15 to 1.71). Older age, female sex, full-time employment and working in small organisations correlated with extended disability duration.

CONCLUSION

There is considerable variation in the duration and burden of work disability due to psychological injury across occupational groups in the HSC sector. Findings suggest the need for occupation-specific workplace rehabilitation and psychological support to reduce the impact of psychological injury on HSC workers and improve return-to-work outcomes.

Work-related injuries in the Australian education sector: A retrospective cohort study

INTRODUCTION

Educators are exposed to several work-related hazards. Evidence suggests musculoskeletal pain, psychological distress, and student-inflicted violence-related injuries are common. However, there is little evidence on the burden of workplace injury among Australian educators.

AIM

To compare incidence of injury claims and duration of compensated time off work between educators and non-educators, and associated factors.

METHODS

Retrospective cohort study of 1,559,676 Australian workers' compensation claims, including 84,915 educator claims, lodged between July 2009 to June 2015, from the National Dataset for Compensation-based Statistics. Cases were included if aged 18+ years and working in the education sector less than 100 h per week. Negative binomial regression models estimated the relative risk of making a compensation claim and survival analyses calculated disability duration within educators by sex, age, injury type and mechanism, socioeconomic area, remoteness, and jurisdiction.

RESULTS

Compared to non-educators, educators had lower rates of injury claims and shorter disability durations. However, educators had a higher rate of claims for mental health conditions and assault, with the highest risk being among those in special education and education aides. Among educators, injury claim rates were highest among special educators, education aides, and secondary educators.

DISCUSSION AND CONCLUSION

Though surveys indicate Australians in the education sector have higher incidences of work-related injuries, this study found lower incidence of injury claims and shorter disability durations than others. Educators' injury-reporting and absenteeism behaviors may be constrained by ethical, social, and administrative attitudes. Educators had higher rates of claims for mental health and assault-related injury, particularly special educators, and education aides, which suggests a need for targeted prevention efforts.

Experiences, impacts and service needs of injured and ill workers in the WSIB process: evidence from Thunder Bay and District (Ontario, Canada)

INTRODUCTION

Individuals experience negative physical, social and psychological ramifications when they are hurt or become ill at work. Ontario's Workplace Safety and Insurance Board (WSIB) is intended to mitigate these effects, yet the WSIB process can be difficult. Supports for injured workers can be fragmented and scarce, especially in underserved areas. We describe the experiences and mental health needs of injured and ill Northwestern Ontario workers in the WSIB process, in order to promote system improvements.

METHODS

Community-recruited injured and ill workers (n = 40) from Thunder Bay and District completed an online survey about their mental health, social service and legal system needs while involved with WSIB. Additional Northwestern Ontario injured and ill workers (n = 16) and community service providers experienced with WSIB processes (n = 8) completed interviews addressing similar themes.

RESULTS

Northwestern Ontario workers described the impacts of workplace injury and illness on their professional, family, financial and social functioning, and on their physical and mental health. Many also reported incremental negative impacts of the WSIB processes themselves, including regional issues such as "small town" privacy concerns and the cost burden of travel required by the WSIB, especially during COVID-19. Workers and service providers suggested streamlining and explicating WSIB processes, increasing WSIB continuity of care, and region-specific actions such as improving access to regional support services through arm's-length navigators.

CONCLUSION

Northwestern Ontario workers experienced negative effects from workplace injuries and illness and the WSIB process itself. Stakeholders can use these findings to improve processes and outcomes for injured and ill workers, with special considerations for the North.

Framing the Care of Injured Workers: An Empirical Four-Jurisdictional Comparison of Workers' Compensation Boards' Healthcare Policies

PURPOSE

The objective of this study was to explore how workers' compensation policies related to healthcare provision for workers with musculoskeletal injuries can affect the delivery and trajectories of care for injured workers. The principal research question was: What are the different ways in which workers' compensation (WC) policies inform and transform the practices of healthcare providers (HCPs) caring for injured workers?

METHODS

We conducted a cross-jurisdictional policy analysis. We conducted qualitative interviews with 42 key informants from a variety of perspectives in the provinces of Ontario and Quebec in Canada, the state of Victoria in Australia and the state of Washington in the United States. The main methodological approach was Framework Analysis.

RESULTS

We identified two main themes: (1) Shaping HCPs' clinical practices and behaviors with injured workers. In this theme, we illustrate how clinical practice guidelines and non-economic and economic incentives were used by WCs to drive HCP's behaviours with workers; (2) Controlling workers' trajectories of care. This theme presents how WC policies achieve control of the workers' trajectory of care via different policy mechanisms, namely the standardization of care pathways and the power and autonomy vested in HCPs.

CONCLUSIONS

This policy analysis shed light on the different ways in which WC policies shape HCP's day-to-day practices and workers' trajectories. A better understanding and a nuanced portrait of these policies' impacts can help support reflections on future policy changes and inform policy development in other jurisdictions.

