勞工職業傷害發生後之精神疾病調查

Abstract

前言: 職傷後所引起之精神方面損傷是造成勞工無法回復正常工作一個很重要的因素，在回到工作後因心理精神損傷而再度離職的比例也不容忽視。到目前為止，在台灣並沒有針對職場傷害後產生之創傷後壓力症候群(Post-traumatic stress disorder, PTSD)的盛行率與其危險因子進行調查。由於職傷引起之創傷後壓力症候群已列於職業病補償項目當中，因此藉由建立當前台灣勞工職傷後產生之創傷後壓力症候群盛行率及調查其影響回復正常工作情況，作為介入預防之憑據。因此，本研究之目標為：1) 調查職傷後3個月勞工發生創傷後壓力症候群及其他精神疾病的盛行率與可能之危險因子；2）追蹤職傷後12個月勞工發生慢性創傷後壓力症候群及其他精神疾病的盛行率與可能之危險因子；3) 評估職傷後勞工之精神症狀對於復工的影響。 方法: 本研究使用之評量工具為簡式精神症狀自陳量表 (Brief symptom rating scale, BSRS-50)、創傷後症候群檢查表 (Post-traumatic symptom checklist, PTSC)與中文版迷你國際神經精神會談工具 (the Chinese version of the mini-international neuropsychiatric interview, MINI)。研究分為兩階段式評估調查，第一階段將在勞工受傷發生之後的3個月與12個月以郵寄問卷方式寄給4403位勞工填答，作為問卷評估，問卷內容包含BSRS-50、PTSC、復工。第二階段則是針對問卷初篩發現可能有心理問題，尤其PTSD者，由精神科專科醫師使用MINI作電話訪談，進行診斷之篩檢。本研究經台大醫院研究倫理委員會審查通過。 結果: 總共有2001位職傷勞工受傷後3個月第一階段BSRS及PTSC評估，回收率為45.5% (2001/4403)。結果17.8% (357/2001)顯示精神症狀得分較高。有高精神症狀得分者，41.5% (148/357)完成MINI電話訪視。結果發現勞工職業傷害後3個月發生PTSD的個案佔2.7%、創傷後壓力症候群亞症候群(Partial PTSD, PPTSD)4.1%、重鬱症3.0%、而PTSD/PPTSD與重鬱症共病者有2.3%，因此有PTSD/PPTSD或重鬱症者為7.5%。在危險因子方面，研究發現性別（女性）、婚姻狀態（離婚�分居�鰥寡）、職傷後曾昏迷、受傷影響外觀、傷後住院天數、自評受傷嚴重程度、受傷前經歷生活重大事件與受傷後經歷生活重大事件、受傷前收入提供家用都是勞工職傷後容易有慢性精神症狀與創傷後壓力症候群症狀的危險因子。在復工方面，1149位勞工在受傷後3個月復工，而852位尚未復工的勞工在受傷後12個月有225位復工。在未復工危險因子方面，研究發現女性、低教育程度、受傷後住院天數、傷造成身體外觀上的缺陷、受傷類型、受傷後3個月BSRS-50與BSRS-5量表得分高為勞工職業外傷後12個月未能復工之危險因子。而BSRS-50中所評估的十種常見精神症狀中，發現畏懼是未復工的危險因子之一。 結論: 本研究顯示一部分的勞工發生職業傷害後會罹患精神疾病，甚至發展成慢性精神疾病，需要心理輔導及精神醫療。此外，職傷後的精神症狀可預測勞工的復工情形，而畏懼是最能預測未復工的精神症狀。所以，本研究結果顯示職業外傷對於勞工不僅僅造成身體外傷的影響，心理的創傷也需要及時介入，做為預防慢性精神疾病的依據。

Background and objective: The labor who has exposed to a traumatic event may display significant psychiatric disorders that make them unable to return to the work place. The proportion of those returned to the work place, but immediately retarded has been increased. So far, in Taiwan there has no research focused on the prevalence and risk factors of post-traumatic stress disorder (PTSD) in the workplace. However, PTSD has been included in the list of occupational diseases; therefore, the purposes of this study are to examine the prevalence rates of post-traumatic stress disorder in the workplace after occupational injuries, risk factors of post-traumatic stress disorder after occupational injuries, and the effects on return to work (RTW) among the injured workers, in order to reduce the employer’s doubt and to ensure the quality of life of the labors. Therefore, the aims of this study are: 1) To determine the prevalence and risk factors of post-traumatic stress disorder (PTSD) and other psychiatric disorders at 3 months after occupational injuries; 2) To determine the prevalence and risk factors of chronic post-traumatic stress disorder (PTSD) and other psychiatric disorders at 12 months after occupational injuries; 3) To investigate the impact of psychological symptoms on return to work (RTW) in workers after occupational injuries. Methods: Our study candidates were injured workers in Taiwan who were hospitalized for 3 days or longer and received hospitalization benefits from the Labor Insurance program. A two-staged survey study was conducted. A self-reported questionnaire including the Brief Symptom Rating Scale (BSRS-50) and Post-traumatic Symptom Checklist (PTSC) was sent to workers at 3 months and 12 months after injury. Those who met the criteria were recruited for the second stage phone interview with a psychiatrist using the Mini-international Neuropsychiatric Interview (MINI). Results: A total of 2001 workers completed the questionnaire (response rate 45.5%) at 3 months after occupational injury. Among them, 357 (17.8%) fulfilled the criteria for the MINI interview and were invited. A total of 148 (41.5%) completed the phone interview. The estimated rates of PTSD, partial PTSD (PPTSD), major depression, comorbid PTSD/PPTSD and major depression, and either PTSD/PPTSD or major depression were 2.7%, 4.1%, 3.0%, 2.3%, and 7.5%, respectively. The risk factors for developing psychological symptoms at 3 months after occupational injury were gender, loss of consciousness after occupational injury, injury affecting physical appearance, occupational injury experience before this event, life experience before and after this injury, length of hospital stay, self-rated injury severity, and percentage of income to the family. On the other hand, a total of 1233 workers completed the questionnaire (response rate 28.0%) at 12 months after occupational injury. Among them, 167 (13.5%) fulfilled the criteria for the MINI interview and were invited. A total of 106 (63.5%) completed the phone interview. The estimated rate of either PTSD/PPTSD or major depression was 5.2%. The risk factors for developing long-term psychological symptoms were gender, education level, loss of consciousness after occupational injury, injury affecting physical appearance, occupational injury experience before this event, life experience before and after this injury, length of hospital stay, self-rated injury severity, and percentage of income to the family. Among 2001 workers who completed RTW questionnaire at 3 months after injury, 1149 had returned to work. Among the 852 who were unable to return to work at 3 months after injury, 225 reportedly returned to work by one year. A proportional hazards regression indicated that after adjusting for all possible risk factors, higher scores in BSRS-50 and BSRS-5 at 3 months after injury were significant risk factors for not return to work (NRTW) at one year after injury. Other risk factors were gender, education level, length of hospitalization, affected physical appearance, and injury type. Among 10 psycho-physiological symptoms of BSRS-50, a proportional hazards regression indicated that high score in phobic-anxiety scale was a risk factor for NRTW. Conclusion: These results showed that after occupational injuries, a significant proportion of workers suffered from psychiatric disorders, and occupational injury can cause long-term psychological impact in the workers. After considering all other factors, psychological symptoms further predicted poorer probability of returning to work after occupational injury, and phobic-anxiety was the most significant symptom predicting poor RTW. Development of preventive measures among injured workers according to the risk factors identified in this study is warranted.