Marital instability following a work accident

Principal Investigator: Emile Tompa

Co-investigators: Heather Scott-Marshall, Miao Fang

Community involvement: The conceptualization of this study originated from the community and was developed through various workshops with the community. Versions of this study have been presented at community forums and feedback has been incorporated into the analysis.

Interest to community: The social implications of work injury are not often investigated in the workers' compensation literature, nor are they often on the radar for workers' compensation boards. Yet these implications are critical for injured workers since they are important aspects of participation and well being.

Project abstract: Disabling work injury is a major negative life event with implications for marital stress. This study examines the probability of marital breakup due to a permanent impairment from a workplace accident. Using a novel longitudinal database created from a linkage of workers' compensation claims data with income tax records, we model the time to marital breakup in married workers who have sustained a permanent impairment from a workplace injury using a matched non-injured sample as the comparison group. Controlling for factors known to contribute to the risk of marital breakup, we find evidence that disabling work injury significantly increases the probability of marital dissolution. We discuss these findings in terms of the need for a strengthened research agenda on the social consequences of work injury.

Literature review

Studies on the economic consequences of work injury
Research on the economic consequences of work injury has shown that injured workers are at risk of experiencing significant financial losses in the long-term. A major contributing factor to these losses has been identified as the inadequacy of wage-replacement benefits provided through workers' compensation programs. Several studies of earnings loss due to work injury show that wage loss benefits replace only a small fraction of lifetime earnings losses due to disability (Berkowitz & Burton, 1987; Biddle, 1998; Boden & Galizzi, 1999; Cheit, 1961; Ginnold, 1979; Johnson, Cullinan, & Curington, 1979; Peterson, Reville, Stern, & Barth, 1998). For example, Boden and Galizzi (1999) used workers' compensation data and unemployment insurance wage data to estimate lost earnings from workplace injuries and illnesses occurring in Wisconsin between 1989 and 1990. Using a projection window of 10 or 30 years depending on the severity of the injury, they estimated that workers with compensated injuries and illnesses experienced annual pre-tax losses totaling more than $530,000,000 (1994 dollars), with only about 60% of after-tax losses replaced by workers' compensation. Furthermore, workers with more serious injuries that required more than eight weeks off work received workers' compensation benefits covering less than 40% of their losses (Boden & Galizzi, 1999).

Brown, Shannon, Mustard, and McDonough (2007) compared the use of social assistance between a group of workers injured in 1994 who lost work time due to injury (LT), and another group who did not lose work time post-accident (NLT). Using records from the British Columbia Linked Health Database (BCLHD) which links individual medical service plan payment data, workers' compensation claims, and employment/income assistance data for the entire population of British Columbia (BC), the study found that LTs were significantly more likely to collect income assistance benefits compared to NLTs. The study also found that LTs who were off work for 12 weeks or longer were more likely to receive income assistance than LTs who were off for less time (Brown, Shannon, Mustard, & McDonough, 2007).

Other studies have shown that the prolonged adjudication of workers' compensation claims can delay the receipt of critical benefits. In interviews with workers in Pennsylvania, Dawson (1994) found that claimants reported waiting an average of 20 months to receive income replacement benefits following a workplace injury contributing to a 68.4% drop in income. Another study by MacEachen et al. (2007) concluded that delayed claims can produce significant suffering for workers and their families in large part due to the resulting financial hardship. In a review of the literature on workers' compensation experiences, Dembe (2001) concludes that there are substantial barriers confronting injured workers trying to gain benefits through the system that can result in "significant economic hardship" (Dembe, 2001, p. 408).

Studies on the functional and psychological consequences of work injury
A number of studies have documented the adverse consequences of work injury on performance of domestic roles and the activities of daily living. A study of workers in Maryland found that upper-extremity cumulative trauma disorders (i.e., disorders of the muscle or bone in the upper body) interfere with sleep and the performance of household activities (Keogh, Nuwayhid, Gordon, & Gucer, 2000). Forty percent of these workers reported problems performing several key activities of daily living (e.g., opening a window, writing with a pen, lifting a child) more than two years after the initial workers' compensation claim filing. Likewise Morse, Dillon, Warren, Levenstein, & Warren (1998) found that workers with upper-extremity musculoskeletal disorders are much more likely than non-injured workers to report difficulty performing activities of daily living such as writing, household chores, child care, bathing and driving a car. In ethnographic interviews of workers with disabling work-related back injuries, Strunin and Boden (1997) found that more than one-third reported some difficulty performing household tasks such as cleaning, shopping, taking out the garbage, or carrying laundry.

