Comorbid Mental Health Disorders in Workers’ Compensation & Auto No-fault: Part two

Clinical Connection team
| Oct 17, 2019

It’s no secret there’s a close connection between mental health and overall physical health. For this reason, injuries can lead to a number of unexpected outcomes such as depression, sleep-related disorders and anxiety disorders. And the likelihood of developing depression increases as the severity of pain strengthens. One study demonstrated that injured workers were 45% more likely to suffer from depression than non-injured workers.1

These problems can cause devastating consequences disrupting overall quality of life and straining relationships that often protect against these disorders in the first place. In addition, comorbid mental health disorders in an injured individual can result in a longer duration of treatment and increased cost burden.2

For example, an injured worker with a lumbar sprain and disc involvement is typically out of work 30 days, add in comorbid depression and the missed time from work nearly doubles to 53 days.3

Inability to work can worsen psychological symptoms
Work provides an individual with a structured sense of self, identity and purpose in life. When physical injury prevents a person from being able to function in this capacity, the worker’s psyche is often impacted negatively. Physical pain from these injuries can limit a worker’s ability to do their job, as well as normal activities of daily life, often requiring medication, such as opiates. Over time, these medications can become addictive, leading to higher rates of opioid use disorders.

Persons with a substance abuse disorder miss between 15-29 days per year of work.4 It is estimated that healthcare costs are three times higher for persons who abuse opioids.5

The impact of depression on health outcomes
Physical pain as well as prolonged periods of time away from work can often lead to signs and symptoms of depression, such as decreased interest in pleasurable activities, decreased appetite, impaired sleep, feelings of guilt and, in extreme cases, thoughts of suicide. These symptoms often go unnoticed as they can sometimes be confused with pain syndromes.6 Coexisting depression is two times more likely when an individual is in pain.

A traumatic injury with associated pain has a typical return to work period of 45 days. However, if depression is a comorbidity, the anticipated return to work time increases to 83 days.

Research also shows significantly greater costs associated with treatment of depression.

A 2016 study estimated the annual cost of treatment of major depression was $6,787. Add in the cost of an injury with medical leave and costs escalated to $13,929.7

Trauma from injuries can intensify mental health issues
For some injured individuals, the actual injury can be a traumatic experience. Over time, the original trauma can trigger sleep impairment, anxiety, flashback and nightmares, and lead to post-traumatic stress disorder.

Early intervention has proven to improve outcomes
Early recognition of these conditions and applying prompt treatment with appropriate medications (antidepressant medication, sedatives, and anxiolytics), as well as therapeutic modalities such as cognitive behavioral therapy, can have a very positive impact and increase the probability of a successful return to work.

As noted by Teh et al in a 2010 study, any treatment, regardless of type, improved pain scores, reduced depression severity and improved social functioning.8

Over the next few weeks, we’ll release another blog post each week covering comorbid conditions that can negatively impact workers’ compensation and auto no-fault cases: hypertension, respiratory issues, and diabetes/obesity.

Check out our entire series on comorbid conditions in workers’ comp and auto no-fault on our Comorbidity Conditions page here.  We cover comorbid conditions that can negatively impact workers’ compensation and auto no-fault cases: 1. Effect of comorbidities, 2. Mental Health, 3. Hypertension, 4. Respiratory Issues, 5. Diabetes/Obesity.



  1. Asfaw A, Souza K. Incidence and cost of depression after occupational injury. Journal of Occupational and Environmental Medicine. 2012, 54(9) 1086-1091.
  2. Kim: Depression as a psychosocial consequence of occupational injury in the US working population: findings from medical expenditure panel survey. BMC Public Health 2013, 13:303.
  3. Official Disability Guidelines. Comorbidity Calculator. Available on subscription at: Accessed October 11, 2019.
  4. Centers for Disease Control and Prevention. NiOSH launhes a new framework to tackle opioid crisis in the workplace. Accessed Oct 11, 2019.
  5. McCormick V. The rise of workplace opioid abuse. Clan Lab, Health and Safety Training May 2019. Accessed Oct 11,2019
  6. Cosio, David, et al. “The Association Between Depressive Disorder and Chronic Pain.” Practical Pain Management, 2017,
  7. Goldberg R, Steury S. Depression in the workplace: costs and barriers to treatment. Psychiatric Services Online. Accessed October 11, 2019.
  8. Teh CF, Zaslavasky A, Reynolds CF et al. Effect of depression treatment on chronic pain outcomes. Psychosom Med. 2010 72(1):61-67/

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