職業傷害勞工受傷後第六年的心理健康與生活品質

Abstract

根據世界勞工組織估計，2010年約有313百萬名勞工發生需要離開工作至少4天以上的職業傷害，而在台灣每年平均亦有超過五萬名勞工發生職業傷害。過去研究發現勞工在職業傷害發生後的第三個月與第12個月，有部分勞工會產生自殺意念與精神疾病，而這些精神症狀也影響其復工情形。 過去的研究發現，在創傷事件發生後多年，有部分的人仍飽受精神症狀與自殺意念所苦，然而，目前鮮少有流行病學研究，對發生職業傷害的勞工進行長期追蹤調查，因此本研究目的，希望了解在職業傷害後多年，勞工們的精神疾病與自殺意念盛行率，以及其生活品質狀況，並且找出影響其精神健康與生活品質的因子。 在2009年，我們追蹤4,403位發生職業傷害的勞工，分別在他們發生職業傷害發生後第三個月與12個月，調查精神症狀與復工情形。本計畫預計追蹤過去曾經回覆過我們問卷的勞工，調查他們受傷後第六年的精神疾病與自殺意念盛行率，及生活品質。本研究將使用簡式健康表(Brief Symptom Rating Scale, BSRS-5)、創傷後症候群檢查表（Post-traumatic Symptoms Checklist, PTSC）、世衛組織生活品質問卷台灣簡明版(World Health Organization Quality of Life, WHOQOL-BREF)作為測量工具。對於精神症狀(BSRS-5或PTSC或有自殺意念)嚴重的個案，我們會使用中文版迷你國際神經精神會談工具(the Taiwanese version of the Mini-international Neuropsychiatric Interview, MINI)為其進行精神疾病與自殺傾向之診斷。本研究目的如下： 1. 推估勞工職業傷害後第六年精神疾病的盛行率、與探討影響其精神症狀之相關因子。 2. 推估勞工職業傷害後第六年自殺傾向的盛行率、與影響自殺意念的相關因子，並計算危害因子對自殺意念的可歸因風險( population attributable risk, PAR)。 3. 探討勞工職業傷害後第六年的生活品質，以及影響其生活品質的相關因子。 此系列研究的重要發現如下：1) 與職業傷後害第三個月與第十二個月相比，勞工在受傷後第六年精神疾病盛行率較高，憂鬱症盛行率為9.2%，創傷壓力症候群與創傷後壓力症候群亞症候群7.2%，廣泛性焦慮症盛行率6.9%。影響精神症況的相關因子為受傷嚴重度，再次發生需住院三天以上之職業傷害，失業，與職業傷後害工作不穩定。2) 與職業傷後害第三個月與第十二個月相比，勞工在受傷後第六年的自殺傾向盛行率較高，為10.2%。影響勞工自殺意念的相關因子為嚴重外觀受損，再次發生需住院三天以上之職業傷害，過去一年不穩定的工作狀態，與職業傷後害薪水減少；其可歸因風險分別為12.7%，4.9%， 13.2%與19.0%。3) 職業傷害後重大生活事件，過去一年不穩定的工作狀態，與職業傷害後薪水減少，影響勞工受傷後第六年生活品質。

In 2010, the International Labour Organization (ILO) estimated that more than 313 million nonfatal occupational accidents (requiring at least 4 days of absence from work). In Taiwan, >50,000 workers suffer from occupational injury yearly, and 68% of them are hospitalized. Previous studies found that a certain proportion of workers reported having suicidal ideation and developed psychiatric disorders at 3 month and 12 months after occupational injury. Moreover, these psychological symptoms affected their return-to-work. Several years after a traumatic event, some people still experience psychological symptoms and suicidality. However, literature on the long-term following up in workers with occupational injury is relatively lacking. Therefore, this study investigated the long-term prevalence of psychiatric disorders and suicidality after occupational injury, and their Health-related quality of life (HRQOL) at 6 years after occupational injury. In Taiwan, a total of 4,403 workers were hospitalized for 3 days or longer and received occupational inpatient compensation from labor insurance between February 1 and August 31, 2009. We recruited them and followed up their psychological symptoms at 3 and 12 months. Those who completed the questionnaire at 3 or 12 months participated in a survey at 6 years after occupational injury. We used Brief Symptom Rating Scale (BSRS-5), Post-traumatic Symptoms Checklist (PTSC), and World Health Organization Quality of Life (WHOQOL-BREF) to assess their psychological symptoms and HRQOL. For Participants who reported sever psychological symptoms or having suicidal ideation, an in-depth psychiatric evaluation was performed using the Mini-international Neuropsychiatric Interview. The purposes of this series of studies were to estimate the prevalence rates of psychiatric disorders and suicidality at 6 years after occupational injury and identify relative factors for poor psychological symptoms. In addition, we followed up occupationally injured workers to determine their HRQOL at 6 years after injury and to determine factors affecting each HRQOL domain. The main findings of results were as follows: 1) the estimated rates of major depression and post-traumatic stress disorder (PTSD)/partial PTSD were 9.2% and 7.2%, respectively, and both these rates were higher at 6 years after injury than at 3 and12 months after injury. Relevant factors for poor psychological health were severity of injury and instability of work. 2) the estimated MINI-diagnosed suicidality rates at 3 months, 12 months, and 6 years after occupational injury were 5.6%, 5.9%, and 10.2%, respectively. Injury majorly affecting the physical appearance, experienced additional occupational injury requiring hospitalization for >3 days, unstable employment, and having lower income than that before occupational injury were the most crucial factors. The adjusted PARs (aPARs) for these factors were 12.7%, 4.9% 13.2%, and 19.0%, respectively, for having suicidal ideation.3) Adverse life events and additional severe occupational injuries that occurred within the follow-up period, unstable employment, and decreased salary after the injury were significant factors for low scores in all domains of the WHOQOL-BREF.