Guest Rebecca, Tran Yvonne, Gopinath Bamini, Cameron Ian D, Craig Ashley
John Walsh Centre for Rehabilitation Research, Kolling Institute for Medical Research, Sydney Medical School-Northern, The University of Sydney, Sydney, Australia.
BMJ Open. 2017 Sep 5;7(9):e017515. doi: 10.1136/bmjopen-2017-017515.
To determine whether psychological distress associated with musculoskeletal injuries sustained in a motor vehicle crash (MVC), regardless of time of onset, impacts compensation outcomes such as claim settlement times and costs. Second, to identify factors routinely collected by insurance companies that contribute to psychological distress during the compensation process.
Statewide retrospective study.
Analysis of the New South Wales statewide (Australia) injury register for MVC survivors who lodged a compensation claim from 2011 to 2013.
6341 adults who sustained a musculoskeletal injury and who settled a claim for injury after an MVC. Participants included those diagnosed with psychological distress (n=607) versus those not (n=5734).
Time to settlement and total costs of claims, as well as socio-demographic and injury characteristics that may contribute to elevated psychological distress, such as socio-economic disadvantage, and injury severity.
Psychological distress in those with a musculoskeletal injury was associated with significantly longer settlement times (an additional 17 weeks) and considerably higher costs (an additional $A41 575.00 or 4.3 times more expensive). Multivariate logistic regression analysis identified risk factors for psychological distress including being female, social disadvantage, unemployment prior to the claim, not being at fault in the MVC, requiring ambulance transportation and rehabilitation as part of recovery.
Results provide compelling evidence that psychological distress has an adverse impact on people with musculoskeletal injury as they progress through compensation. Findings suggest that additional resources should be directed toward claimants who are at risk (eg, the socially disadvantaged or those unemployed prior to the claim), the major aim being to reduce risk of psychological distress, such as post-traumatic stress disorder, and associated risk of increased settlement times and claim costs. Prospective studies are now required that investigate treatment strategies for those at risk of psychological distress associated with an MVC.
确定机动车碰撞事故（MVC）中遭受的肌肉骨骼损伤所伴随的心理困扰，无论其发病时间如何，是否会影响理赔结果，如理赔解决时间和成本。其次，识别保险公司在理赔过程中常规收集的、导致心理困扰的因素。
全州范围的回顾性研究。
对2011年至2013年在新南威尔士州（澳大利亚）全州范围内因MVC而提出理赔申请的幸存者的损伤登记册进行分析。
6341名遭受肌肉骨骼损伤且在MVC后就损伤理赔达成协议的成年人。参与者包括被诊断为有心理困扰的人（n = 607）和未被诊断为有心理困扰的人（n = 5734）。
理赔解决时间和理赔总成本，以及可能导致心理困扰加剧的社会人口统计学和损伤特征，如社会经济劣势和损伤严重程度。
肌肉骨骼损伤患者的心理困扰与显著更长的理赔解决时间（额外17周）和高得多的成本（额外41575.00澳元或贵4.3倍）相关。多因素逻辑回归分析确定了心理困扰的风险因素，包括女性、社会劣势、理赔前失业、在MVC中无过错、需要救护车运送以及康复是康复的一部分。
结果提供了令人信服的证据，表明心理困扰在人们进行理赔过程中对肌肉骨骼损伤患者有不利影响。研究结果表明，应将额外资源用于有风险的索赔人（例如社会弱势群体或理赔前失业者），主要目的是降低心理困扰的风险，如创伤后应激障碍，以及理赔解决时间延长和理赔成本增加的相关风险。现在需要进行前瞻性研究，以调查与MVC相关的有心理困扰风险者的治疗策略。
