心理疾病与受伤后重返工作岗位：多中心队列研究。
Psychological morbidity and return to work after injury: multicentre cohort study.
作者信息
Kendrick Denise, Dhiman Paula, Kellezi Blerina, Coupland Carol, Whitehead Jessica, Beckett Kate, Christie Nicola, Sleney Judith, Barnes Jo, Joseph Stephen, Morriss Richard
机构信息
School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham.
Research Design Service East Midlands, Queen's Medical Centre, Nottingham.
出版信息
Br J Gen Pract. 2017 Aug;67(661):e555-e564. doi: 10.3399/bjgp17X691673. Epub 2017 Jun 19.
BACKGROUND
The benefits of work for physical, psychological, and financial wellbeing are well documented. Return to work (RTW) after unintentional injury is often delayed, and psychological morbidity may contribute to this delay. The impact of psychological morbidity on RTW after a wide range of unintentional injuries in the UK has not been adequately quantified.
AIM
To quantify the role of psychological factors, including anxiety, depression, and post-traumatic distress, on RTW following unintentional injuries.
DESIGN AND SETTING
A longitudinal multicentre prospective study was undertaken in Nottingham, Bristol, Leicester, and Guildford, UK.
METHOD
Participants ( = 273) were 16-69-year-olds admitted to hospital following unintentional injury, who were in paid employment prior to injury. They were surveyed at baseline, then at 1, 2, 4, and 12 months following injury; demographic data were collected along with injury characteristics, psychological morbidity, and RTW status. Associations between demographic, injury and psychological factors, and RTW between 2 and 12 months after injury were quantified using random effects logistic regression.
RESULTS
The odds of RTW between 2 and 12 months after injury reduced as depression scores early in the recovery period (1 month after injury) increased (odds ratio [OR] 0.87, 95% confidence interval [CI] = 0.79 to 0.95) and as length of hospital stay increased (OR 0.91, 95% CI] = 0.86 to 0.96). For those experiencing threatening life events following injury (OR 0.27, 95% CI = 0.10 to 0.72) and with higher scores on the Crisis Support Scale (OR 0.93, 95% CI] = 0.88 to 0.99), the odds of RTW between 2 and 12 months after injury were lower. Multiple imputation analysis found similar results, but those relating to crisis support did not remain statistically significant.
CONCLUSION
Primary care professionals can identify patients at risk of delayed RTW who may benefit from management of psychological morbidity and support to RTW.
背景
工作对身体、心理和财务健康的益处已有充分记录。意外伤害后重返工作岗位（RTW）的时间往往会延迟，心理疾病可能是导致这种延迟的原因之一。在英国，心理疾病对各种意外伤害后RTW的影响尚未得到充分量化。
目的
量化心理因素，包括焦虑、抑郁和创伤后应激，对意外伤害后RTW的作用。
设计与地点
在英国诺丁汉、布里斯托尔、莱斯特和吉尔福德进行了一项纵向多中心前瞻性研究。
方法
参与者（n = 273）为16 - 69岁因意外伤害入院的患者，受伤前有带薪工作。在基线时进行调查，然后在受伤后的1、2、4和12个月进行调查；收集人口统计学数据以及损伤特征、心理疾病和RTW状态。使用随机效应逻辑回归量化人口统计学、损伤和心理因素与受伤后2至12个月RTW之间的关联。
结果
受伤后2至12个月RTW的几率随着恢复期早期（受伤后1个月）抑郁评分的增加而降低（比值比[OR] 0.87，95%置信区间[CI] = 0.79至0.95），并且随着住院时间的延长而降低（OR 0.91，95% CI = 0.86至0.96）。对于受伤后经历威胁生命事件的患者（OR 0.27，95% CI = 0.10至0.72）以及危机支持量表得分较高的患者（OR 0.93，95% CI = 0.88至0.99），受伤后2至12个月RTW的几率较低。多重填补分析发现了类似的结果，但与危机支持相关的结果在统计学上不再显著。
结论
初级保健专业人员可以识别有RTW延迟风险的患者，这些患者可能受益于心理疾病的管理和RTW支持。
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