Access to our Brisbane, Canberra and Melbourne offices is currently restricted. To visit us at these locations, call 1300 366 979 to arrange an appointment.

Psychosocial hazard case studies

These case studies are based on Comcare regulatory activity in response to incidents involving psychosocial hazards and risks at workplaces in the Commonwealth jurisdiction.

They are intended as an education resource to provide the jurisdiction with examples of hazards and risks and how they can be managed.

CASE STUDY 1 – Poor organisational change management

Poor change management can lead to psychological injuries and other adverse health outcomes, as well as reduced productivity. It is identified as a common hazard in the Model Code of Practice: Managing psychosocial hazards at work.

Consulting workers is a critical element of implementing organisational change and is a legal requirement under work health and safety laws.

What happened?

An Australian Public Service agency introduced a new performance management system across part of its business. The new system included performance ratings which determined the number and frequency of work assessments.

The agency decided that only ongoing staff – not contractors – needed to be consulted ahead of implementation. Staff working on labour hire contracts complained the new system caused bullying and harassment, increased their stress and had negative effects on their mental health.

Action and outcomes

A Comcare inspection found it was foreseeable that all affected workers may feel pressure from the increased scrutiny and that it would impact their psychological health and safety. This was particularly the case for workers in more vulnerable labour hire employment arrangements.

The agency’s actions contravened the Work Health and Safety Act 2011 (WHS Act) in relation to:

  • failure to manage the risks to psychological health and safety in the rollout of the performance management system; and
  • failure to consult all workers on a change that may affect their psychological health and safety, and a failure to include Health and Safety Representatives (HSRs) in that consultation.

The organisation was directed to develop a corrective action plan to ensure:

  • there was a process/system in place to identify and manage psychological hazards associated with organisational change that could affect workers’ health and safety that change; and
  • all workers and their HSRs were included in consultation on the change.
  • WHS Act section 19 : Duty to manage risks to psychological health and safety. Persons Conducting a Business or Undertaking (PCBUs) have a duty to manage risks to the psychological health and safety of workers by eliminating or minimising exposure to psychosocial hazards so far as reasonably practicable.
  • WHS Act section 47 – Duty to consult with workers. This provides that a PCBU has a duty to consult with workers who are likely to be affected by a matter relating to work health and safety.

More information

  • Model Code of Practice: Managing psychosocial hazards at work
  • Work Health and Safety Consultation, Co-operation and Co-ordination Code of Practice 2015
  • Psychosocial hazards
  • Poor organisational change management

---------------------------------------------------------------------------------------------------------------------------

CASE STUDY 2 – Work demands

Work demands are one of the most common sources of workplace stress and psychological harm.

Poor health outcomes from work demands are far less likely in organisations with a supportive culture that rewards workers, promotes early reporting of issues and proactively manages risk.

Employers have a legal obligation under work health and safety laws to implement safe systems of work that identify hazards and effectively manage psychosocial risks to prevent harm to workers.

An APS agency was experiencing high workloads and staff shortages in one of its key frontline business areas over a period of at least a year. Staff reported workloads that were excessive and unsafe, with obvious negative impacts on workers’ mental health.

The agency advised it planned to implement a number of controls over a period of several months to control psychosocial risks associated with workloads, including boosting staff numbers and streamlining workflows and roles.

However, a Comcare inspection found the organisation was contravening work health and safety laws by failing to adequately address immediate psychosocial risks across its workplaces.

A Comcare inspection found the organisation was not meeting its duties under the Work Health and Safety Act and Regulations 2011 :

  • Failure to provide and maintain a safe system of work relating to psychosocial risks associated with workload management.

The agency developed and implemented a corrective action plan which detailed measures to manage and control immediate risks including:

  • Engaging with Health and Safety Representatives to discuss the agency’s approach to managing psychosocial risks from work demands
  • Closer monitoring of workloads, including structured and documented engagement by line managers with workers
  • A range of workplace wellbeing activities

The inspector also recommended improvements to communication with workers about psychosocial hazards and risks, and in the way Work Health and Safety Committee meetings were run.

