O'Donnell Meaghan L, Grant Genevieve, Alkemade Nathan, Spittal Matthew, Creamer Mark, Silove Derrick, McFarlane Alexander, Bryant Richard A, Forbes David, Studdert David M
Australian Centre for Posttraumatic Mental Health, Level 3, Alan Gilbert St, 161 Barry St, Carlton, VIC, 3053, Australia
J Clin Psychiatry. 2015 Aug;76(8):e1000-5. doi: 10.4088/JCP.14m09211.
Claiming for compensation after injury is associated with poor health outcomes. This study examined the degree to which compensation-related stress predicts long-term disability and the mental health factors that contribute to this relationship.
In a longitudinal, multisite cohort study, 332 injury patients (who claimed for compensation) recruited from April 2004 to February 2006 were assessed during hospitalization and at 3 and 72 months after injury. Posttraumatic stress, depression, and anxiety symptoms (using the Mini-International Neuropsychiatric Interview) were assessed at 3 months; compensation-related stress and disability levels (using the World Health Organization Disability Assessment Schedule II) were assessed at 72 months.
A significant direct relationship was found between levels of compensation-related stress and levels of long-term disability (β = 0.35, P < .001). Three-month posttraumatic stress symptoms had a significant relationship with compensation-related stress (β = 0.29, P < .001) as did 3-month depression symptoms (β = 0.39, P < .001), but 3-month anxiety symptoms did not. A significant indirect relationship was found for posttraumatic stress symptoms and disability via compensation stress (β = 0.099, P = .001) and for depression and disability via compensation stress (β = 0.136, P < .001).
Stress associated with seeking compensation is significantly related to long-term disability. Posttraumatic stress and depression symptoms increase the perception of stress associated with the claims process, which in turn is related to higher levels of long-term disability. Early interventions targeting those at risk for compensation-related stress may decrease long-term costs for compensation schemes.
受伤后索赔与不良健康结果相关。本研究调查了与索赔相关的压力对长期残疾的预测程度以及促成这种关系的心理健康因素。
在一项纵向、多地点队列研究中，对2004年4月至2006年2月招募的332名受伤患者（索赔者）在住院期间以及受伤后3个月和72个月进行评估。在3个月时评估创伤后应激、抑郁和焦虑症状（使用迷你国际神经精神病学访谈）；在72个月时评估与索赔相关的压力和残疾水平（使用世界卫生组织残疾评估量表第二版）。
发现与索赔相关的压力水平和长期残疾水平之间存在显著的直接关系（β = 0.35，P <.001）。3个月时的创伤后应激症状与索赔相关压力有显著关系（β = 0.29，P <.001），3个月时的抑郁症状也是如此（β = 0.39，P <.001），但3个月时的焦虑症状并非如此。发现创伤后应激症状和残疾通过索赔压力存在显著的间接关系（β = 0.099，P =.001），抑郁和残疾通过索赔压力也存在显著的间接关系（β = 0.136，P <.001）。
与索赔相关的压力与长期残疾显著相关。创伤后应激和抑郁症状增加了与索赔过程相关的压力感，这反过来又与更高水平的长期残疾相关。针对有与索赔相关压力风险的人群进行早期干预可能会降低赔偿计划的长期成本。
