Associations between workers’ compensation and self-harm: A retrospective case-series study of hospital admissions data

BACKGROUND: While workers’ compensation schemes aim to assist and support injured workers, there is some evidence that the process of pursuing a compensation claim may be extremely stressful for workers. This research aimed to compare hospital admissions for self-harm among workers’ compensation claimants and non-claimants. METHODS: A retrospective case-series design, this study used hospital admissions data for 42,567 patients (2011-2018) to estimate rates of hospital admission for intentional self-harm and 'self-harm and probable self-harm' (due to intentional self-harm, poisoning, or undetermined intent) and compare these between workers’ compensation claimants and non-claimants. Rates were stratified by gender and calculated for each age group. FINDINGS: For males, there was no observable difference between claimants and non-claimants for admission due to intentional self-harm. For female claimants, the incidence rate for admission for intentional self-harm was higher than non-claimants (rate ratio (RR) 2.4, 95%CI 1.8-3.2, risk difference (RD) 47.7 per 100,000 person-years). For the combined category of ‘self-harm and probable self-harm’, the incidence rate was elevated in both male (RR 5.8, 95%CI 5.0-6.6, RD 167.7 per 100,000 person-years) and female workers’ compensation claimants (RR 3.4, 95%CI 2.8-4.2, RD 114.8 per 100,000 person-years) relative to non-claimants. INTERPRETATION: Female workers’ compensation claimants appear to have elevated rates of admission for intentional self-harm and ‘self-harm and probable self-harm’ compared to non-claimants. Male claimants appear to have increased rates of hospital admission for ‘self-harm and probable self-harm’. This suggests that the process of pursuing workers’ compensation may be associated with increased risk of self-harm, and highlights a need for further research. FUNDING: Suicide Prevention Australia Innovation Grant.