Impact of hand injuries in foreign workers in Singapore

1. Psychological impact of hand injuries
among foreign workers in Singapore
Ian Dhanaraj (1), Vaikunthan Rajaratnam (1)
, Mohamad Hasif Jaafar (2)
, Karen Morgan (2)
(1) Hand and Reconstructive Microsurgery Service,
Department of Orthopaedic Surgery, KTPH, Singapore
(2) Perdana University, Kuala Lumpur

2. Introduction
• 965,200 foreign workers in Singapore: 26% of total
workforce[1]
• Vocations: FDW, construction, shipyard
• Vulnerable population to psychological illness
• Manual work - prone to hand injuries
• Significant amount of man-hours lost per year
1. www.mom.gov.sg

3. Literature
• Commonly reported sequalae are depression, anxiety and
posttraumatic stress disorder.[2]
• Psychological impact of hand injuries correlates closely to
the functional outcome at both early and late stages of
recovery.[3]
• No particular type of hand injury was found to be associated
with an increased preponderance of psychological injury.[4]
2. Avinash De Sousa, Sushma Sonavane, Aruna Kurvey, Sanjay Kukreja, Nilesh Shah PSYCHOLOGICAL ISSUES IN HAND TRAUMA ASEAN Journal of
Psychiatry, Vol. 14 (1), January - June 2013
3. Dogu B, Kuran B, Sirzai H, Sag S, Akkaya N, Sahin F The relationship between hand function, depression, and the psychological impact of trauma in
patients with traumatic hand injury Int J Rehabil Res. 2014 Jun;37(2):105-9
4. Gustafsson M, Ahlström G Emotional distress and coping in the early stage of recovery following acute traumatic hand injury: a questionnaire survey
Int J Nurs Stud. 2006 Jul;43(5):557-65

4. Local studies?
• Single institution study in 2010 [5]
• Reviewed 504 ED visits with isolated hand injuries over 3
month period
• Most were male, between 20-30yrs, sustained industrial
accidents which were lacerations or crush.
• No local studies have yet studied the psychological impact
of these injuries on foreign workers.
4
5. Hey HW, Seet CM. Hand injuries seen at an emergency department in Singapore. Eur J Emerg Med. 2010 Dec;17(6):343-5.

5. Aim
• To evaluate the psychological impact of hand injuries among
foreign workers in Singapore.

6. Methodology
• Prospective
• Consecutively recruited (June 2018 – current)
• Single encounter, questions administered by same author
• Single-centre: KTPH, Singapore
• DSRB approval number: 2018/00362
Inclusion Criteria Exclusion Criteria
>21yo Congenital hand deformity
Foreign worker Previous hand injury/surgery
Isolated Hand/Finger injury Self inflicted injury
Industrial/work accident Pre-existing psychiatric illness
At least 1/12 from injury Polytrauma

7. Outcome measures
Primary
• DASS-21 score
Secondary
• Quick DASH
Other
• Demographic
• Injury specific data

8. Study Population
Male
94.40% (34)
Female
5.6% (2)
Gender
 Mean age: 32.6 years (23-48)
Married
, 21,
58%
Single,
14, 39%
Divorced,
1, 3%
Marital
<1k, 21,
59%
1-1.5k, 9,
25%
1.51-2k, 3,
8% >2k, 3,
8%
Salary
Salary per month, mean (SD) 1101.56 (589.98)
<1000 21 (58.3)
1000 – 1500 9 (25.0)
1501 – 2000 3 (8.3)
>2000 3 (8.3)

9. Study population - Nationality
Bangladeshi,
13, 36%
Indian, 13, 36%
Malaysian, 6,
17%
Chinese, 2, 5%
Indonesian, 1,
3%
Philippines, 1,
3%

10. Injury
Domina
nt, 17,
47%
Non-
domina
nt, 19,
53%
Side of injury
Penetrating
, 21, 58%
Blunt , 9,
25%
Others, 6,
17%
Mechanism
Yes, 33,
92%
No, 3,
8%
Surgery
Duration since injury, week, mean (SD) 8.17 (8.52)
4 – 8 weeks 29 (80.6)
9 – 16 weeks 4 (11.1)
>16 weeks 3 (8.3)

11. Results: DASS-21
25
19
22
11
17
14
DEPRESSION ANXIETY STRESS
Normal Abnormal
11
Of the 36 patients enrolled, 11 (30.6%) were found to have depression, 17
(47.2%) anxiety and 14 (38.9%) stress.

12. Results
12
Correlation of DASS-21 with Quick-DASH
Correlation of DASS-21 with VAS
QUICKDASH p-value Adjusted p-value
Depression 0.59 <0.001 0.008
Anxiety 0.62 <0.001 0.017
Stress 0.71 <0.001 <0.001
VAS p-value Adjusted p-value
Depression 0.53 0.001 0.026
Anxiety 0.46 0.005 0.003
Stress 0.39 0.018 0.026
Depression, anxiety and stress were found to have a positive association with Quick-
DASH and VAS independently and on regression analysis

13. Limitations
• Single centre experience
• Small sample size
• Small number of conservatively managed patients
• Further research – quantitative analysis, non foreign-workers

14. Conclusion
• At least 1 in 3 foreign workers with hand injuries in Singapore
has a significant psychological impact
• Strong correlation with Quick-DASH and VAS
• Integrating mental health assessment and treatment
strategies into the hand care pathway
• Incorporating mental health management in health care
financing and coverage

15. THANK YOU