Diagnosing and managing work‐related mental health conditions in general practice: new Australian clinical practice guidelines

Mazza, Danielle; Chakraborty, Samantha P; Brijnath, Bianca; Nowak, Heather; Howell, Cate; Brott, Trevor; Atchison, Michelle; Gras, David; Kenardy, Justin; Buchanan, Richard; Tawia, Seyram

doi:10.5694/mja2.50240

ARTICLE
AUTHORS
REFERENCES

Topics

General medicine

Mental disorders

Occupational diseases

Abstract

Introduction: In Australia, mental health conditions (MHCs) arising from workplace factors are a leading cause of long term work incapacity and absenteeism. While most patients are treated in general practice, general practitioners report several challenges associated with diagnosing and managing workplace MHCs.

This guideline, approved by the National Health and Medical Research Council and endorsed by the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine, is the first internationally to address the clinical complexities associated with diagnosing and managing work‐related MHCs in general practice.

Main recommendations: Our 11 evidence‐based recommendations and 19 consensus‐based statements aim to assist GPs with:

the assessment of symptoms and diagnosis of a work‐related MHC;
the early identification of an MHC that develops as a comorbid or secondary condition after an initial workplace injury;
determining if an MHC has arisen as a result of work factors;
managing a work‐related MHC to improve personal recovery or return to work;
determining if a patient can work in some capacity;
communicating with the patient's workplace; and
managing a work‐related MHC that is not improving as anticipated.

Changes in management as result of the guideline: This guideline will enhance care and improve health outcomes by encouraging:

the use of appropriate tools to assist the diagnosis and determine the severity of MHCs;
consideration of factors that can lead to the development of an MHC after a workplace injury;
more comprehensive clinical assessments;
the use of existing high quality guidelines to inform the clinical management of MHCs;
consideration of a patient's capacity to work;
appropriate communication with the workplace; and
collaboration with other health professionals.

1 Monash University, Melbourne, VIC
2 National Ageing Research Institute, Melbourne, VIC
3 Mental Health Australia, Canberra, ACT
4 Royal Australian College of General Practitioners, Melbourne, VIC
5 Western Industrial Screening and Accident Clinic, Melbourne, VIC
6 Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC
7 Royal Australasian College of Physicians, Melbourne, VIC
8 University of Queensland, Brisbane, QLD
9 Australian Psychological Society, Melbourne, VIC
10 Office of Industrial Relations, Queensland Government, Brisbane, QLD
11 Comcare, Melbourne, VIC

Correspondence: Danielle.Mazza@monash.edu

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Acknowledgements:

The development of this guideline was supported by the Australian Government Department of Jobs and Small Business and Comcare, the Office of Industrial Relations — Queensland Government, the State Insurance Regulatory Authority (NSW), ReturntoWorkSA, WorkCover WA and the Institute of Safety, Compensation and Recovery Research. The development of the final recommendations has not been influenced by the views or interests of the funding bodies.

Competing interests:

The online Supporting Information includes the declaration of competing interests.

