Ascellus Blog

The Science Behind Identification of Psychosocial Risk Factors

October 5, 2020
The Science Behind Identification of Psychosocial Risk Factors

We know that early intervention is critical to preventing delayed recoveries. One of the challenges has been to identify injured workers at higher risk of poor outcomes.

Fortunately, we have the tools to determine which patients are more likely to develop chronic pain and languish in a disability mindset. The process is fairly simple and backed by strong, research-based evidence. With increased awareness among payers, providers and other industry stakeholders, we can prevent creeping catastrophic claims, help injured workers regain functionality quicker and significantly reduce workers’ compensation costs.

Reasons for Getting Stuck

Psychosocial risk factors used to be little more than a buzz term among workers’ compensation professionals. While those of us who’ve worked extensively with chronic pain patients understood that psychological issues can easily derail a workers’ compensation claim, the research that proves this to be true has become widespread only in recent years.

In fact, some of the most recent research says that psychological factors can be more of a predictor of poor outcomes than the underlying medical conditions. We now know for certain that the biomedical model of disease does not hold true for everyone, and the biopsychosocial model of illness must be considered.

Where the former is based on the idea that a physical ailment can be cured through medical solutions, the latter acknowledges that some people have an underlying psychobiological dysfunction that has clinically significant distress or disability. They are the injured workers who can greatly benefit from early identification and intervention.

Inadequate coping skills and a lack of knowledge of what is causing their pain can drive delayed recoveries and overutilization of treatments and medications. Chronic pain is the final common pathway of this delayed recovery.

Research validated through meta-analyses, prospective studies and control group studies shows that injured workers with delayed recoveries typically have:

    • Catastrophic thinking
    • A history of anxiety or depression
    • Anger and perceived injustice about their plight
    • An external locus of control
    • Minimal resilience

They may also have fear avoidance, meaning they engage in little to no physical activity out of fear they will injure themselves more and experience increased pain.

There are myriad reasons why some people have these issues. It could be childhood and life experiences, their relationship and interactions with their environment, issues in the workplace or home or other reasons altogether. It’s important that we identify injured workers with these issues as soon as possible after their injuries.

Pain Screening Questionnaires

One of the most effective ways to pinpoint injured workers with psychological issues is through specially designed, self-administered questionnaires. The one we use to identify patients at risk of developing chronic pain and disability is the Early Intervention Pain Questionnaire (EIPQ). 

Ascellus uses the EIPQ test and FLAG-DR™ scoring algorithm to identify cases at high-risk for delayed recovery due to behavioral and emotional factors. EIPQ includes 10-questions and can be administered as early as just two weeks post lost-time injury.

The EIPQ takes about 6 minutes to administer and yields predictive analysis with 98% accuracy. The injured worker is asked to rate on a scale of 1 to 10 things such as:

    • How would you rate the pain you have had during the past week?
    • In your view, how large is the risk that your current pain may become permanent?
    • Is an increase in pain an indication that I should stop what I’m doing until the pain decreases?

Depending on the score, the injured worker is categorized as low risk, moderate risk, high risk or very high risk. Those on the lower end of the scale are most appropriately managed through take-home educational materials on chronic pain. Moderate-risk injured workers are good prospects for a self-managed workbook-style intervention. High- and very-high risk injured workers should be referred for additional assessment and a generally short (6-session) intervention program, incorporating cognitive behavioral therapy (CBT).

In a program of early identification and intervention, Albertson’s Safeway found that referring “high” and “very high” risk claimants for just a 6 sessions minimal intervention program cut medical and indemnity costs in half, saving an average of $36,859 per case. Claimants returned to work more quickly. Because of the results, primary treating physicians who work with Albertson’s injured workers have been referring them to the program earlier in the claims process.


It is estimated that 10 percent of workers’ compensation claims consume at least 80 percent of medical and indemnity resources. The vast majority of these are injured workers with delayed recoveries due to psychosocial risk factors.

With solid science backing up the successful identification and interventions of these employees, we can prevent needless disability, substantially reducing workers’ compensation costs.

Ascellus – Integrated Medical Case Solutions – is the premier behavioral medicine network for pain and trauma response with evidence-based outcomes and a proven track record for transforming workers’ compensation cases. Ascellus makes intervention efficient with a national network of 1,500+ psychologists and psychiatrists in all 50 states.

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Ascellus bridges the gap between mental and physical health to accelerate recovery for our nation's workforce. By connecting the workers' compensation industry with our expert behavioral care and evidence-based treatments, we deliver high-quality outcomes, helping injured workers reemerge with increased strength, purpose and resilience in the workplace.