| Summary: | 博士 === 國立臺灣大學 === 職業醫學與工業衛生研究所 === 101 === Background and objective: The labor who has exposed to a traumatic event may display significant psychiatric disorders that make them unable to return to the work place. The proportion of those returned to the work place, but immediately retarded has been increased. So far, in Taiwan there has no research focused on the prevalence and risk factors of post-traumatic stress disorder (PTSD) in the workplace. However, PTSD has been included in the list of occupational diseases; therefore, the purposes of this study are to examine the prevalence rates of post-traumatic stress disorder in the workplace after occupational injuries, risk factors of post-traumatic stress disorder after occupational injuries, and the effects on return to work (RTW) among the injured workers, in order to reduce the employer’s doubt and to ensure the quality of life of the labors. Therefore, the aims of this study are: 1) To determine the prevalence and risk factors of post-traumatic stress disorder (PTSD) and other psychiatric disorders at 3 months after occupational injuries; 2) To determine the prevalence and risk factors of chronic post-traumatic stress disorder (PTSD) and other psychiatric disorders at 12 months after occupational injuries; 3) To investigate the impact of psychological symptoms on return to work (RTW) in workers after occupational injuries.
Methods: Our study candidates were injured workers in Taiwan who were hospitalized for 3 days or longer and received hospitalization benefits from the Labor Insurance program. A two-staged survey study was conducted. A self-reported questionnaire including the Brief Symptom Rating Scale (BSRS-50) and Post-traumatic Symptom Checklist (PTSC) was sent to workers at 3 months and 12 months after injury. Those who met the criteria were recruited for the second stage phone interview with a psychiatrist using the Mini-international Neuropsychiatric Interview (MINI).
Results: A total of 2001 workers completed the questionnaire (response rate 45.5%) at 3 months after occupational injury. Among them, 357 (17.8%) fulfilled the criteria for the MINI interview and were invited. A total of 148 (41.5%) completed the phone interview. The estimated rates of PTSD, partial PTSD (PPTSD), major depression, comorbid PTSD/PPTSD and major depression, and either PTSD/PPTSD or major depression were 2.7%, 4.1%, 3.0%, 2.3%, and 7.5%, respectively. The risk factors for developing psychological symptoms at 3 months after occupational injury were gender, loss of consciousness after occupational injury, injury affecting physical appearance, occupational injury experience before this event, life experience before and after this injury, length of hospital stay, self-rated injury severity, and percentage of income to the family. On the other hand, a total of 1233 workers completed the questionnaire (response rate 28.0%) at 12 months after occupational injury. Among them, 167 (13.5%) fulfilled the criteria for the MINI interview and were invited. A total of 106 (63.5%) completed the phone interview. The estimated rate of either PTSD/PPTSD or major depression was 5.2%. The risk factors for developing long-term psychological symptoms were gender, education level, loss of consciousness after occupational injury, injury affecting physical appearance, occupational injury experience before this event, life experience before and after this injury, length of hospital stay, self-rated injury severity, and percentage of income to the family. Among 2001 workers who completed RTW questionnaire at 3 months after injury, 1149 had returned to work. Among the 852 who were unable to return to work at 3 months after injury, 225 reportedly returned to work by one year. A proportional hazards regression indicated that after adjusting for all possible risk factors, higher scores in BSRS-50 and BSRS-5 at 3 months after injury were significant risk factors for not return to work (NRTW) at one year after injury. Other risk factors were gender, education level, length of hospitalization, affected physical appearance, and injury type. Among 10 psycho-physiological symptoms of BSRS-50, a proportional hazards regression indicated that high score in phobic-anxiety scale was a risk factor for NRTW.
Conclusion: These results showed that after occupational injuries, a significant proportion of workers suffered from psychiatric disorders, and occupational injury can cause long-term psychological impact in the workers. After considering all other factors, psychological symptoms further predicted poorer probability of returning to work after occupational injury, and phobic-anxiety was the most significant symptom predicting poor RTW. Development of preventive measures among injured workers according to the risk factors identified in this study is warranted.
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