Suicidality 6 Years After Occupational Injury.

OBJECTIVE: Suicide attempts can result from traumatic events, including those caused by occupational injury. However, literature on the long-term prevalence rates of suicidality after occupational injury is relatively lacking. This study investigated the long-term prevalence of suicidality after occupational injury. METHODS: Between February 1 and August 31, 2009, 4,403 workers in Taiwan sustained occupational injuries and were hospitalized for 3 days or longer. Surveys were conducted at 3 and 12 months after occupational injury, and 2,308 workers responded to either survey. They were invited to join the follow-up at 6 years after occupational injury, using the Brief Symptom Rating Scale (BSRS-5), Posttraumatic Symptom Checklist (PTSC), and 1 question on suicidal ideation. Workers with a high score on the BSRS-5 or PTSC were invited to participate in an in-depth psychiatric evaluation using the Chinese version of the Mini-International Neuropsychiatric Interview (MINI). RESULTS: The estimated MINI-diagnosed suicidality rates at 3 months, 12 months, and 6 years after occupational injury were 5.4%, 4.8%, and 9.5%, respectively. Injured workers who reported that the injury majorly affected their physical appearance, experienced additional occupational injury requiring hospitalization for > 3 days, had unstable employment, and had lower income in the past 1 year than that before occupational injury had a higher risk of suicidal ideation. Injury majorly affecting the physical appearance, unstable employment, and lower income than that before occupational injury were the most crucial factors. These factors accounted for 12.7%, 13.2%, and 19.0% of suicidal ideation among the injured workers. CONCLUSIONS: The suicidality rate increased at 6 years after occupational injury. The relevant factors for suicidal ideation were injury severity and work instability. Periodic monitoring of psychological and physical health and economic stability are warranted.

Quality of life at 6 years after occupational injury.

PURPOSE: Occupational injuries have considerable impact on workers' lives. However, data regarding workers' health-related quality of life (HRQOL) at several years after the injury are lacking. This study assessed workers' HRQOL at 6 years after occupational injury and determined related factors in each HRQOL domain. METHODS: Workers who sustained an occupational injury in 2009 and who responded to a previous survey at 3 or 12 months after their injury were followed up in 2015. A total of 1715 participants were candidates for this study. The Taiwanese version of the World Health Organization Quality of Life scale-abbreviated version (WHOQOL-BREF) was used to assess their HRQOL. Multiple linear regression analysis identified predictive factors for HRQOL at 6 years after occupational injury. RESULTS: A total of 563 workers completed the questionnaire (response rate, 32.8%). Adverse life events and additional severe occupational injuries that occurred within the follow-up period, and decreased salary after the injury were significant factors for low scores in all domains of the WHOQOL-BREF. In addition, unmarried participants had low scores in the social relationship domain. Workers with family members requiring care scored low in the physical and environment domains. Workers whose injuries had major effects on their physical appearance had low scores in the physical and psychological domains. Workers with unstable employment had low scores in physical, psychological, and environment domains. CONCLUSION: At 6 years after occupational injury, workers' HRQOL was poor among those whose salaries decreased after the injury, after adjustment for other factors.

Depressive, anxiety and post-traumatic stress disorders at six years after occupational injuries.

The aim of this study is to determine the prevalence rates of depressive, anxiety and PTSDs, and the risk factors for psychological symptoms at 6 years after occupational injury. This longitudinal study followed workers who were occupationally injured in 2009. Psychological symptoms and return to work were assessed at 3 and 12 months after injury. Injured workers who had completed the initial questionnaire survey at 3 or 12 months after injury were recruited. A self-administered questionnaire was mailed to the participants. For workers with high Brief Symptom Rating Scale and Post-traumatic Symptom Checklist scores, an in-depth psychiatric evaluation was performed using the Mini-international Neuropsychiatric Interview. A total of 570 workers completed the questionnaire (response rate, 28.7%). Among them, 243 (42.6%) had high psychological symptom scores and were invited for a phone interview; 135 (55.6%) completed the interview. The estimated rates of major depression and post-traumatic stress disorder (PTSD)/partial PTSD were 9.2 and 7.2%, respectively, and both these rates were higher at 6 years after injury than at 12 months after injury (2.0 and 5.1%). After adjustment for family and social factors, the risk factors for high psychological scores were length of hospitalization immediately after injury, affected physical appearance, repeated occupational injuries, unemployment, and number of quit jobs after the injury. At 6 years after occupational injury, the re-emergence of psychiatric disorders was observed. Relevant factors for poor psychological health were severity of injury and instability of work. Periodic monitoring of psychological and physical health and economic stability are warranted.

Psychiatric disorders after occupational injury among National Health Insurance enrollees in Taiwan.

This study aimed to determine the incidence rates of psychiatric disorders within 1 year after occupational injury and to examine the association between occupational injury and the incidence of psychiatric disorders using National Health Insurance Research Database (NHIRD). We used cohort approach in this investigation. All eligible subjects were from the NHIRD, and aged 18-65 years old. A total of 542,208 patients were enrolled in this study. Among them, 1038 patients sustained occupational injury, 6891 patients sustained non-occupational injury. The reference group in this study was 534,279 patients who ever used the NHI for any medical condition in 2001. The incidence rates of any psychiatric disorders within 1 year after occupational injury (inpatient), occupational injury (outpatient), non-occupational injury (inpatient), non-occupational injury (outpatient), and any disease were 9.5%, 2.5%, 7.4%, 1.5%, and 1.1%, respectively. Occupational injury was found as a significant factor for developing psychiatric disorders within 1 year after the target injury. The incidence rate of any psychiatric disorders was higher in patients after occupational injury than those after non-occupational injury and any medical condition.