  • WHS Act Section 19(3)(c) : Provision and maintenance of safe system of work, so far as reasonably practicable, relating to psychosocial risks associated with workload management.
  • Work demands

-------------------------------------------------------------------------------------------------------------------------

CASE STUDY 3 – Bullying and harassment

Bullying is repeated, unreasonable behaviour directed towards a worker or group of workers, that creates a risk to health and safety. Harassment is harmful behaviour that creates a risk to health or safety when a person is treated poorly based on personal characteristics such as age, disability, race, nationality, religion, political affiliation, sex or gender identity.

Workplace bullying and harassment are often the result of poor workplace culture supported by an environment which allows this behaviour to occur. Identifying and addressing these conflicts early helps promote respectful behaviour and prevents bullying and harassment from becoming accepted behaviour.

Comcare received complaints from workers at an Australian Government entity who raised concerns about a range of workplace issues including:

  • Alleged bullying and harassment by managers
  • Unrealistic timeframes for completing training
  • Insufficient resources to complete tasks
  • Excessive hours and fatigue

Comcare’s inspection did not identify a specific contravention of the Work Health and Safety Act and Regulations 2011.

However, the inspector did recommend a range of improvements to strengthen responses to identified psychosocial hazards and risks, including:

  • Consulting with all workers likely to be directly affected by a health and safety matter
  • Updating workplace risk assessments to refer to psychosocial hazards, including bullying and harassment
  • Retraining all workers on policies and procedures regarding bullying and harassment and grievance procedures
  • Improving executive managers’ understanding of workplace hazards and risks to assist in meeting Officer Due Diligence obligations and promote a positive safety culture
  • WHS Act section 19: Duty to manage risks to psychological health and safety. Persons Conducting a Business or Undertaking (PCBUs) have a duty to manage risks to the psychological health and safety of workers by eliminating or minimising exposure to psychosocial hazards so far as reasonably practicable.
  • WHS Act section 47: Duty to consult with workers. This provides that a PCBU has a duty to consult with workers who are likely to be affected by a matter relating to work health and safety.
  • WHS Act section 27: Duty of officers. Officers of corporations, the Crown or a public authority in the Commonwealth jurisdiction have a specific duty to exercise due diligence to ensure the organisation meets its work health and safety obligations.
  • Regulatory guide - Duties of officers

--------------------------------------------------------------------------------------------------------------------------

CASE STUDY 4 – Combined hazards

Psychosocial hazards often don’t occur in isolation, with workers likely to be exposed to a combination of hazards. Some hazards may always be present in the workplace, while others may be occasional.

Health and Safety Representatives contacted Comcare to address complaints of unresolved psychosocial hazards resulting in multiple psychological and physical injuries to workers at an Australian Government agency.

The hazards were reported to relate to managerial administrative action for performance management, code of conduct action, a review of flexible working hours and a restructure.

The issues combined a range of common psychosocial hazards including:

  • Poor organisational justice
  • Job demands
  • Lack of role clarity

Comcare carried out multiple inspections and issued an Improvement Notice in relation to these matters.

Inspectors formed a reasonable belief that the organisation had contravened several duties under the Commonwealth Work Health and Safety Act. Failures included:

  • Ineffective Work Health and Safety Management Systems to prevent or minimise psychological injury to workers
  • Lack of a change management plan and inadequate worker consultation
  • Inadequate rehabilitation management system that did not integrate with the hazard identification component of the WHS Management System
  • Failure to conduct incident investigations into the causal factors that contribute to psychosocial incidents

In response, the agency introduced and strengthened a range of existing controls across its business, including:

  • A mediation process to resolve staff grievances
  • Regular staff wellbeing checks
  • Establishing a unit to assist with integrating teams in future Machinery of Government changes
  • Developing a suite of tools to improve performance management

Comcare GPO Box 9905, Canberra, ACT 2601 1300 366 979 | www.comcare.gov.au

Date printed 24 Feb 2024

https://www.comcare.gov.au/safe-healthy-work/prevent-harm/psychosocial-hazards/more-information-on-psychological-health-and-safety-in-the-workplace/whs-regulations-case-studies

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Phineas Gage: His Accident and Impact on Psychology

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

psychological injury case studies

Emily is a board-certified science editor who has worked with top digital publishing brands like Voices for Biodiversity, Study.com, GoodTherapy, Vox, and Verywell.

psychological injury case studies

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  • Phineas Gage's Accident
  • Change in Personality
  • Severity of Brain Damage
  • Impact on Psychology

What Happened to Phineas Gage After the Brain Damage?

