Psychosocial factors are strong predictors of delayed recovery and other adverse outcomes in patients with work-related injuries.

A recent white paper from the Workers Compensation Research Institute (WCRI) examines the correlations between a worker’s mental health and the time it takes to recover from a physical workforce injury.

The paper, A Primer in Behavioral Health Care in Workers Compensation, uses information taken from open-ended interviews with mental health care professionals, health care providers, employers, labor advocates and workers’ compensation insurers. It also draws from a review of select national and state occupational medical treatment guidelines.

Studies have shown that early identification and treatment of both pre-existing behavioral health risk factors and those triggered by a work-related injury will result in improved outcomes.

The Colorado Division of Workers’ Compensation suggests that 3 to 10 percent of all workers with injuries may experience delayed recovery related to behavioral health issues.

Behavioral Health Obstacles

Concerns about the impact of behavioral health problems work-related injury has risen in recent years as studies estimate 30-50 percent of adults have a mental illness over the course of their lifetime.

Common psychosocial issues inhibiting recovery can include:

  • Poor recovery expectations after injury,
  • Fear of pain and re-injury
  • Perceived injustice
  • Job dissatisfaction
  • Pessimism
  • Fearfulness
  • Low motivation
  • Lack of family and community support

For some workers, poor recovery expectations become a self-fulfilling prophecy. Fear of pain may be more disabling than pain itself, consistent with chronic pain and disfunction.

Job satisfaction prior to injury also comes into play. About one in four workers surveyed reported being not at all or somewhat satisfied with their job at the time of the injury, and 27% said they feared being fired after a work-related injury. Having a lower level of trust in the workplace makes employees recover more slowly and maybe even less likely to work after an injury.

Cycle of Pain and Mental Health Issues

Several studies show that poor behavioral health increases the likelihood of developing physical conditions and vice versa.

Up to 85% of patients with chronic pain are affected by severe depression. They exhibit a poorer prognosis than those with chronic pain only. Workers may report feeling downhearted, stressed, and anxious about reinjury.

Depression and stress disorders, whether derived from the workplace injury or preexisting, can contribute to chronic pain, which slows or masks recovery.

First Steps

Workers’ compensation stakeholders recognize the importance of unaddressed behavioral health issues and how they might delay a worker’s recovery, return to work and medical costs after an injury.

Early identification of mental health factors is important to assess how they may affect a worker’s recovery. Early mental health intervention can be key to minimizing the time a worker needs to recover.

For example, the Washington State Department of Labor and Industries Guidelines recommend screening for risk factor at two to six weeks of time lost after an injury. The Colorado Low Back Pain guidelines recommend behavioral health screenings as a routine part of care or when psychosocial factors appear to be impacting recovery.

The WCRI study outlines and references specific testing protocols that can help identify specific issues and set workers on a course to recovery.

Assistance can come in the form of educating patients, teaching self-management strategies and referring them to behavioral health specialists.

An assessment is recommended during follow-up care if expected progress is not observed within six weeks of injury and if symptom validity cannot be established with objective data.

A Primer of Behavioral Health Care in Worker’s Compensation by Vennela Thumula and Sebastian Negrusa is available for download at A fee is required for non-members.

This article was originally published on the Insurance Journal website

Topics Workers' Compensation