When a person leaves a job due to a serious injury, the resulting mental health issues, like depression or post-traumatic stress, can endure longer than the physical ones. New research by Aimee Palumbo, assistant professor in the Department of Epidemiology and Biostatistics, finds a connection between returning to work and mental health outcomes in Black men in Philadelphia recovering from serious injuries.
The research, newly published in the journal Injury, finds not returning to work after injury to be strongly associated with depression and post-traumatic stress disorder (PTSD). Men in the study who had not returned to work after traumatic injury had 2.7 times greater odds of poor mental health than men who had returned to work.
“Work is such an important part of one's identity for many adults,” says Palumbo, whose research often applies foundational principles of epidemiology to understand how social exposures, such as where people live and work, influence health.
The return-to-work study examines data that was assembled during Palumbo’s postdoctoral work at the University of Pennsylvania. Therese Richmond, a Penn nursing professor, led a study gathering information from 623 men following traumatic injury, to explore psychological outcomes of trauma. Palumbo has drilled down on the return-to-work information that was gathered as part of that research.
She found that returning to work, type of insurance, and experiences of racism factor into mental health and recovery after traumatic injury. “These issues intertwine in complex ways,” Palumbo says. Many of the men in the study were economically vulnerable to begin with. Seventy-five percent of those who reported incomes reported their annual household income to be below the median income for Philadelphia, with 51 percent reporting income below $20,000. That may contribute to why not returning to work was associated with poor mental health. Men in the group who had public insurance or no insurance had worse mental health outcomes than men with private insurance.
Those who reported substantial experiences of racism in and out of the workplace were less likely to have returned to work at the time of the study’s follow-up. The study asked the men validated questions about their experiences of racial discrimination, including whether others thought they couldn’t handle a job, if they had been treated unfairly by bosses or coworkers, or if others hinted that they must be lazy. Forty-one percent of the men reported having experienced substantial racism prior to the injury; just 10 percent reported never experiencing racism.
“So you can see how those perceptions might shape somebody’s willingness to return to work when they are not fully recovered,” Palumbo says.
The findings suggest that approaches to optimize recovery after injury should go beyond physical rehabilitation, she says. Engagement with mental health services is important for post-injury patients who meet screening criteria for depression and PTSD, as well as considerations of structural factors such as financial stability and the impact of experiences with racism could be useful components of post-injury care.