Course of Depressive Symptoms Following a Workplace Injury: A 12-Month Follow-Up Update.

Abstract

Introduction To estimate the prevalence, incidence and course of depressive symptoms, their relationship with return-to-work, and prevalence of depression diagnosis/treatment 12months following a lost-time workplace musculoskeletal injury. Methods In a prospective cohort study, 332 workers' compensation claimants with a back or upper extremity musculoskeletal disorder completed interviews at 1, 6 and 12months post-injury. Participants self-reported they had not received a depression diagnosis 1year pre-injury. Cutoff of 16 on the CES-D defined a high level of depressive symptoms. Self-reported data on depression diagnosis and treatment and work status since injury were collected. Results Cumulative incidence of high depressive symptom levels over 12months was 50.3% (95% CI 44.9-55.7%). At 12months, 24.7% (95% CI 20.1-29.3%) of workers exhibited high levels. Over 12months, 49.7% (95% CI 44.3-55.1%) had low levels at all 3 interviews, 14.5% (95% CI 10.7-18.2%) had persistently high levels, and 25.6% (95% CI 20.9-30.3%) demonstrated improvements. Among workers with low baseline levels, incidence of high levels at 12months was 6.0% (95% CI 2.7-9.3%). For workers with high baseline levels, 36.1% (95% CI 27.9-44.3%) exhibited persistent high symptoms at 6 and 12months, while 38.4% (95% CI 30.1-46.6%) experienced low levels at 6 and 12months. Problematic RTW outcomes were common among workers with a poor depressive symptom course. Among workers with persistent high symptoms, 18.8% (95% CI 7.7-29.8%) self-reported receiving a depression diagnosis by 12months and 29.2% (95% CI 16.3-42.0%) were receiving treatment at 12months. Conclusions Depressive symptoms are common in the first year following a lost-time musculoskeletal injury and a poor depressive symptom course is associated with problematic RTW outcomes 12months post-injury. While symptoms appear to improve over time, the first 6months appear to be important in establishing future symptom levels and may represent a window of opportunity for early screening.