Regional Differences in Time Off Work After Injury: A Comparison of Australian States and Territories Within A Single Workers' Compensation System

Purpose Time off work after workplace injury varies by compensation system. While often attributed to features of the compensation system, unaccounted regional factors may drive much of the effect. In this study, we compare disability durations by state and territory of residence within a single national workers' compensation system. Large differences would indicate that factors other than compensation system settings are responsible for system effects observed in previous studies. Methods We applied crude and adjusted Cox proportional hazards models to compare disability durations by state and territory of residence. Confounders included factors known to influence disability duration. Durations were left-censored at two weeks and right-censored at 104 weeks. Results We analysed N = 31,641 claims. In both crude and adjusted models, three of the seven states and territories significantly differed from the reference group, New South Wales. However, two of the three were different between crude and adjusted models. Regional effects were relatively small compared to other factors including insurer type, age, and type of injury. Conclusions Regional factors influence disability duration, which persist with adjustment for demographic, work, insurer type, and injury confounders. However, the effects are inconsistently significant and fairly small, especially when compared to the effect of confounders and system effects found in previous studies. Regional factors likely only account for a small share of the difference in disability duration between compensation systems.

Comparison of Compensated Low Back Pain Claims Experience in Australia with Limb Fracture and Non-Specific Limb Condition Claims: A Retrospective Cohort Study

Objectives To describe the incidence, duration, and patterns of working time loss claims in compensated Australian workers with low back pain (LBP), and compare this with limb fracture (LF) and non-specific limb condition (NSLC) claims. Methods The National Dataset for Compensation-based Statistics was used for this study. Accepted workers' compensation time loss claims for LBP, LF or NSLC occurring between July 2010 and June 2015 were included. Counts, rates per 10,000 covered workers, the relative risk and median duration of time loss were calculated. Multivariate Cox and quantile regression models were used to determine factors affecting time loss duration and patterns. Results There were 56,102 LBP claims, 42,957 LF claims, and 18,249 NSLC claims. The relative risk of a claim for LBP was significantly greater than LF after adjustment for all covariates (ARR 1.30, 95% CI 1.29-1.32, p < 0.001). LBP claims had similar median time loss (9.39 weeks) to LF claims (9.21 weeks). Claims for LBP were significantly more likely to be resolved in the early phase (10th and 25th quantiles of time loss; 25th quantile: - 1.12 weeks, 95% CI - 1.20 to - 1.05) than claims for LF, but significantly less likely to be resolved in the later phase (75th and 90th quantiles; 75th quantile: 7.02 weeks, 95% CI 6.42-7.61). Claims for NSLC had generally greater time loss than claims for LF, but less time loss than LBP above the 90th quantile. Conclusions The risk of a claim for LBP is higher than LF and NSLC. Although LBP claims are more likely to resolve in the early phase than limb fracture and NSLC claims, LBP claims have longer durations when workers are away from work more than seven weeks.

Concerns About Claiming, Postclaim Support, and Return to Work Planning: The Workplace's Impact on Return to Work

OBJECTIVE

The aim of this study was to determine how injured Australian workers perceived employer emotional (eg, empathy) and instrumental [eg, return-to-work (RTW) planning] support during the RTW process and examine associations between support and RTW.

METHODS

Using data from the 2014 National Return to Work Survey of injured workers with a workers' compensation claim, multinomial regression models examined relationships between support and RTW.

RESULTS

Receiving support and developing RTW plans were significantly associated with a greater likelihood of RTW. When controlled for one another in a single model, postclaim support had the strongest association with RTW, with RTW planning also significantly and positively associated with RTW.

CONCLUSION

Provision of both emotional and instrumental support are important employer-led work disability management interventions. Research is required to develop strategies for increasing employer support to lead to improved RTW outcomes for injured workers.

Experiences of Healthcare in Australia's Workers' Compensation Schemes: A Cross-Sectional Study

OBJECTIVE

To determine personal, injury, and scheme factors are associated with experiencing stressful healthcare provider (HCP) interactions, and to determine impact of stressful HCP interactions on return to work (RTW).

METHODS

Using the 2018 National RTW Survey of 4574 injured workers that submitted a workers' compensation claim, multivariable logistic regression determined factors associated with stressful HCP interactions (recorded as "a bit stressful" to "extremely stressful") and RTW (self-reported yes/no at interview).

RESULTS

Workers claiming for mental illness, who found healthcare difficult to access, who consulted with multiple HCPs, and who experienced psychological or financial stress, were significantly more likely to experience stressful HCP interactions. Stressful HCP interactions were associated with lower odds of RTW.

CONCLUSIONS

Findings provide impetus to investigate why HCP interactions are stressful to enable efforts to reduce stress, possibly improving RTW outcomes.