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Abstract
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The primary objective of this research was to evaluate the prospective relation between depressive symptoms and rehabilitation outcomes in individuals who had sustained work-related musculoskeletal injuries.
Methods: A sample of 225 individuals with musculoskeletal injuries completed measures of depression, pain severity, catastrophizing, and fear of movement at admission, mid-treatment, and discharge from a 4 to 7 week rehabilitation intervention. participants also completed a follow-up telephone interview 12-months following treatment termination.
Results: the prevalence of clinically significant levels of depression was 40% at initial assessment and 20% at termination. Depressed participants were more likely than non-depressed participants to drop out of treatment. Pretreatment levels of depression and catastrophizing predicted pain at 1-year follow-up. Depression also predicted return to work status.Reductions in catastrophizing, but not depression, were associated with higher probability of return to work. Depression was associated with higher probability of using narcotics for pain, and a lower probability of work retention.
Conclusions: The findings in this study indicate that depression has a negative affect on response to rehabilitation treatment and return-to-work outcomes.
Discussion: In previous research, depression has been shown to contribute to longer periods of work absence following injury and lower probability of return to work. The researchers point out that there are different processes by which depression might impact on pain-related disability. Depression might add to the burden of disability associated with pain by accentuating the negative impact of the pain symptoms that ensue from whiplash injury. In spite of limitations, the present study showed that individuals who enter rehabilitation treatment with high levels of depression are less likely to return to work following treatment. Of the individuals who returned to work, depressed individuals were also less likely to maintain employment. Future research will need to identify the processes by which depression impacts on disability and the intervention approaches that are most effective in targeting disability associated with depression and pain. |