Occupational Injury and Suicide in Washington State, Adjusting for Pre-Injury Depression

Details

• Personal Author:
  Applebaum KM ; Asfaw A ; Boden LI ; Busey A ; Fox MP ; Gradus JL ; O'Leary PK ; Tripodis Y
• Description:
  Introduction: Occupational injuries have been associated with increased suicide mortality, but prior studies have not accounted for pre-injury depression. Methods: We linked injuries that occurred from 1994 to 2000 in the Washington State workers' compensation system with Social Security Administration data on earnings and mortality through 2018. We estimated the subdistribution hazard ratio (sHR) and 95% confidence interval using competing risks regression of suicide deaths with lost time compared with medical-only injuries separately for men and women, adjusting for age, pre-injury annual earnings, and industry. We further adjusted for pre-injury diagnosis of major depressive disorder by using a quantitative bias analysis (QBA), with the prevalence of this disorder in workers derived from an external health insurance claims data set. Results: Elevated suicide mortality was observed following lost-time injuries compared with medical-only injuries for men (sHR = 1.49, 95% CI [1.14, 1.93]) and women (sHR = 1.30, 95% CI [1.00, 1.69]), adjusting for age, pre-injury earnings, and industry. Adjusted for pre-injury depression using a QBA, elevated suicide risk in men remained statistically significant (median sHR = 1.33, simulation interval [1.18, 1.47]) but not for women. Discussion: Workplace injury requiring time off work appeared to remain influential in increasing suicide risk among men, even after controlling for pre-injury depression. The relationship between mental health before and after occupational injury is complex and studies should better integrate mental health pre-injury. Conclusions: Though many questions remain on the complex relationship between work, depression, injuries, and suicide, employers should work to prevent injuries and consider implementing mental health programs, which could be helpful in reducing suicide risk. [Description provided by NIOSH]
• Subjects:
  Epidemiology Mental Health Mortality Nervous System Occupational Health Safety Suicide
• Keywords:
  Injuries Mental Health Mortality Rates
• ISSN:
  0271-3586
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Boston Region [OSHA] ; District of Columbia ; Massachusetts ; Philadelphia Region [OSHA] ; San Francisco Region [OSHA] ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OD - Office of the Director
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  122-131
• Volume:
  28
• Issue:
  2
• NIOSHTIC Number:
  nn:20070414
• Citation:
  Am J Ind Med 2025 Feb; 28(2):122-131
• Contact Point Address:
  Katie M. Applebaum, Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
• Email:
  kapplebaum@gwu.edu
• Federal Fiscal Year:
  2025
• Performing Organization:
  Boston University Medical Campus
• Peer Reviewed:
  True
• Start Date:
  20140701
• Source Full Name:
  American Journal of Industrial Medicine
• End Date:
  20170630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:d026900d889fa9501b7ac74ec336914a55b66faef93337f396a607393ebd60b371d65b85e419db7c8b71ea70a28b8cff84e184679e439aac7cc5df3225cc8814
• Download URL:
  https://stacks.cdc.gov/view/cdc/208636/cdc_208636_DS1.pdf
• File Type:
  [PDF - 359.18 KB ]