Other research indicates that work injuries are associated with several adverse effects on individuals' psychological well-being and behavior. The overall mental health status of individuals with work injuries has been found to be worse than the general population especially for individuals who have been out of work for at least one year following an injury (Pransky et al., 2000). Injured workers who endure a prolonged claims adjudication process report a variety of adverse consequences for themselves and their families including emotional stress arising from feelings of depression and lowered self-esteem, the inability to participate in family activities, and diminished sex life (Dawson, 1994). Self-reported feelings of anxiety and depression have been found to be higher among individuals with work-related repetitive strain injuries (Helliwell, Mumford, Smeathers, & Wright, 1992; Keogh et al., 2000). Workers who suffer back injuries commonly report feelings of depression, anger, and strain on family relationships due to chronic pain and other limitations arising from their injuries (Strong, Ashton, & Large, 1994; Strunin & Boden, 2004). The disruption in working lives arising from injury, including the loss of the support structure provided by work and other social aspects has also been associated with adverse psychological outcomes (Keogh et al., 2000; Morse et al., 1998). Furthermore, individuals with more serious work-related disabilities have shown higher rates of psychological problems, drug abuse and marital difficulties (Texas Workers' Compensation Research Center, 1995).

Studies on economic stress and marital dissolution
In standard economic models of marriage, pecuniary gains from a spouse play a central role in the assessment of fit of a relationship (Becker, Landes, & Michael, 1977; Charles & Stephens, 2004). Events that cause a decrease in one spouse?s earnings capacity also produce a decrease in the overall household income leading to reduced fit. A handful of studies have investigated how unexpected changes in household income, both positive and negative, impact marital dissolution. One study by Weiss and Willis (1997) examined how unanticipated changes in the predicted earnings capacity of husbands and wives (what the authors refer to as 'surprises') affected the probability of divorce. They found that an unexpected increase in the husband?s earning capacity lowers the divorce hazard whereas an unexpected increase in the wife's earning capacity raises the divorce hazard. Other factors affecting marital stability were also identified including the duration of marriage (increased hazard), the presence of children and the accumulation of property assets (decreased hazard).

Other studies have considered the effects of unemployment on marital dissolution. Jensen and Smith (1999) used panel data for a sample of married couples in Denmark to estimate a model for the probability of marital dissolution taking into account the possible effects of unemployment for both spouses. They found that unemployment appears to be an important factor in marital instability, though only unemployment of the husband has a significant effect on the probability of marital dissolution. Estimates showed that the divorce probability is more than twice as high for a couple where the husband has been unemployed for the entire year compared to a couple that has not experienced unemployment. Unemployment of the wife, on the other hand, had no impact on the probability of divorce in this study.

Eliason (2004) examined the effect of job loss due to plant closure on the probability of divorce using a cohort of married couples in Sweden. The focus on job loss due to plant closure as the outcome helped to control for reverse causality (i.e., that job loss is caused by divorce). In contrast to the Jensen and Smith study (1999), the findings showed that job losses on the part of either the husband or the wife increased the immediate risk of divorce by 18 percent. A follow-up period of 13 years post-job loss found that the risk of divorce was still significant for both husbands and wives, although the risk was lower for the former than the latter. The study also found that job losses did not appear to have a substantial effect on disposable family income, suggesting that either the displaced workers were able to find another job relatively easily without any intervening spell of unemployment, or they were able to access generous benefits from the Swedish welfare state. Eliason (2004) concludes that, because job loss increases the risk of divorce even under relatively favorable economic circumstances, more research is needed into the non-pecuniary costs of displacements (e.g., loss of social networks, time structure and self-esteem).

