At Northwest Return to Work, we treat injured workers whose lives have been significantly impacted due to a work injury. This year, however, we are also managing the added stressors of a worldwide pandemic. We are seeing clients experience the added stress due to loss of work for their family members, loss of available childcare, the financial impacts associated with these issues, and the increased psychosocial stress related to things such as the loss of loved ones, the loss of family, and community contact (church, school, etc.).
The effects that the SARS (Severe Adult Respiratory Syndrome) had on patients in the 2003, as referenced in a recent article from the journal Translational Psychiatry (Tzeng, October, 2020), provides validation of what we are currently seeing and a prelude to what additional effects could occur. The purpose of the study was to examine whether SARS was associated with the risk of psychiatric disorders and suicide. The results,
“…found that SARS was associated with anxiety, depression, sleep disorders, PTSD/ASD, and suicide, which is similar to the findings of the association between severe coronavirus infections and PTSD, anxiety, and depressive disorders. However, we found that the risk of psychiatric disorders could be increased even in a long-term follow-up of 12 years, not just a shorter term of up to 30-month of follow-up, in this study.”
This is sobering information, and as clinicians we should begin to prepare. (Tzeng, October, 2020)
How can healthcare providers prepare?
We can take a very practical approach, by becoming familiar with the signs and symptoms of these identified conditions. Knowing what to look for and clear communication with our care providing teams (referring doctors, vocational counselors, claim managers, nurse case managers, etc.) will help us find ways of addressing these barriers for our injured worker clients. For example, here is a list of symptoms (as outlined by the Mayo Clinic) to look for.
Suicide and Suicidal Thoughts, such as:
- Talking about suicide (making statements such as “I’m going to kill myself,” “I wish I were dead” or “I wish I hadn’t been born”)
- Getting the means to take your own life (such as buying a gun or stockpiling pills)
- Withdrawing from social contact and wanting to be left alone
- Severe mood swings (such as being emotionally high one day and deeply discouraged the next)
- Being preoccupied with death, dying or violence
- Feeling trapped or hopeless about a situation
- Increasing the use of alcohol or drugs
- Changing normal routines, particularly eating, or sleeping patterns
- Doing risky or self-destructive things (such as using drugs or driving recklessly)
- Giving away belongings or getting affairs in order without a logical explanation
- Saying goodbye to people as if they won’t be seen again
- Developing personality changes or being severely anxious or agitated, particularly when experiencing some of the warning signs listed above
Warning signs are not always obvious, and they may vary from person to person. Some people make their intentions clear, while others keep suicidal thoughts and feelings secret.
Anxiety Symptoms, such as:
- Feeling nervous, restless, or tense
- Having a sense of impending danger, panic, or doom
- Having an increased heart rate
- Breathing rapidly (hyperventilation)
- Feeling weak or tired
- Trouble concentrating or thinking about anything other than the present worry
- Having trouble sleeping
- Experiencing gastrointestinal (GI) problems
- Having difficulty controlling worry
- Having the urge to avoid things that trigger anxiety
Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:
- Feelings of sadness, tearfulness, emptiness, or hopelessness
- Angry outbursts, irritability or frustration, even over small matters
- Loss of interest or pleasure in most or all normal activities, such as sex, hobbies, or sports
- Sleep disturbances, including insomnia or sleeping too much
- Tiredness and lack of energy, so even small tasks take extra effort
- Reduced appetite and weight loss or increased cravings for food and weight gain
- Anxiety, agitation, or restlessness
- Slowed thinking, speaking or body movements
- Feelings of worthlessness or guilt, fixating on past failures or self-blame
- Trouble thinking, concentrating, making decisions, and remembering things
- Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
- Unexplained physical problems, such as back pain or headaches
Sleep Disorder Symptoms:
Sleep disorders include being very sleepy during the daytime and having trouble falling asleep at night. Some people may fall asleep at inappropriate times, such as while driving. Other symptoms include breathing in an unusual pattern or feeling an uncomfortable urge to move while you are trying to fall asleep. Unusual or bothersome movements or experiences during sleep or having an irregular sleep and wake cycle.
Post-Traumatic Stress Disorder (PTSD) Symptoms:
PTSD symptoms may start within one month of a traumatic event, but sometimes symptoms may not appear until years after the event. These symptoms cause significant problems in social or work situations and in relationships. They can also interfere with your ability to go about your normal daily tasks. PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. Symptoms can vary over time or vary from person to person.
- Recurrent, unwanted distressing memories of the traumatic event
- Reliving the traumatic event as if it were happening again (flashbacks)
- Upsetting dreams or nightmares about the traumatic event
- Severe emotional distress or physical reactions to something that reminds you of the traumatic event
- Trying to avoid thinking or talking about the traumatic event
- Avoiding places, activities or people that remind you of the traumatic event
- Negative thoughts about yourself, other people, or the world
- Hopelessness about the future
- Memory problems, including not remembering important aspects of the traumatic event
- Difficulty maintaining close relationships
- Feeling detached from family and friends
- Lack of interest in activities you once enjoyed
- Difficulty experiencing positive emotions
- Feeling emotionally numb
Changes in physical and emotional reactions:
- Being easily startled or frightened
- Always being on guard for danger
- Self-destructive behavior, such as drinking too much or driving too fast
- Trouble sleeping
- Trouble concentrating
- Irritability, angry outbursts, or aggressive behavior
- Overwhelming guilt or shame
Our heightening awareness of how past pandemics have affected those we care for can help us significantly improve our level of care and the impact we can make on the lives of our clients and their families. Work injuries do not exist in a bubble. We know they overlap with all aspects of life.
Northwest Return to Work is not only a partner with our clients, but all the healthcare specialists we work with. These are challenging times, and we are all struggling to define some of the risk factors and long-term effects this pandemic is creating. By continuing to remind one another of these cries for help, and these symptoms of underlying issues, we can work together to get our clients the help they need. Learn more about our Services, and our Referring Partners.
If you are feeling overwhelmed by thoughts of not wanting to live or you’re having urges to attempt suicide, get help now.
- Call 911 or your local emergency number immediately.
- National Suicide Prevention Lifeline at 1-800-273-8255 any time of day — press “1” to reach the Veterans Crisis Line or use Lifeline Chat.
Josh Cobbley, OT
CEO, Northwest Return to Work