Research shows that uncertainty is a key factor in the link between work accidents and mental health

Funnel plot (a and b) and contour-enhanced funnel plot (c and d) of the weighted average correlation coefficients. Note: Black dots = observed studies. Light dots = imputed studies from the trim-and-fill method. For contour-enhanced funnel plots (c and d): white shading = p > .05; dark gray shading = p .01; light gray = p. Personal Psychology (2024). DOI: 10.1111/peps.12649

It is well known that mental health and workplace injuries are closely linked, but there are significant gaps in our deeper understanding of this reciprocal relationship. How does one influence the other, what moderates the relationship, and what are the long-term implications for injury recovery and return to work?

In a meta-analysis of the existing literature recently published in the journal Personnel psychologyAssistant Professor of Management Steve Granger and his co-author Nick Turner of the University of Calgary argue that the relationship is not equal. They found that work-related injuries are more likely to precede mental health problems than mental health problems are to precede injuries.

“We initially just wanted to get an overview of what we know about this particular context based on what has already been done in the English language,” says Granger.

“This led us to the impact of mental health problems on workplace accidents. We discovered this reciprocal relationship, which shows that workplace accidents can cause and exacerbate pre-existing mental health problems. In addition, the experience of struggling with mental health problems on a daily basis has a non-negligible influence on the likelihood of a workplace accident.”

The pain of not knowing

The authors found a possible explanation in a theory from the nursing literature. Developed in the late 1980s, the uncertainty theory of illness is a framework designed to understand how people suffering from illness cope with the uncertainty associated with it and try to make sense of their condition. Granger says the same theory can also be applied to people who are injured in the workplace.

“When you get injured, you tend to ruminate and think counterfactually: 'What if I hadn't gone to work that day or agreed to do that extra shift?' These negative perceptions and maladaptive thoughts can exacerbate mental health problems after an injury. They are all fed by uncertainty,” explains Granger.

According to Granger, this creates a circular effect in which negative perceptions can lead to a more dangerous workplace.

“When you struggle with depression or suffer from anxiety, there is often an extra burden on your shoulders. Work tasks that you can normally do on a regular basis just seem a little more difficult, or you may be more distracted and unable to focus your attention on what you should,” he says.

Granger notes that the reciprocal relationship is not equal. The evidence suggests that the relationship between earlier workplace injuries and later mental health problems is more robust than the evidence between mental health problems and later workplace injuries.

The authors point out that these findings have significant practical and theoretical implications. First and foremost, they demonstrate that the treatment of workplace injuries needs to be rethought. They argue that there is an urgent need to place a greater focus on psychological rehabilitation alongside existing physical rehabilitation and return to work programs.

Addressing both physical and psychological rehabilitation can be an important step in preventing a downward mental health spiral that can result from workplace injuries. They stress that dignity, fair treatment and appropriate support after an injury are critical to returning to work.

“You want to get people back to work as quickly as possible because the longer they are away, the more difficult and expensive it becomes,” Granger says.