Course of Depressive Symptoms Following a Workplace Injury: A 12-Month Follow-Up Update


Introduction To estimate the prevalence, incidence and course of depressive symptoms, their relationship with return-to-work, and prevalence of depression diagnosis/treatment 12 months following a lost-time workplace musculoskeletal injury. Methods In a prospective cohort study, 332 workers’ compensation claimants with a back or upper extremity musculoskeletal disorder completed interviews at 1, 6 and 12 months post-injury. Participants self-reported they had not received a depression diagnosis 1 year pre-injury. Cutoff of 16 on the CES-D defined a high level of depressive symptoms. Self-reported data on depression diagnosis and treatment and work status since injury were collected. Results Cumulative incidence of high depressive symptom levels over 12 months was 50.3 % (95 % CI 44.9–55.7 %). At 12 months, 24.7 % (95 % CI 20.1–29.3 %) of workers exhibited high levels. Over 12 months, 49.7 % (95 % CI 44.3–55.1 %) had low levels at all 3 interviews, 14.5 % (95 % CI 10.7–18.2 %) had persistently high levels, and 25.6 % (95 % CI 20.9–30.3 %) demonstrated improvements. Among workers with low baseline levels, incidence of high levels at 12 months was 6.0 % (95 % CI 2.7–9.3 %). For workers with high baseline levels, 36.1 % (95 % CI 27.9–44.3 %) exhibited persistent high symptoms at 6 and 12 months, while 38.4 % (95 % CI 30.1–46.6 %) experienced low levels at 6 and 12 months. Problematic RTW outcomes were common among workers with a poor depressive symptom course. Among workers with persistent high symptoms, 18.8 % (95 % CI 7.7–29.8 %) self-reported receiving a depression diagnosis by 12 months and 29.2 % (95 % CI 16.3–42.0 %) were receiving treatment at 12 months. Conclusions Depressive symptoms are common in the first year following a lost-time musculoskeletal injury and a poor depressive symptom course is associated with problematic RTW outcomes 12 months post-injury. While symptoms appear to improve over time, the first 6 months appear to be important in establishing future symptom levels and may represent a window of opportunity for early screening.

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We would like to thank Marjan Vidmar and Hyunmi Lee for preparing and managing the data for this study. Nancy Carnide was supported by a Vanier Canada Graduate Scholarship from the Canadian Institutes of Health Research during the conduct of this research.

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Corresponding author

Correspondence to Nancy Carnide.

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Renée-Louise Franche and Sheilah Hogg-Johnson conceptualized and designed the study. Renée-Louise Franche supervised the study. Colette Severin was responsible for coordinating the project. Nancy Carnide and Renée-Louise Franche performed the statistical analyses with substantive feedback from Sheilah Hogg-Johnson, Pierre Côté, F. Curtis Breslin, Colette Severin, Ute Bültmann, and Niklas Krause. Nancy Carnide and Renée-Louise Franche wrote the paper. All authors critically reviewed the manuscript and approved the final version.


This study was funded by a research grant provided by the Workplace Safety and Insurance Board of Ontario (WSIB) and by the Social Science and Humanities Research Council - Research Action Alliance on Consequences of Work Injury (RAACWI). WSIB was involved in providing feedback on the questionnaire used in this study and in the recruitment of participants, only. WSIB was not involved in the analysis, interpretation of data, writing, and decision to submit this paper for publication. RAACWI did not have direct input in this project. The Institute for Work & Health operates with the support of the Province of Ontario. The views expressed in this document are those of the authors and do not necessarily reflect those of the Province of Ontario.

Ethical Standard

This study was approved by the University of Toronto’s Ethics Review Board. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

Conflict of interest

Nancy Carnide, Pierre Côté, Colette Severin, Ute Bültmann, and Niklas Krause declare that they have no conflict of interest. Salaries for Renée-Louise Franche, F. Curtis Breslin, and Sheilah Hogg-Johnson at the Institute for Work & Health came from a core funding grant from the Workplace Safety & Insurance Board during the conduct of this research.

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Carnide, N., Franche, RL., Hogg-Johnson, S. et al. Course of Depressive Symptoms Following a Workplace Injury: A 12-Month Follow-Up Update. J Occup Rehabil 26, 204–215 (2016).

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  • Depression
  • Occupational injuries
  • Workers’ compensation