Phineas Gage is often referred to as the "man who began neuroscience." He experienced a traumatic brain injury when an iron rod was driven through his skull, destroying much of his frontal lobe .

Gage miraculously survived the accident. However, his personality and behavior were so changed as a result of the frontal lobe damage that many of his friends described him as an almost different person entirely. The impact that the accident had has helped us better understand what the frontal lobe does, especially in relation to personality .

At a Glance

In 1948, Phineas Gage had a workplace accident in which an iron tamping rod entered and exited his skull. He survived but it is said that his personality changed as a result, leading to a greater understanding of the brain regions involved in personality, namely the frontal lobe.

Phineas Gage's Accident

On September 13, 1848, 25-year-old Gage was working as the foreman of a crew preparing a railroad bed near Cavendish, Vermont. He was using an iron tamping rod to pack explosive powder into a hole.

Unfortunately, the powder detonated, sending the 43-inch-long, 1.25-inch-diameter rod hurling upward. The rod penetrated Gage's left cheek, tore through his brain , and exited his skull before landing 80 feet away.

Gage not only survived the initial injury but was able to speak and walk to a nearby cart so he could be taken into town to be seen by a doctor. He was still conscious later that evening and able to recount the names of his co-workers. Gage even suggested that he didn't wish to see his friends since he would be back to work in "a day or two" anyway.

The Recovery Process

After developing an infection, Gage spent September 23 to October 3 in a semi-comatose state. On October 7, he took his first steps out of bed, and, by October 11, his intellectual functioning began to improve.

Descriptions of Gage's injury and mental changes were made by Dr. John Martyn Harlow. Much of what researchers know about the case is based on Harlow's observations.

Harlow noted that Gage knew how much time had passed since the accident and remembered clearly how the accident occurred, but had difficulty estimating the size and amounts of money. Within a month, Gage was well enough to leave the house.

In the months that followed, Gage returned to his parent's home in New Hampshire to recuperate. When Harlow saw Gage again the following year, the doctor noted that while Gage had lost vision in his eye and was left with obvious scars from the accident, he was in good physical health and appeared recovered.

Theories About Gage's Survival and Recovery

The type of injury sustained by Phineas Gage could have easily been fatal. While it cannot be said with certainty why Gage was able to survive the accident, let alone recover from the injury and still function, several theories exist. They include:

  • The rod's path . Some researchers suggest that the rod's path likely played a role in Gage's survival in that if it had penetrated other areas of the head—such as the pterygoid plexuses or cavernous sinus—Gage may have bled to death.
  • The brain's selective recruitment . In a 2022 study of another individual who also had an iron rod go through his skull—whom the researchers referred to as a "modern-day Phineas Gage"—it was found that the brain is able to selectively recruit non-injured areas to help perform functions previously assigned to the injured portion.
  • Work structure . Others theorize that Gage's work provided him structure, positively contributing to his recovery and aiding in his rehabilitation.

How Did Phineas Gage's Personality Change?

Popular reports of Gage often depict him as a hardworking, pleasant man before the accident. Post-accident, these reports describe him as a changed man, suggesting that the injury had transformed him into a surly, aggressive heavy drinker who was unable to hold down a job.

Harlow presented the first account of the changes in Gage's behavior following the accident. Where Gage had been described as energetic, motivated, and shrewd prior to the accident, many of his acquaintances explained that after the injury, he was "no longer Gage."

Severity of Gage's Brain Damage

Since there is little direct evidence of the exact extent of Gage's injuries aside from Harlow's report, it is difficult to know exactly how severely his brain was damaged. Harlow's accounts suggest that the injury did lead to a loss of social inhibition, leading Gage to behave in ways that were seen as inappropriate.