1. Safe Work Australia. Work‐related mental health disorders profile. Canberra: Safe Work Australia, 2015. https://www.safeworkaustralia.gov.au/system/files/documents/1702/work-related-mental-disorders-profile.pdf (viewed May 2019).
2. Brijnath B, Mazza D, Singh N, et al. Mental health claims management and return to work: qualitative insights from Melbourne, Australia. J Occup Rehabil 2014; 24: 766–776.
3. Mazza D, Brijnath B, Chakraborty SP, et al. Clinical guideline for the diagnosis and management of work‐related mental health conditions in general practice. Melbourne: Monash University, 2019. www.monash.edu/work-related-mental-health-guideline (viewed May 2019).
4. Australasian Faculty of Occupational and Environmental Medicine; Royal Australasian College of Physicians. Consensus statement on the Health Benefits of Good Work. Sydney: NSW: RACP, 2017. https://www.racp.edu.au/docs/default-source/advocacy-library/afoem-realising-the-health-benefits-of-work-consensus-statement.pdf?sfvrsn=baab321a_14 (viewed May 2019).
5. Department of Health. The Fifth National Mental Health and Suicide Prevention Plan (the Fifth Plan). Canberra: Commonwealth of Australia, 2017. https://apo.org.au/sites/default/files/resource-files/2017/10/apo-nid114356-1220416.pdf (viewed May 2019).
6. National Health and Medical Research Council. Procedures and requirements for meeting the 2011 NHMRC standard for clinical practice guidelines. Canberra: NHMRC, 2011. https://www.nhmrc.gov.au/about-us/publications/meeting-2011-nhmrc-standard-clinical-practice-guidelines; (viewed May 2019).
7. Schunemann H, Brozek J, Guyatt G, et al. GRADE Handbook: introduction to GRADE Handbook. Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. GRADE Working Group, 2013. http://gdt.guidelinedevelopment.org/app/handbook/handbook.html (viewed Jan 2017).
8. Craddock N, Mynors‐Wallis L. Psychiatric diagnosis: impersonal, imperfect and important. Br J Psychiatry 2014; 204: 93–95.
9. State Insurance Regulatory Authority. Workers compensation guide for medical practitioners. Sydney: NSW Government, 2019. https://www.sira.nsw.gov.au/resources-library/workers-compensation-resources/publications/health-professionals-for-workers-compensation/sira-nsw-medical-guide; (viewed Apr 2019).
10. Kroenke K, Spitzer RL, Williams JB. The PHQ‐9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16: 606–613.
11. Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD‐7. Arch Intern Med 2006; 166: 1092–1097.
12. Nieuwenhuijsen K, de Boer AG, Verbeek JH, et al. The Depression Anxiety Stress Scales (DASS): detecting anxiety disorder and depression in employees absent from work because of mental health problems. Occup Environ Med 2003; 60 (Suppl): i77–i82.
13. Weathers FW, Litz BT, Herman D, et al. The PTSD checklist — civilian version (PCL‐C). Boston, MA: National Center for PTSD, 1994. https://www.mirecc.va.gov/docs/visn6/3_ptsd_checklist_and_scoring.pdf (viewed May 2017).
14. Bradley KA, Bush KR, Epler AJ, et al. Two brief alcohol‐screening tests From the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population. Arch Intern Med 2003; 163: 821–829.
15. Stockwell T, Murphy D, Hodgson R. The severity of alcohol dependence questionnaire: its use, reliability and validity. Br J Addict 1983; 78: 145–155.
16. Raistrick D, Bradshaw J, Tober G, et al. Development of the Leeds Dependence Questionnaire (LDQ): a questionnaire to measure alcohol and opiate dependence in the context of a treatment evaluation package. Addiction 1994; 89: 563–572.
17. World Health Organization. WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) Geneva: WHO; 2018. http://www.who.int/classifications/icf/more_whodas/en (viewed Apr 2018).
18. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington: American Psychiatric Association Publishing, 2013. https://doi.org/10.1176/appi.books.9780890425596 (viewed May 2019).
19. Kessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry 2003; 60: 184–189.
20. Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales, 2nd ed. Sydney: Psychology Foundation of Australia, 1995; p. 42.
21. Weathers FW, Litz BT, Keane TM, et al. PTSD checklist for DSM‐5 (PCL‐5). Boston: National Center for PTSD, 2013. https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp (viewed Nov 2018).
22. Read JR, Sharpe L, Modini M, et al. Multimorbidity and depression: a systematic review and meta‐analysis. J Affect Disord 2017; 221: 36–46.
23. Tiller JW. Depression and anxiety. Med J Aust 2013; 199 (Suppl): S28–S31. https://www.mja.com.au/journal/2013/199/6/depression-and-anxiety.
24. Dersh J, Gatchel RJ, Polatin P, et al. Prevalence of psychiatric disorders in patients with chronic work‐related musculoskeletal pain disability. J Occup Environ Med 2002; 44: 459–468.
25. Heads of Workers’ Compensation Authorities Australia and New Zealand. Guide: Nationally consistent approval framework for workplace rehabilitation providers. Australia: Heads of Workers’ Compensation Authorities Australia and New Zealand, 2015. http://www.hwca.org.au/wp-content/uploads/2016/08/1-Guide-Nationally-Consistent-Approval-Framework-for-Workplace-Rehabi....pdf (viewed May 2019).
26. Doroud N, Fossey E, Fortune T. Recovery as an occupational journey: a scoping review exploring the links between occupational engagement and recovery for people with enduring mental health issues. Aust Occup Ther J 2015; 62: 378–392.
27. Modini M, Joyce S, Mykletun A, et al. The mental health benefits of employment: results of a systematic meta‐review. Australas Psychiatry 2016; 24: 331–336.
28. Bunzli S, Singh N, Mazza D, et al. Fear of (re)injury and return to work following compensable injury: qualitative insights from key stakeholders in Victoria, Australia. BMC Public Health 2017; 17: 313.

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Diagnosing and managing work‐related mental health conditions in general practice: new Australian clinical practice guidelines

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