• Workers who need more than a week off work following injury are more prone to deaths of despair, such as suicide and drug overdose, than those with brief absences.
• We need to better identify and treat post-injury depression and substance use disorders, and provide more mental health support for injured workers.

The period following workplace injury can be a time of great vulnerability for the injured worker. Pain, uncertainty about employment and income, the loss of a clear social role and the stresses of claiming compensation can all take their toll.

This article hones in on a worst-case scenario: deaths of despair such as drug overdose or suicide. Are workers with lost time injuries (LTIs) more likely to die from these preventable causes than other workers?

It sounds plausible.

Workers’ advocates, qualitative research and government entities tell us that the strain of workplace injury, and battles with compensation systems, can push some people over the edge. Suicides have been reported. We also know that many workers’ compensation recipients are prescribed opioids to help manage their pain. Whilst opioids are sometimes appropriate in the short-term, addiction and misuse are common and can be deadly.

However, for Australians aged 15-44 generally, suicide is already the leading cause of death. National suicide rates have been trending upwards since 2009. Are injured workers really a special case? 

Similarly, opioids are a contributing factor to more than two-thirds of drug-related deaths in Australia. Opioid-induced deaths have been on the rise since the early 2000s, and prescription opioids are particularly problematic. Do injured workers have a particular vulnerability to drug-related mortality, or is the general population just as vulnerable? 

We’re unaware of Australian studies tackling these issues, but researchers in the US have answered these questions using hard data.

Led by Dr Katie M. Applebaum of George Washington University, researchers accessed more than 100,000 non-fatal workplace injury records collected between 1994 and 2000 by the New Mexico Workers’ Compensation Administration. All the workers were aged between 15 and 80. 

The researchers divided the injury records into two groups. One group comprised workers (numbering around 36,000) who had at least a week off work because of the injury. We’ll call these workers with lost time injuries, or LTIs. The other group of workers (numbering around 64,000) were off work for less than a week. We’ll call these workers with short-term injuries. 

By the end of December, 2013, 8313, or 8% of the original 100,000 workers, had died. The researchers wanted to know whether the workers with LTIs were at greater risk of dying from drugs and suicide than the other workers. 

The leading cause of mortality was cancer, causing nearly a quarter (22.4%) of deaths overall. This was followed by circulatory problems (22.2%), accidental causes (10%), drug-related deaths (8.1%), respiratory illness (8.1%), suicide (5.8%) and alcohol-related deaths (4.9%).

Given the uncertainty that can attend cases of drug overdose, the researchers also created a category that combined death from drugs and / or suicide. Women with LTIs were more than two and a half times more likely to dies from this cause than other women. Men were close to one and a half times more likely.

Alcohol-related death was also more likely for workers with LTIs than other workers – 62% greater risk for women and 39% greater risk for men.

The researchers concluded that: 

Workplace injuries severe enough to require more than a week off work may impair workers’ long‐term health and well‐being. Drug‐related deaths and suicides may be important contributors to the long‐term excess mortality of injured workers. Improved workplace conditions, improved pain treatment, better treatment of substance use disorders, and treatment of post-injury depression may substantially reduce mortality consequent to workplace injuries.

This research is compelling but not conclusive. The study didn’t report on levels of drug addiction or suicidal ideation before the work injury occurred. It’s possible that workers who took more time off had higher levels of both even before they were injured at work. It’s also possible that New Mexico may be a special case, even within America. Nevertheless, these tragic findings are a strong indication that workers who are off work for more than a week are vulnerable to further harm, including harm that is self-inflicted. 

We would welcome more research on this vital topic, including research focused on Australia and New Zealand.

Original research

Applebaum, K.M., Asfaw, A., O'Leary, P.K., Busey, A.H., Tripodis, Y., & Boden, L.I. (2019). Suicide and drug-related mortality following occupational injury. American journal of industrial medicine. DOI: 10.1002/ajim.23021