In a 1994 study, researchers utilized neuroimaging techniques to reconstruct Phineas Gage's skull and determine the exact placement of the injury. Their findings indicate that he suffered injuries to both the left and right prefrontal cortices, which would result in problems with emotional processing and rational decision-making .

Another study conducted in 2004 used three-dimensional, computer-aided reconstruction to analyze the extent of Gage's injury. It found that the effects were limited to the left frontal lobe.

In 2012, new research estimated that the iron rod destroyed approximately 11% of the white matter in Gage's frontal lobe and 4% of his cerebral cortex.

Some evidence suggests that many of the supposed effects of the accident may have been exaggerated and that Gage was actually far more functional than previously reported.

Why Is Phineas Gage Important to Psychology?

Gage's case had a tremendous influence on early neurology. The specific changes observed in his behavior pointed to emerging theories about the localization of brain function, or the idea that certain functions are associated with specific areas of the brain.

In those years, neurology was in its infancy. Gage's extraordinary story served as one of the first sources of evidence that the frontal lobe was involved in personality.

Today, scientists better understand the role that the frontal cortex has to play in important higher-order functions such as reasoning , language, and social cognition .

After the accident, Gage was unable to continue his previous job. According to Harlow, Gage spent some time traveling through New England and Europe with his tamping iron to earn money, supposedly even appearing in the Barnum American Museum in New York.

He also worked briefly at a livery stable in New Hampshire and then spent seven years as a stagecoach driver in Chile. He eventually moved to San Francisco to live with his mother as his health deteriorated.

After a series of epileptic seizures, Gage died on May 21, 1860, almost 12 years after his accident. Seven years after his death, Gage's body was exhumed. His brother gave his skull and the tamping rod to Dr. Harlow, who subsequently donated them to the Harvard University School of Medicine. They are still exhibited in its museum today.

Bottom Line

Gage's accident and subsequent experiences serve as a historical example of how case studies can be used to look at unique situations that could not be replicated in a lab. What researchers learned from Phineas Gage's skull and brain injury played an important role in the early days of neurology and helped scientists gain a better understanding of the human brain and the impact that damage could have on both functioning and behavior.

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By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Introducing Psychological Injury and Law

  • Published: 04 December 2020
  • Volume 13 , pages 452–463, ( 2020 )

Cite this article

  • Gerald Young   ORCID: orcid.org/0000-0002-3689-6924 1 ,
  • William E. Foote 1 ,
  • Patricia K. Kerig 1 ,
  • Angela Mailis 1 ,
  • Julie Brovko 1 ,
  • Eileen A. Kohutis 1 ,
  • Shawn McCall 1 ,
  • Eleni G. Hapidou 1 ,
  • Kathryn F. Fokas 1 &
  • Jane Goodman-Delahunty 1  

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Psychology injury and law is a specialized forensic psychology field that concerns reaching legal thresholds for actionable negligent or related injuries having a psychological component, such as for posttraumatic stress disorder, chronic pain, and mild traumatic brain injury. The presenting psychological injuries have to be related causally to the event at issue, and if pre-existing injuries, vulnerabilities, or psychopathologies are involved at baseline, they have to be exacerbated by the event at issue, or added to in unique ways such that the psychological effects of the event at issue go beyond the de minimis range. The articles in this special issue deal with the legal aspects of cases of psychological injury, including in legal steps and procedures to follow and the causal question of whether an index event is responsible for claimed injuries. They deal with the major psychological injuries, and others such as somatic symptom disorder and factitious disorder. They address best practices in assessment such that testimony and reports proffered to court are probative, i.e., helping the trier of fact to arrive at judicious decisions. The articles in the special issue review the reliable and valid tests in the field, including those that examine negative response bias, negative impression management, symptom exaggeration, feigning, and possible malingering. The latter should be ruled in only through the most compelling evidence in the whole file of an examinee, including test results and inconsistencies. The court will engage in admissibility challenges when testimony, reports, opinions, conclusions, and recommendations do not meet the expected standards of being scientific, comprehensive, impartial, and having considered all the reliable data at hand. The critical topics in the field that cut across the articles in the special issue relate to (a) conceptual and definitional issues, (b) confounds and confusions, (c) assessment and testing, (d) feigning/malingering, and (e) medicolegal/legal/court implications. The articles in the special issue are reviewed in terms of these five themes.

