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Are there differences in the return to work process for work-related psychological and musculoskeletal injuries? A longitudinal path analysis



To examine differences in the return to work (RTW) process for workers’ compensation claimants with psychological injuries compared to those with musculoskeletal (MSK) injuries.


We collected data from 869 workers’ compensation claimants in Victoria, Australia, at three time points over a 12-month period (21% with psychological injury claims). RTW was assessed through self-report. Potential mediators were identified at the personal, health-care provider, workplace and system levels. The relationships between injury type, mediating factors and RTW were assessed using path analysis, with adjustment for confounders through inverse probability weighting.


We observed better RTW outcomes for claimants with MSK injuries (compared to those with psychological injuries) at T1 and T2, but not at T3. We also observed differences between psychological injuries and MSK injuries and all but two of the mediating factors examined. These differences, in particular related to supervisor response to injury, consultative RTW planning and offers of accommodation, as well as differences in mental health symptoms, explained approximately two-thirds of differences in RTW between injury types at T1. Differences in RTW at T2 were explained by mediating factors, and differences in RTW at T1.


Claimants with work-related psychological injuries experience a variety of challenges in RTW compared to those with MSK injuries. While treating and preventing further exacerbation of psychological symptoms should remain an important part of the rehabilitation process, other modifiable factors, in particular supervisor response to injury and consultative RTW planning and modified duties, should be prioritised to reduce inequalities in RTW across injury types.

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Fig. 1


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    From here on we use the term “injury” and “injuries” to refer to both injury/injuries and illness/illnesses.


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This study is funded through the Australian Research Council (ARC) linkage grant (Project number LP130100091). During the study, PS was supported by the Discovery Early Career Researcher Award from the Australian Research Council (DE120101580), and a Research Chair in Gender, Work and Health from the Canadian Institutes of Health Research. We would like to acknowledge the Social Research Centre (SRC) for undertaking the interviews. We acknowledge the assistance of WorkSafe Victoria, SafeWork Australia, Office of The Age Discrimination Commissioner, Beyond Blue and the Australian Industry Group as part of the project. The authors declare that they have no competing interests

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Correspondence to Peter Smith.

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See Appendix Table 4.

Table 4 Distribution of covariates across injury type prior and subsequent to addition of inverse probability weights (N = 869)

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Smith, P., LaMontagne, A.D., Lilley, R. et al. Are there differences in the return to work process for work-related psychological and musculoskeletal injuries? A longitudinal path analysis. Soc Psychiatry Psychiatr Epidemiol (2020).

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  • Return to work
  • Occupational injuries
  • Psychological injury
  • Path analysis