Anxiety Off of Work
Essentially every patient I see that has been off work more than three months has elevated anxiety. This gets noted on my intake questionnaire or comes out in conversation. I always directly address the anxiety. If I had a choice, every patient would have some access to education, support, and the tools to diminish stress. The system can do only so much to decrease patient stress. Even the potential of loss of employment is a huge stressor. It has been mentioned that questionnaires are not adequate to assess anxiety. From my perspective, I am not sure what an appropriate alternative would be.
What is anxiety? Here’s one definition:
- Feeling of worry
- Something that worries somebody
- Strong wish to do something
- Extreme apprehension
I tried to look up anxiety on Google Scholar this morning. I could not find a clear definition. I finally just went to the dictionary and pulled off the one above. I looked at the first part of the DSM manual (which defines mental health disorders) and am now curious as to what diagnosis I would make from my orthopedic perspective to enable mental health support to be provided to an injured worker. More importantly, what would a claims examiner use to “buy” or accept a diagnosis?
Degrees of Anxiety
There are 5 levels or Axes of severity with respect to mental disorders. Axis I is the level that the major diagnoses are made, such as depression, ADHD, anxiety disorders, addictions, etc. Anxiety is part of essentially every Axis I diagnosis. It is also an aspect of the others.
Axis IV is “Psychosocial and Environmental Problems.” Here are a few of the Axis IV choices:
- Occupational problems
- Problems related to the social environment
- Problems with primary support group
- Educational problems
- Economic problems
An injured worker has most of these issues.
Every human being experiences anxiety. Anxiety is increased by Axis IV issues. Does that not qualify one for assistance?
Confusions in Mental Health Diagnoses
If a person has a diagnosable pre-existing anxiety condition, it is unlikely that it would have already been a diagnosis that an injured worker is carrying around. If a mental health professional makes the diagnosis after the person has been in the worker’s comp system for awhile, then it is impossible to really sort out what is going on. The Axis IV issues become a major factor.
So when is worker’s comp supposed to provide mental health services? If there happens to be a pre-existing condition, then it is a major obstacle in return to function and it would make financial as well as humane sense to treat it.
If the anxiety, etc. is caused by the stress of the claim then worker’s comp should cover it, as the injury was the cause of the person’s emotional distress.
Axis III is the Axis where the general medical conditions are listed that can directly or indirectly affect an Axis I diagnosis. If there is a direct cause and effect, then the Axis III diagnosis is also listed in Axis I. One can make a strong argument that there are multiple musculoskeletal diagnoses that cause a significant increase in anxiety and should be put under Axis I. The DSM should take the adversity experienced by the injured worker into account. Unfortunately, it most likely does not.
I am going to purchase the DSM book today. I would like to ask the roundtable to provide me with the criteria needed to obtain mental health support for an injured worker. At this moment, I have no idea.