Uncertainty is a key factor in the relationship between work injury and mental health, research shows

Mental health and workplace injuries are known to be closely linked, but there are significant gaps in our deeper understanding of that bidirectional relationship. How does one affect the other, what moderates the relationship and what are the long-term implications for overcoming injuries and returning to work?

In a recent meta-analysis of the existing literature published in the journal Personnel Psychology, assistant professor of management Steve Granger and his University of Calgary co-author Nick Turner argue that the relationship is not equal. They found that work-related injuries are more likely to precede mental health challenges than mental health challenges preceding injuries.

"We initially wanted to simply get a grasp on what we know, based on what has already been done in the English language, on this particular relationship," Granger says.

"That led us to the consequences of mental health challenges on work injuries. We uncovered this bidirectional relationship showing that work injuries can elicit and exacerbate pre-existing mental health challenges. As well, the experience of struggling with a mental health challenge on a day-to-day basis has a non-negligible impact on the likelihood of a workplace injury."

The pain of not knowing

The authors found a possible explanation in a theory drawn from nursing literature. The Uncertainty in Illness theory, developed in the late 1980s, is a framework used to understand how people suffering from an illness cope with the uncertainty around it and try to make sense of their condition. Granger says the same theory can be applied to people who suffer workplace injuries.

"When you experience an injury, you tend to ruminate on it and counterfactually think, 'What if I hadn't gone into work that day or not agreed to take on that extra shift?' These negative cognitions and maladaptive thoughts can exacerbate mental health problems following an injury. These are all fed by uncertainty," Granger explains.

Granger says this creates a loop effect, where negative cognitions can result in a more dangerous workplace.

"When you are struggling with depression or are suffering with anxiety, there tends to be an extra weight on your shoulders. Job tasks you are usually able to deal with on a regular basis just seem a little harder, or maybe you are more distracted and can't focus your attention on what you should," he says.

Granger notes that the bidirectional relationship is not an equal one. The evidence suggests that the relationship between preceding work injuries and later mental health challenges is more robust than the evidence from mental health challenges to later work injuries.

The authors note these findings have significant practical and theoretical implications. First and foremost, it demonstrates the need to rethink the way workplace injuries are treated. They argue that there is an urgent need for a stronger focus on psychological rehabilitation alongside existing physical rehab return-to-work programs.

Addressing both the physical and psychological rehabilitation dimensions can be a vital step to preventing downward mental health spirals that can emerge due to workplace injuries. They stress that dignity, fair treatment and adequate support following an injury are critical to reintegration into the work force.

"You want to get people back to work as soon as possible, because the longer they are away, the harder and more expensive it's going to be," Granger says.