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Gerald Young, William E. Foote, Patricia K. Kerig, Angela Mailis, Julie Brovko, Eileen A. Kohutis, Shawn McCall, Eleni G. Hapidou, Kathryn F. Fokas & Jane Goodman-Delahunty

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Young, G., Foote, W.E., Kerig, P.K. et al. Introducing Psychological Injury and Law. Psychol. Inj. and Law 13 , 452–463 (2020). https://doi.org/10.1007/s12207-020-09396-5

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Received : 14 October 2020

Accepted : 26 October 2020

Published : 04 December 2020

Issue Date : December 2020

DOI : https://doi.org/10.1007/s12207-020-09396-5

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  • Volume 50, Issue 3
  • The psychological response to injury in student athletes: a narrative review with a focus on mental health
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  • Margot Putukian 1 , 2
  • 1 Department of Athletic Medicine , University Health Services, Princeton University , Princeton, New Jersey , USA
  • 2 Rutgers—Robert Wood Johnson Medical School, University Health Services, Princeton University , Princeton, New Jersey , USA
  • Correspondence to Dr Margot Putukian, Department of Athletic Medicine, University Health Services, Princeton University, Princeton, NJ 08540, USA; putukian{at}Princeton.edu

Background Injury is a major stressor for athletes and one that can pose significant challenges. Student athletes must handle rigorous academic as well as athletic demands that require time as well as significant physical requirements. Trying to perform and succeed in the classroom and on the playing field has become more difficult as the demands and expectations have increased. If an athlete is injured, these stressors increase.

Main thesis Stress is an important antecedent to injuries and can play a role in the response to, rehabilitation and return to play after injury. The psychological response to injury can trigger and/or unmask mental health issues including depression and suicidal ideation, anxiety, disordered eating, and substance use/abuse. There are barriers to mental health treatment in athletes. They often consider seeking help as a sign of weakness, feeling that they should be able to ‘push through’ psychological obstacles as they do physical ones. Athletes may not have developed healthy coping behaviours making response to injury especially challenging.

Purpose I discuss the current state of knowledge regarding the psychological response to injury and delineate resources necessary to direct the injured athlete to a mental health care provider if appropriate.

https://doi.org/10.1136/bjsports-2015-095586

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Introduction

Whether participation in sport is protective or harmful to mental health remains unclear. Though exercise and participation in sport is generally favourable, improving mood and self-esteem, at the extremes of exercise we see increased stress and burnout and the potential for adverse effects. 1–5 Growing research is dedicated to understanding the relationship between exercise and mental health disorders 1 as well as to chronic stress and mental health. 6 Mental health concerns such as eating disorders, depression and suicide, anxiety, gambling and substance use are among the most important in college-aged students, both athletes and non-athletes. 7–12 Some data exist that certain concerns, such as performance anxiety, eating disorders and binge drinking may be more common in athletes than their non-athletic peers. 13–15 Symptoms of depression are not uncommon in athletes 16 , 17 and in one study symptoms were reported in 21% of collegiate athletes with women, freshman and those that self-reported pain had a significantly increased risk for reporting depressive symptoms. 16 Depression in some athletes may also be related with performance failure, and elite athletes may be at a greater risk for depression than less elite athletes. 18

Injuries: antecedents and the emotional response

Injuries are common in athletes and the psychological response to injury can include normal as well as problematic responses,. 19–22 Preinjury factors, including biological, physical, psychological sociocultural, and most importantly stress, can increase an athlete's risk of injury and poor recovery. 19–23 After injury, several factors such as cognition, affect and behaviour are all inter-related and can also affect each other in the short and long term. 21