Studies on work-related disability and marital dissolution
A few studies have investigated the relationship between work-related disability and marital dissolution. A US study found that workers who experienced a workplace injury were 25% more likely to divorce than the non-injured population (Dembe, 1999). Another study by Morse et al. (1998) investigated the economic and social consequences of work-related musculoskeletal disorders (WRMSDs) including its association with divorce. Using a random sample of working-aged individuals in Connecticut, the study compared workers who reported chronic upper extremity conditions with a control group. Findings showed that compared to controls, WRMSD cases were almost twice as likely to report having been divorced (OR = 1.91), though the cross-sectional design of the study makes it difficult to determine a causal association between the two variables. The study also found that WRMSD cases were more likely than controls to report stress at home, and that 13% of these workers reported no longer holding the status as main wage earner in the family following the onset of WRMSD, both factors that could contribute to the probability of divorce.

Qualitative research on the consequences of work injury corroborates its adverse impact on marital stability. In a study of 40 workers with permanent partial impairments receiving compensation benefits in Ontario, Ballantyne (2001) found that many workers experienced relationship breakups, with several individuals attributing the breakup to the disruption of social roles caused by the injury. A New Zealand study of seriously injured workers, there were several reports of separation, divorce, loss of physical intimacy and breakdown of the family unit (Adams et al., 2002).

Other research on the association between work-related disability and marital instability has yielded somewhat mixed results. Brown et al. (2007) used the British Columbia Linked Health Database (BCLHD) to compare the probability of marital breakup between a group of married workers injured in 1994 who lost time due to work injury (LT) and another group who did not lose work time due to injury (NLT) for the period 1995 to 1999. The analyses showed that LTs were slightly less likely than NLTs to experience marital breakup following the injury. Additional stratified analysis of LTs showed that time-off work (specifically, 12+ weeks versus <12 weeks) was not associated with relationship breakup. The authors note that although these findings regarding marital breakup appear to contradict much of the qualitative literature (e.g., Adams et al., 2002; Ballantyne, 2001), this may be due to the fact that qualitative studies typically use samples of severely injured workers, and that indicators of injury severity are limited in administrative data such as that used in their study.

A study by Charles and Stephens (2004) compared the effects of earnings shocks on the probability of divorce under two circumstances, spousal job displacement and spousal disability. An "earnings shock" is defined as an unanticipated change in the earnings capacity of one spouse, which has an impact on both the family's consumption of goods and leisure, as well as the gains conferred by marriage to each member of the union. Using a sample of married couples drawn from the U.S. Panel Survey of Income Dynamics (1968-1993) the study found that the divorce hazard increases significantly following a spouse's job displacement but that the hazard does not change following a spousal disability. It should be noted, however, that part of the reason for the null findings for spousal disability in this study may be its use of a "softer" self-report measure of disability, which may conflate more serious disabilities with less serious ones. This caveat notwithstanding, the authors suggest that the results call into question explanations for divorce that are based on purely pecuniary factors since both circumstances - i.e., spousal job displacement and spousal disability - result in similar long-term economic consequences (Charles & Stephens, 2004).

Project references

Berkowitz M, Burton JF, Jr. The wage-loss study of California, Florida, and Wisconsin. Permanent Disability Benefits in Workers' Compensation.Kalamazoo (MI): W.E. Upjohn Institute for Employment Research; 1987. p. 317-61.

Biddle J. Estimation and analysis of long term wage losses and wage replacement rates of Washington state workers' compensation claimants. 1998. Ref Type: Unpublished Work

Boden LI, Galizzi M. Economic Consequences of Workplace Injury and Illnesses: Lost Earnings and Benefits Adequacy. American Journal of Industrial Medicine 1999;36:487-503.

Cheit EF. Measuring economic loss due to occupational death and disability. Injury and Recovery in the Course of Employment.New York (NY): John Wiley & Sons; 1961. p. 61-93.

Ginnold R. A following study of permanent disability cases under Wisconsin workers' compensation. Research report of the Interdepartmental Workers' Compensation Task Force.Eugene, OR: Education and Research Center, University of Oregon; 1979. p. 79-93.

