Article Text

other Versions

Download PDFPDF
Mental health and other factors associated with work productivity after injury in the UK: multicentre cohort study
  1. Blerina Kellezi1,2,
  2. Paula Dhiman3,4,
  3. Carol Coupland2,
  4. Joanne Whitehead2,
  5. Richard Morriss5,
  6. Stephen Joseph6,
  7. Kate Beckett7,
  8. Jude Sleney8,
  9. Jo Barnes9,
  10. Denise Kendrick2
  1. 1Department of Psychology, Nottingham Trent University, Nottingham, UK
  2. 2Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
  3. 3Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
  4. 4School of Medicine, Research Design Service East Midlands (RDS EM), Queen's Medical Centre, Nottingham, UK
  5. 5Faculty of Medicine and Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
  6. 6School of Education, University of Nottingham, Nottingham, UK
  7. 7University of the West of England, Bristol, UK
  8. 8Department of Sociology, University of Surrey, Guildford, UK
  9. 9Loughborough Design School, Loughborough University, Loughborough, UK
  1. Correspondence to Dr Blerina Kellezi, Psychology, Nottingham Trent University, Nottingham NG1 4FQ, UK; Blerina.kellezi{at}


Introduction Mental health conditions are a major contributor to productivity loss and are common after injury. This study quantifies postinjury productivity loss and its association with preinjury and postinjury mental health, injury, demographic, health, social and other factors.

Methods Multicentre, longitudinal study recruiting hospitalised employed individuals aged 16–69 years with unintentional injuries, followed up at 1, 2, 4 and 12 months. Participants completed questionnaires on injury, demographic factors, health (including mental health), social factors, other factors and on-the-job productivity upon return to work (RTW). ORs were estimated for above median productivity loss using random effects logistic regression.

Results 217 adults had made an RTW at 2, 4 or 12 months after injury: 29% at 2 months, 66% at 4 months and 83% at 12 months. Productivity loss reduced over time: 3.3% of working time at 2 months, 1.7% at 4 months, 1% at 12 months. Significantly higher productivity loss was associated with preinjury psychiatric conditions (OR 21.40, 95% CI 3.50 to 130.78) and post-traumatic stress avoidance symptoms at 1 month (OR for 1-unit increase in score 1.15, 95% CI 1.07 to 1.22). Significantly lower productivity loss was associated with male gender (OR 0.32, 95% CI 0.14 to 0.74), upper and lower limb injuries (vs other body regions, OR 0.15, 95% CI 0.03 to 0.81) and sports injuries (vs home, OR 0.18, 95% CI 0.04 to 0.78). Preinjury psychiatric conditions and gender remained significant in analysis of multiply imputed data.

Conclusions Unintentional injury results in substantial productivity loss. Females, those with preinjury psychiatric conditions and those with post-traumatic stress avoidance symptoms experience greater productivity loss and may require additional support to enable successful RTW.

  • mental health
  • longitudinal
  • functional outcome

Data availability statement

No data are available.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

No data are available.

View Full Text


  • Twitter @Blerina_Kellezi, @luffjo

  • Contributors DK, CC, RM, SJ and BK contributed to the conception or the design of the work. BK, DK, PD, KB, JB and JS contributed to the acquisition of data. DK, CC, PD and BK contributed to the analysis and interpretation of data. BK, DK, PD and JW drafted the manuscript. All authors provided final approval for the manuscript.

  • Funding This study was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Nottinghamshire, Derbyshire and Lincolnshire. RM is currently funded by the NIHR CLAHRC East Midlands and the Nottingham NIHR Biomedical Research Centre.

  • Disclaimer The views expressed are those of the authors and not necessarily of the National Health Service, NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient and public involvement statement A Patient and Public Involvement member was involved in the design and conduct of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.