Women Workers Are at Greater Risk of Suicide or Overdose When Suffering a Lost-Time Injury
A new study from the American Journal of Industrial Medicine found large differences in the increased risk of suicide and overdose deaths between men and women who suffer work injuries that resulted in one week or more of lost time.
Researchers from the Boston University School of Public Health assessed data from the New Mexico Workers’ Compensation Administration. They ultimately culled records from 100,806 workers injured in 1994 through 2000 with Social Security Administration earnings and mortality data through 2013 and National Death Index cause of death data.
Using those records, they estimated the association between receiving lost‐time workers’ compensation benefits and mortality hazard ratios.
The results were striking.
Drug and Suicide Trends in Workers’ Comp
Overall, drug-related causes were present in 8.1% of deaths, and suicide was the cause in 5.8%. Combined, suicide and drug overdose caused 12.9% of deaths. The study found an additional 4.9% of deaths related to alcohol, also categorized colloquially as “deaths of despair.”
The combined risk of suicide and overdose among female injured workers was 2.63 times the rate for those with less serious injuries in the comparison group (which the study refers to as medical-only claims), while the risk for men was 1.42 times higher.
Taken individually, drug-related mortality among women with lost time claims was 2.93 times that of medical-only, while suicide risk was slightly more aligned between the sexes, with women facing a 1.92 hazard ratio and men facing a 1.72 hazard ratio.
While undoubtedly appropriate detection and treatment of depression by claims handlers would help offset this dramatic risk, the differences between men and women as delineated in this study seem worthy of special attention.
Lead study author Dr. Leslie I. Boden of Boston University told Risk & Insurance® that the “why” behind the numbers for women is largely a mystery. However, he concludes in the article that work-related injuries are part of a larger public health picture with respect to the increase in suicide and overdose across the general population.
“Our analysis suggests that reducing occupational injury rates may affect subsequent mortality from specific causes,” he wrote.
“It, therefore, seems prudent that public health policies should focus on both preventing workplace injuries and improving health care for injured workers.”
Calling the numbers “powerful,” Dr. Douglas Lurie, orthopaedic surgeon with Orthopaedic Associates of New Orleans, explained to Risk & Insurance that the increased suicide and overdose risk among women could have to do with the kinds of diagnoses women may or may not receive over the course of treatment, plus the simple fact that being out of work has a negative impact on health.
“Being out of work is bad for your health, the relative risk for mortality is higher there in general,” he explained.
A 2015 study published in the European Journal of Public Health from Oxford University found that all-cause mortality risk among unemployed persons was nearly twice that of employed persons. While this study was not designed to prove causality, the observed effect remained strong even when controlling for factors such as socioeconomic status and prior health.
Ironically though, in the context of this new mortality study, the Oxford researchers found that “effects for women were smaller and statistically insignificant,” though they did say that female unemployment was more complex. Why then does female unemployment related to work injury carry such steep consequences?
According to Dr. Lurie, the answer may lie in under-diagnosis as lost-time claims mature and comorbidities develop: “Women are more likely to have undiagnosed and untreated mental health disorders, which might explain the higher risk in women,” he said.
“Anecdotally, it’s a stacked deck against this population. People with mental health disorders are more likely to have work injuries and bad outcomes like prolonged disability. It’s a chicken or egg question in terms of the suicide.”
Mental Health and Chronic Pain
A 2016 review from the Mayo Clinic on the relationship between mental health disorders and chronic pain in the general population bears this out.
Specifically for depression, Dr. W. Michael Hooten notes: “The frequent co-occurrence of chronic pain and depression reflects the shared risks that exist between these 2 conditions as exemplified in the following 2 examples.
“First,” he continues, “in a population-based study involving 845 adults, study participants with mild or disabling neck or low back pain were 2.0 to 2.5 times more likely to experience an episode of depression at 6- and 12-month follow-up than individuals without spinal pain. Conversely, pain-free individuals with severely elevated levels of depressive symptoms were 4 times more likely to develop neck or low back pain at 6- and 12-months follow-up than individuals with low levels of depressive symptoms.”
We also know that chronic pain increases the risk of suicide, sometimes by opioid overdose. A 2018 study published in the Annals of Internal Medicine using Centers for Disease Control and Prevention data in that agency’s 18-state National Violent Death Reporting System showed that “of 123,181 suicide decedents included in the study, 10,789 (8.8%) had evidence of chronic pain.”
The researchers further found that the percentage increased from 7.4% in 2003 to one out of ten by the study’s conclusion in 2014.
A full 16.2% carried out suicide by opioid overdose.
Of additional importance here, the authors noted, their results likely underestimate the true prevalence of chronic pain among suicide descendants.
Workers’ compensation patients are a special population with unique needs aside from the generally unemployed and those generally diagnosed with chronic pain. However, what this new piece of research from the American Journal of Industrial Medicine adds to the picture is a layer of necessarily gendered perspective. &