«Work Impairment And Limitations Associated With Posttraumatic Stress Disorder Background It is estimated that 3.6% of adults in the United States ...»
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Work Impairment And Limitations Associated With Posttraumatic Stress Disorder
It is estimated that 3.6% of adults in the United States have PTSD in any given year, with 7.8% developing PTSD during their lifetime (National Comorbidity Survey - Kessler et al., 1995). Oneyear prevalence rates in other countries vary from 0.1% in a German male population to 1.2% in Australia and 1.3% in six European cities combined (Perkonnig et al., 2000; Creamer et al., 2001; Alonso et. al., 2004). In terms of Canadian prevalence rates, two studies have estimated the one-year rate of PTSD in Canada to be 2.7% and 1.0% respectively (Stein et al., 1997;
Sareen et al., 2007). In addition, approximately 3 – 10% of Canadian adults may have a number of symptoms of PTSD without developing the full disorder, sometimes labeled “partial PTSD” (Stein et al., 1997, 2000).
While between 50% and 90% of adults have experienced at least one traumatic event in their life, only 5 – 10% of these actually go on to develop PTSD (Reznick et al., 1993; Breslau et al., 1998, 2002; Kessler et al., 1995, Ozer et al., 2003). In addition, it appears that the majority of individuals recover from trauma in 6 – 16 months without developing any long-term problems, making resiliency the most common outcome after traumatic events (Baum & Fleming, 1993;
Green et al., 1994; La Greca et al., 1996; Bryant, 2003, 2006). A number of factors have been found to increase the risk for developing PTSD (and other mental disorders) including history of mental health problems, previous trauma, poor social support, poor ability to cope with stress, type of traumatic event, severity of injuries, high level of immediate distress, and post-trauma dissociative symptoms (Brewin et al., 2000; Norris et al., 2001, 2002; Ozer et al., 2003).
The following chart outlines the different rates of PTSD associated with various traumatic events (highlighted events are likely to occur in a work setting):
Rape 49% Bombing 34% Severe assault 32% Combat action 30% Plane crash 29% Mass shooting 28% Armed Robbery 24% Serious accident/injury 17% Shooting or stabbing 16% Wi
al., 2003; Nyberg et al., 2003). Interestingly, in studies that compared work-related accidents to non-work accidents, work-related cases had less severe injuries, more PTSD symptoms, and were more likely to involve litigation (Mason et al., 2002). In addition, research has found that certain types of injuries or incidents are associated with more severe PTSD including upper limb injuries (vs. lower limb amputation), amputations (vs. burns), electrical burns (vs. other burns), high stress (vs. low/med stress incidents), and robberies (vs. work accidents). Factors most likely to affect return to work from PTSD include severity of injury, tendency to blame others, involvement in litigation, physical recovery, and overall mental health functioning (Mason et al., 2002).
In a recent study of WorkSafeBC clients with PTSD (MacDonald et al., 2003), 84% directly experienced a traumatic event (45% robbery, 32% assault, 7% other) and 16% witnessed a traumatic event. In terms of diagnoses, 55% of workers had PTSD only, while 45% had PTSD plus other disorders. Comorbid diagnoses included depressive disorders (27%), anxiety disorders (9%), and mixed depression/anxiety disorders (9%). At a four-year follow-up, 65.9% clients had returned to work while 34.1% had not re-entered the workforce. Of those returning to work, 43.2% returned to the same job, 2.3% returned to a different position with the same employer, 4.5% returned to the same industry, and 34.1% had moved on to a new industry.
Only 1% of workers were assessed with a psychological permanent functional impairment.
Impact of PTSD on work functioning
The relationship between PTSD and work has not been investigated to the same extent as for depression, particularly in relation to reduced productivity and performance on the job (often called “presenteeism”). However, the available research has found that PTSD is associated with impaired occupational functioning, as indicated by absenteeism, unemployment, and work disability (Breslau, 2001; Breslau et al, 2004; Hull et al., 2002; Matthews & Chinnery, 2005). In fact, work impairment associated with PTSD appears to be very similar to the amount of work impairment associated with major depression (Nicoletta et al., 2001).
In addition, PTSD symptom severity has been found to be associated with occupational impairment, even after controlling for the effects of comorbid disorders (Breslau et al., 2004;
Ciechanowski et al., 2004; Momartin et al., 2004; Stein et al., 1997; Zatzick et al., 1997).
However, while work impairment was significantly more pronounced in persons with full PTSD than in those with only partial symptoms, the latter nonetheless exhibited clinically meaningful levels of impairment association with their symptoms (Stein et al., 1997; Zlotnick et al., 2002;
Breslau et al., 2004; Matthews & Chinnery, 2005).
Work impairments and limitations Below are outlined possible work-related impairments and limitations which may result from symptoms in workers diagnosed with PTSD. As in previous memos, these have been derived from the research literature, clinical experience, and consensus among psychologists working in the workers compensation system. It should be noted that individual limitations will depend on a worker’s circumstances, specific constellation of symptoms, severity of the disorder, and response to treatment.
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