Objective To examine the reciprocal longitudinal associations between depression or anxiety with work-related injury (WRI) at a large employer in the southwestern United States.
Method Three administrative datasets (2011–2013) were merged: employee eligibility, medical and prescription claims, and workers’ compensation claims. The sample contained 69 066 active employees. Depression and anxiety were defined as episodes of medical visits care (ie, claims) with corresponding ICD-9-CM codes. For an individual’s consecutive claims, a new case of depression or anxiety was defined if more than 8 weeks have passed since the prior episode. The presence of a workers’ compensation injury claim was used to identify WRI. Three-wave (health plan years 2011 or T1, 2012 or T2, and 2013 or T3) autoregressive cross-lagged models were used to estimate whether depression or anxiety predicted WRI, also if WRI predicted depression or anxiety in the following year(s).
Results Depression predicted injury from T1 to T2 (β=0.127, p<0.001) and from T2 to T3 (β=0.092, p=0.001). Injury predicted depression from T1 to T3 (β=0.418, p<0.001). Effects of anxiety on WRI were small and inconsistent, from T1 to T2 (β=0.013, p=0.622) and from T2 to T3 (β=−0.043, p=0.031). T1 injury had a protective effect on T3 anxiety (β=−0.273, p<0.001).
Conclusions We found evidence of reciprocal effects for depression with WRI after adjustment for prior injuries and depression. The evidence for the relationship between anxiety and WRI is less clear. WRI prevention and management programmes should incorporate depression prevention and management.
- mental Health
- occupational injury
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Contributors VG designed the study, analysed the data and wrote the manuscript with the help of other authors. UB helped in study design, paper writing and interpreting results. PMD consulted on autoregressive cross-lagged modelling. JMT provided access to the data, software and consulted in interpreting results and drafting the manuscript. GLD consulted throughout the paper with the heaviest input on measuring WRIs and interpreting results. DGRdP consulted throughout the paper with the heaviest input on methods. BCA proposed the study design and advised drafting all sections of the paper. All authors discussed the results, reviewed the draft of the article and approved to be published.
Funding GLD and DGRP were partially funded by the Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health Education and Research Center Grant [5T42OH008421] to the Southwest Center for Occupational and Environmental Health at the University of Texas Health Science Center at Houston School of Public Health.
Disclaimer The content is solely responsibility of the authors and does not necessarily represent the views of the University of Texas Office of Employee Benefits.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.
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