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Work, Injury, and Depression: The influence of work status on depressive symptoms for those recovering from musculoskeletal injury Open Access


Other title
Work, Injury, and Depression
Type of item
Degree grantor
University of Alberta
Author or creator
Jones, David C
Supervisor and department
Carroll, Linda (Supervisor - School of Public Health, University of Alberta)
Examining committee member and department
Colman, Ian (Committee - Department of Epidemiology and Community Medicine, University of Ottawa)
George, Steven (Examiner - Department of Physical Therapy, University of Florida)
Gross, Douglas (Committee - Department of Physical Therapy, University of Alberta)
Truscott, Derek (Examiner - Department of Educational Psychology, University of Alberta)
Voaklander, Don (Committee - School of Public Health, University of Alberta)
School of Public Health Sciences
Date accepted
Graduation date
Doctor of Philosophy
Degree level
Many individuals obtain a sense of personal identity from work as well as the resources necessary for basic living. Musculoskeletal injury is a common barrier to continued employment in developed countries and despite numerous compensation programs, work absences can significantly disrupt an individual’s sense of self, potentially predisposing the injured individual to significant symptoms of depression. The goal of this dissertation was to investigate the relationship between work status and subsequent depression following injury. Chapter two provided an introductory, theoretical framework from which to view the contribution of work to the possible prevention or resolution of depressive symptoms following injury. In chapter 3, a cohort of whiplash patients were followed forward in time to investigate the temporal relationship between work status and depressive symptoms following injury. From this investigation it was found that work status significantly influence subsequent depression shortly after injury, but not in the longer term. In Chapter 4, a cohort of worker’s compensation claimants were categorized by work status shortly after their injury and followed forward in time for depression outcomes. The relationships observed in chapter 3 were not replicated in chapter 4; however, the worker’s compensation cohort suffered from loss to follow-up and the timing of assessments differed significantly from those used in chapter 3. Chapter five provided a methodological comparison of differing methods with which to control for confounding in studies using continuous baseline health outcome measures which are also used to categorize disease status further on in follow-up. Through this investigation it became apparent that there is no one right answer for using related continuous and categorical outcomes in the same regression models; however, for our research, it was apparent that prior depressive symptom scores were best characterized as a confounding variable in the ‘work-status and subsequent depression’ relationship. In conclusion this dissertation provided three important contributions to the study of depression following injury: 1. There is a plausible and visually explainable mechanism by which alterations in work status can influence subsequent depression following injury; 2. Work status is significantly associated with subsequent depression status shortly after whiplash injury; and 3. The alteration of a single modeling variable can substantially alter the conclusions drawn in follow-up studies of depression and depressive symptomatology; careful consideration must be made when including and excluding seemingly associated variables in a predictive regression model.
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