The relationship between work disability and subsequent suicide or self-harm: A systematic scoping review

Abstract

Background: Work disability occurs when an injury, illness or other health condition limits the ability of a worker to participate in paid employment. Several lines of evidence suggest that people with work disability are also at increased risk of suicide and intentional self-harm, however the evidence on this relationship has not previously been the subject of systematic review. Objective: This systematic scoping review aims to assess and summarise the research literature regarding the relationship between work disability and subsequent suicide or intentional self-harm. Methods: Peer-reviewed quantitative and qualitative studies published in English from 1st January 2000 were included if they reported suicide or self-harm outcomes in people aged 15 years or older with work disability. Narrative synthesis summarised findings according to the system of work disability income support. Results: Literature search yielded 859 records of which 47 eligible studies were included, including nine set in workers compensation, 20 in sickness absence, 13 in disability pension systems, and five from mixed cohorts. Of 44 quantitative studies, 41 reported a positive relationship between work disability and suicidal behaviour. The relationship is observed consistently across nations, work disability income support systems and in people with a range of health conditions. Several factors elevate risk of suicidal behaviour, including presence of mental health conditions and longer work disability duration. There were few quality studies in some nations and no suicide prevention interventions. Conclusion: The risk of suicide and intentional self-harm is elevated in people experiencing work disability. While further observational research is required to fill evidence gaps, this review suggests the need for governments, employers and those involved in the delivery of care and support to people with work disability to focus on identification and monitoring of those at greatest risk of suicidal behaviour, as well as suicide prevention.