Johnson WG, Cullinan PR, Curington WP. The adequacy of workers' compensation benefits. Research report of the Interdepartmental Workers' Compensation Task Force.Syracuse, NY: The Maxwell School, Syracuse University; 1979. p. 95-121.

Peterson MA, Reville RT, Stern RK, Barth PS. Compensating permanent workplace injuries: a study of the California system. Santa Monica, CA: RAND; 1998.

Biddle J. Estimation and analysis of long term wage losses and wage replacement rates of Washington state workers' compensation claimants. 1998. Ref Type: Unpublished Work

Cheit EF. Measuring economic loss due to occupational death and disability. Injury and Recovery in the Course of Employment.New York (NY): John Wiley & Sons; 1961. p. 61-93.

Ginnold R. A following study of permanent disability cases under Wisconsin workers' compensation. Research report of the Interdepartmental Workers' Compensation Task Force.Eugene, OR: Education and Research Center, University of Oregon; 1979. p. 79-93.

Brown JA, Shannon HS, Mustard CA, McDonough P. Social and economic consequences of workplace injury: a population-based study of workers in British Columbia, Canada. Am J Ind Med 2007 Aug 6;50(9):633-45.

Keogh JP, Nuwayhid I, Gordon JL, Gucer P. The impact of occupational injury on injured worker and family: outcomes of upper extremity cumulative trauma disorders in Maryland workers. Am J Ind Med 2000;38:498-506.

The Human Costs of Occupational Injuries. Morgantown, West Virginia: 1997.

Pransky G, Benjamin K, Hill-Fotouhi C, Himmelstein J, Fletcher KE, Katz JN, et al. Outcomes in work-related upper extremity and low back injuries: Results of a retrospective study. Am J Ind Med 2000 Apr;37(4):400-9.

Dawson SE. Workers' compensation in Pennsylvania: The effects of delayed contested cases. Journal of Health & Social Policy 1994;6(1):87-100.

Helliwell PS, Mumford DB, Smeathers JE, Wright V. Work related upper limb disorder: the relationship between pain, cumulatve load, disability, and psychological factors. Ann Rheum Dis 1992;51:1325-9.

Strong J, Ashton R, Large RG. Function and the Patient With Chronic Low Back Pain. The Clinical Journal of Pain 1994;10:191-6.

Strunin L, Boden LI. Family Consequences of Chronic Back Pain. Social Science & Medicine 2004;58(7):1385-93.

Morse TF, Dillon C, Warren N, Levenstein C, Warren A. The economic and social consequences of work-related musculoskeletal disorders: the Connecticut Upper-extremity Surveillance Project (CUSP). International Journal of Occupational and Environmental Health 1998;4(4):209-16.

Texas Workers' Compensation Research Center. Economic Outcomes of Injured Workers with Permanent Impairments. Research Review 1995;27(3):1-4.

Becker G, Landes E, Michael R. An economic analysis of marital instability. Journal of Political Economy 1977;85(6):1141-88.

Charles KK, Stephens MJr. Job displacement, disability, and divorce. J Law Econ 2004;22(2):489-522.

Jensen P, Smith N. Unemployment and marital dissolution. Journal of Population Economics 1999;3:215-29.

Dembe AE. Social Inequalities in Occupational Health and Health Care for Work-Related Injuires and Illnesses. International Journal of Law and Psychiatry 1999;22(5-6):567-79.

Adams M, Burton J, Butcher F, Graham S, McLeod A, Rajan R, et al. Aftermath: The Social and Economic Consequences of Workplace Injury and Illness. Wellington, New Zealand: New Zealand Department of Labor; 2002.

Ballantyne P. Pre-1990 claims unit study: final report to the Workplace Safety and Insurance Board. 2004.

Published works on the project

Tompa E, Scott-Marshall H, Fang M. Does Permanent Impairment from Workplace Accident Increase the Risk of Marital Breakup? Submitted to Social Indicators Research.

Health & well-being

Phase 1 Projects

Mental health and substance use experiences of injured workers with protracted claims

Mental health and quality of life after a work injury claim

Marital instability following a work accident

Health trajectories and health-care utilization: A long-term survey of injured workers

Injured workers' health and well-being

Immigrant workers' experiences after work-related injury and illness