Are the predictors of work absence following a work-related

injury similar for musculoskeletal and mental health claims?

Peter M

1,2
Smith ,

Oliver

1
Black

, Tessa

1,3
Keegel

& Alex

1,4
Collie

1. Monash Centre for Occupational and Environmental Health, Department of Epidemiology and Preventive Medicine, Monash University, Australia;
2. Institute of Work and Health & Dalla Lana School of Public Health, University of Toronto, Canada; 3. The McCaughey Centre, Melbourne School of
Population Health, University of Melbourne, Australia; 4. Institute for Safety, Compensation and Recovery Research, Monash University, Australia

Background
Most of what we know about what works in return-to-work has been from studies examining musculoskeletal injuries. Mental health injuries are increasing in
Victoria and are generally associated with poorer return-to-work outcomes. The objective of this study was to compare the predictors of days of wage
replacement for work-related musculoskeletal and mental health claims.
Figure 1: Quartile coefficients and confidence intervals of
occupational time pressure for mental health and musculoskeletal
claims predicting the number of days of wage replacement

Results

0.5

Between 2005 and 2007, there were a total of 3,004 mental health and 10,889
musculoskeletal claims that met our inclusion criteria. The results presented are
variables with statistically significant differences in coefficients between the mental
health and musculoskeletal claim models.

0.4

Mental health claims from a high occupational time pressure environment were

0.3

associated with an increase in days of wage replacement (figure 1) compared to

musculoskeletal claims.

Musculoskeletal claims from part-time employment (ms=0.17, p<0.001; mh=-

0.2

0.01,p=0.83) were associated with an increase in days of wage replacement

compared to mental health claims.

Musculoskeletal

0.1

claims from a small employer (ms=0.43,p<0.001;

mh=0.13,p<0.001) were associated with an increase in days of wage
replacement compared to mental health claims.

Mental health claims and musculoskeletal claims from the education and training
-0.1
-0.2
Mental
Health
Claims

MSK
Claims

Quartile 2

Mental
Health
Claims

MSK
Claims

Quartile 3

Mental
Health
Claims

MSK
Claims

Quartile 4

industry (mh=.42,p=.004; ms=-0.26 p<0.001) were associated with an increase

and a decrease in days of wage replacement respectively, whereas mental health
claims from the transport, postal and warehousing industry were associated with
a decrease in days of wage replacement (mh=-0.44, p=0.01; ms=0.04, p=0.59)
compared to musculoskeletal claims. Mental health claims from the agricultural,
forestry, fishing and mining industry were also associated with a decrease in days
of wage replacement (mh=-0.72, p=0.005; ms=-0.06,p=0.60). Musculoskeletal
claims from the public administration and safety industry (ms= -0.17,p=0.04;
mh=0.23,p=0.07) were associated with an increase in days of wage replacement
compared to mental health claims.

Method

Figure 2 displays the proportion of claims by the absolute value of the residual

We extracted claims data from the Compensation Research Database,

which is housed by the Institute for Safety, Compensation and Recovery
Research; a joint collaboration between WorkSafe Victoria, the Transport
Accident Commission and Monash University.

Figure 2. Differences between predicted and actual values for the mental
health and musculoskeletal models.

All claimants with a day or more of wage replacement who had suffered a
work-related injury between 2005-2007 (inclusive) were considered for
this study. We restricted our analysis to those claims associated with
upper extremity or lower back musculoskeletal injuries, and mental health
injuries.
The primary outcome was the number of accumulated days of full wage
replacement over a 2-year period following the first day of absence from
work. With a negative binomial model, we modelled the outcome using
socio-demographic, injury, occupational and workplace characteristics.
Socio-demographic characteristics included age, gender, and a previous
work-related injury claim within 2 years of the injury date. Injury
characteristics included the number of days between the injury date and
first day of wage replacement.
Occupational characteristics included the type of employment [full
time(reference) or part-time], occupational strength requirements,
occupational time pressure (grouped into quartiles; quartile 1 = reference
category) and occupational
autonomy. Workplace characteristics
included the size of the employer [small, medium (reference) and large],
and the industry classification of the primary activity of the organisation
[grouped by manufacturing(reference); construction; wholesale trade;
health care and social assistance; retail trade, accommodation and food
services; transport, postal and warehousing; public administration and
safety; education and training; agriculture, fishing, forestry and mining;
and not elsewhere classified].

(|observed fitted value|) for the musculoskeletal and mental health claim
models.

70%
60%
50%
40%
30%
20%
10%
0%
Less than 30
days

31 60 days

61 90 days Greater than 90

days

Mental Health Claim Model. N (%)

MSK Claim Model. N (%)

Conclusions
We observed differences in the association of workplace and occupational level
factors and days of
musculoskeletal claims.

wage

replacement

between

mental

health

and

Higher accuracy estimates for the models were observed for musculoskeletal
claims compared to mental health claims. High variance in outcome of mental
health claims or unobserved variables could explain this difference.

Smith, P., et al. (2013). "Are the Predictors of Work Absence

Following a Work-Related Injury Similar for Musculoskeletal and
Mental Health Claims?" Journal of Occupational Rehabilitation: 1-10.