Long-term psychological outcome of workers after occupational injury: prevalence and risk factors.

INTRODUCTION: This study aimed to examine the prevalence rates of both post-traumatic stress disorder (PTSD) and major depression at 12 months in workers experiencing different types of occupational injury in Taiwan. Demographic and injury-related risk factors for psychological symptoms were also evaluated. METHODS: Our study candidates were injured workers in Taiwan who were hospitalized for 3 days or longer and received hospitalization benefits from the Labor Insurance program. A two-staged survey study was conducted. A self-reported questionnaire including the Brief Symptom Rating Scale and Post-traumatic Symptom Checklist was sent to workers at 12 months after injury. Those who met the criteria were recruited for the second-stage phone interview with a psychiatrist using the Mini-international Neuropsychiatric Interview (MINI). RESULTS: A total of 1,233 workers completed the questionnaire (response rate 28.0 %). Among them, 167 (13.5 %) fulfilled the criteria for the MINI interview and were invited. A total of 106 (63.5 %) completed the phone interview. The estimated rate of either PTSD/PPTSD or major depression was 5.2 %. The risk factors for psychological symptoms were female gender, lower education level, loss of consciousness after occupational injury, injury affecting physical appearance, occupational injury experience before this event, life experience before and after this injury, length of hospital stay, self-rated injury severity, and percentage of income to the family. CONCLUSIONS: These results showed that occupational injury can cause long-term psychological impact in workers. Key demographic and injury characteristics may enhance the identification of at-risk occupational injured workers who would benefit from targeted screening and early intervention efforts.

Psychological outcome of injured workers at 3 months after occupational injury requiring hospitalization in Taiwan.

INTRODUCTION: After a traumatic event, a significant proportion of victims develop psychiatric disorders. Trauma has been an important ailment among workers. This study aimed to determine the prevalence of post-traumatic stress disorder (PTSD) and other psychiatric disorders at three months after occupational injuries. METHODS: Our study candidates were injured workers in Taiwan who were hospitalized for 3 days or longer and received hospitalization benefits from the Labor Insurance program. A two-staged survey study was conducted. A self-reported questionnaire including the Brief Symptom Rating Scale (BSRS-50) and Post-traumatic Symptom Checklist (PTSC) was sent to workers at 3 months after injury. Those who met the criteria were recruited for the second stage phone interview with a psychiatrist using the Mini-international Neuropsychiatrie Interview (MINI). RESULTS: A total of 2001 workers completed the questionnaire (response rate 45.5%). Among them, 357 (17.8%) fulfilled the criteria for the MINI interview and were invited. A total of 148 (41.5%) completed the phone interview. The estimated rates of PTSD, partial PTSD (PPTSD), major depression, comorbid PTSD/PPTSD and major depression, and either PTSD/PPTSD or major depression were 2.7, 4.1, 3.0, 2.3, and 7.5%, respectively. The estimated rates of either PTSD/PPTSD or major depression among workers who suffered from intracranial injury, fracture, burn, crushing injury, and open wound of upper limbs were 10.4, 6.9, 5.9, 5.8 and 0%, respectively. CONCLUSIONS: At three months after occupational injuries, a significant proportion of workers suffered from psychiatric disorders. The rates of psychiatric disorders occurring after intracranial injuries were significantly higher than those occurring after non-intracranial injuries.

Predictors for suicidal ideation after occupational injury.

Risk of suicide has been associated with trauma and negative life events in several studies. Our aim was to investigate the prevalence and risk factors of suicidal ideation, and the population attributable risk among workers after occupational injuries. We investigated workers who had been hospitalized for ≧3 days after occupational injuries between February 1 and August 31, 2009. A self-reported questionnaire including demographic data, injury condition, and the question of suicidal ideation was sent to 4498 workers at 3 months after their occupational injury. A total of 2001 workers (45.5%) completed the questionnaires and were included in final analysis. The prevalence of reporting suicidal ideation was 8.3%. After mutual adjustment, significant risk factors for suicidal ideation higher than "serious" in a self-rated severity scale (adjusted odds ratio, aOR=2.31; adjusted population attributable risk, aPAR=34.7%), total hospital stay for 8 days or longer (OR=1.98; aPAR=20.5%), intracranial injury (OR=2.30; aPAR=10.2%), and marriage status of being divorced/separated/widowed (OR=2.70; aPAR=10.0%). Three months after occupational injury, a significant proportion of workers suffered from suicidal ideation. Significant predictors of suicidal ideation after occupational injury included broken marriage, intracranial injury, injury severity, and total hospital stay. Identification of high risk subjects for early intervention is warranted.

Correlations of quality of life with adverse effects of medication, social support, course of illness, psychopathology, and demographic characteristics in patients with panic disorder.

Care of patients with panic disorder has raised quality-of-life (QOL) issues. The purpose of this study was to identify the level of QOL in patients with panic disorder and to examine the relationships between QOL and adverse effects of medication, social support, course of illness, psychopathology, and demographic characteristics. We recruited 57 patients with panic disorder from outpatient psychiatric clinics. We measured their QOL levels with the Short Form of the World Health Organization Questionnaire on Quality of Life-Taiwan Version (the WHOQOL-BREF Taiwan version) and examined the correlates of QOL. The analysis revealed that multiple factors were associated with poor QOL in patients with panic disorder, including severe adverse effects of medication for panic disorder, perceived low social support, severe current panic symptoms, total Beck Depression Inventory-II (BDI-II) score>/=17, young age, being unmarried, and early onset of panic disorder. The QOL of patients with panic disorder was correlated to multiple factors that were specific to individual subjects and influenced by interactions with treatment and the social environment. The results provide screening factors so that clinicians can intervene to improve QOL for their patients with panic disorder.