Virus linked to mental health issues

The COVID-19 pandemic has pushed mental health to the forefront in general, as experts far and wide attest to an increase in issues among those affected by shutdowns, isolation, illness and job loss. And injured workers navigating the workers compensation system are not immune, according to claims experts.

Mental health awareness “has been going on in this marketplace for quite some time, but I think what is bringing it to the forefront more is COVID-19,” said Verna Jackson, Maplewood, New Jersey-based vice president of case management for Broadspire Services Inc., the third-party administrator for Crawford & Co. 

The pandemic delayed surgeries and impeded return to work as much of the country stayed home. The shutdowns created other hurdles with regards to care and recovery, including issues with prescriptions, physical therapy and more. Couple that with the fear of treatment — already present in many comp claims — compounded by the fear of getting the virus in a medical setting, experts say.

“We have been seeing this since March,” Ms. Jackson said. “They weren’t doing elective surgeries in hospitals coast to coast and physical therapy (clinics) closed their doors to a lot of people.”

The pandemic has hit those in recovery with other injuries especially hard, according to Tammy Bradly, Lillian, Alabama-based vice president of clinical product development for Coventry Workers’ Comp Services.

“Put yourself in the role of an injured worker; all of those things that are preventing you from recovering, plus financial concerns — how are you going to pay your bills? You may be worried about your loss of function — is it going to reduce the quality of your life? Those are the stressors” common in any comp claim, she said. 

Put COVID-19 on top of that and now people have additional stressors, such as whether they will have a job, and childcare responsibilities amid remote learning, she said. “Not to mention they may have close friends or relatives affected by the virus. …There’s more anxiety and depression across the board,” she said.

“Injured workers can often feel isolated because of an injury, especially if it affects their mobility or activity level, or keeps them out of work for an extended period of time,” Deborah Gleason, Philadelphia-based clinical resources manager of medical programs for third-party administrator ESIS Inc., a subsidiary of Chubb Ltd., wrote in an email. “Depending on the local response to COVID, there may be an additional level of isolation because of lockdowns, and that may lead to or increase anxiety, loneliness or depression.” 

Much of the trend is seen anecdotally, as concrete figures on mental health claims in comp in 2020, especially related to the pandemic, are not yet available, experts say. However, data analytics — much of which has driven the industry to focus more on mental health among claimants — show that biopsychosocial concerns are prevalent in comp, according to Joseph Guerriero, Westminster, Colorado-based senior vice president of MGD guidelines at Reed Group. The company helps craft injured-worker treatment guidelines for the American College of Occupational and Environmental Medicine, which this year updated its guidelines on mental health treatment. 

Mr. Guerriero cited research published in the Disability and Health Journal in 2018 in which 21% of disabled workers reported “depression/anxiety/emotional problem” as the condition causing limitations — the No. 2 reason after “back or neck problems,” which was reported by 30.3%.

“Return to work delays are emerging as either a primary or secondary diagnosis of depression, and that’s what’s driving this in comp,” Ms. Bradley said. “We have come to the point in the industry that these compounding pressures can expand the treatment costs as well as the disability duration of the workplace injury.”

The mental effects of a COVID-19 diagnosis and a subsequent workers compensation claim — with nine states now accepting such injury claims — is another new area of focus for the comp industry, according to Reema Hammoud, Southfield, Michigan-based assistant vice president of clinical pharmacy for Sedgwick Claims Management Services Inc. 

A study published in November in The Lancet medical journal found that COVID-19 survivors posed an increased risk for their first-ever diagnosis of psychiatric illness between 14 and 90 days after being diagnosed with the virus. Specifically, the study of 62,354 COVID-19 patients showed the estimated probability of having been diagnosed with any psychiatric illness was 18.1%, “significantly higher” than for all control health events, between 1.2% and 1.5%. The most common psychiatric diagnosis after COVID-19 diagnosis was anxiety disorder, followed by mood disorders, according to the study.

“We do know that COVID affects the brain, and there may be long-term issues,” she said. “We want our clinical staff, too, to be aware of post-intensive care syndrome,” which triggers a mental health diagnosis after a patient is admitted into intensive care in a hospital for complications from the virus. 

“We are keeping an eye on this because it is changing on a daily basis,” she said. “We don’t know what we don’t know.” 

Instances of post-traumatic stress disorder related to COVID-19, especially, are on the rise, according to Mr. Guerriero, who helped oversee the introduction of PTSD guidelines in 2019 and says the guidelines are subject to constant revision — and have been used to craft the Medical Treatment Utilization Schedule Drug List for injured workers in California. “COVID is now a big part of the discussion,” he said.