Stress can cause attentional changes, distraction and increased self-consciousness that all can interfere with performance and predispose an athlete to injury. 20 , 21 , 24 , 25 Chronic stress increases hair cortisol levels in a wide range of contexts/situations such as endurance athletes and pain as well as in patients with major depression. 6 Stress increases muscle tension and coordination that can increase the risk for injury; decreasing stress can actually decrease injury and illness rates. 20 , 24 , 26 , 27

Adolescents who have ‘high mental toughness’ were more resilient to stress and reported a lower number of depressive symptoms. 28 Adolescents with higher ‘resilience’ scores predicted lower scores on levels of depression, anxiety, stress and obsessive-compulsive symptoms after controlling for age and sex. 29 This underscores the importance of identifying which stressors apply to student athletes in general as well as which are at play in individual athlete and are modifiable. These data also emphasise the importance of considering stress reduction techniques in an attempt to decrease the risk for injury and improve performance.

Emotional response to injury (modified from American College of Sports Medicine et al 20 )

Lack of motivation

Frustration

Changes in appetite

Sleep disturbance

Disengagement

Athletes differ in their response to injury. The response to injury extends from the time immediately after injury through to the postinjury phase and then rehabilitation and ultimately with return to activity. For the majority of injuries and illness return to preinjury levels of activity occur. With more serious illness or injury, a career ending injury is possible, and the health care provider should be prepared to address these issues. The Team Physician is ultimately responsible for the return to play decision and addressing psychological issues is a very important component of this decision. 33 , 34

Injuries: problematic responses

Problematic emotional reactions (modified from american college of sports medicine et al 20 ).

Persistent symptoms

Alterations of appetite

Irritability

Worsening symptoms

Alterations of appetite leading to disordered eating

Sadness leading to depression

Lack of motivation leading to apathy

Disengagement leading to alienation

Excessive symptoms

Pain behaviours

Excessive anger or rage

Frequent crying or emotional outbursts

Substance abuse

Examples of problematic reactions include injured athletes who restrict their caloric intake because they feel since they are injured they ‘don't deserve’ to eat, with the restrictive eating then triggering disordered eating. In an athlete already at risk for disordered eating patterns and eating disorders, injury can increase the vulnerability to this problematic response.

Another problematic response to injury is depression. It can be a significant warning sign as it can magnify other responses and can also impact recovery from injury.

Substance use and abuse is a common problematic response and different substances are often used as a method of modulating emotions. For example; cocaine is used to provide stimulation and modify depression, and alcohol is often used to counter mania. Alcohol as well as other recreational drugs or prescription narcotics are often used to self-medicate in an attempt to improve mood in depression.

Gambling and legal problems or fighting are also problematic responses that occur in student athletes, and it is important to understand that it is not infrequent to have several problematic responses occurring concurrently, such as alcohol abuse and depression, depression and eating disorders and alcohol and fighting. 10–13 , 15–18 , 20 , 36

In a review of depression and alcohol use in 262 collegiate athletes, 36 21% reported high alcohol use and problems associated with alcohol. There was a correlation between self-reported symptoms of depression and alcohol abuse. Those athletes with severe depression and psychological symptoms had a significantly greater rate of alcohol abuse than those with low depression and low psychological symptoms. Furthermore, in a review of five collegiate athletes who completed suicide, common factors included (1) considerable success before injury, (2) serious injury requiring surgery (3) long rehabilitation with restriction from play (4) inability to return to the prior level of play and (5) being replaced in their position by a teammate. 37 Of these the greatest predictor was the severity of injury. Other risk factors, such as stressful life events (including injury), chronic mental illness, personality traits with maladjustment, family history of suicidal tendency and psychiatric disorder /other issues (eg, homosexuality, drug use, previous suicide attempts, chronic low self-esteem) were overlapping risk factors.

After a significant time loss injury, athletes can suffer physically as well as emotionally with a decrease in quality of life measures. 38 , 39 The emotional response to an ACL injury can be more significant than that experienced after concussion. 40 When Olympic skier Picabo Street sustained significant leg and knee injuries in March of 1998, she battled significant depression during her recovery. She stated “I went through a huge depression. I went all the way to rock bottom. I never thought that I would ever experience anything like that in my life. I think it was a combination of the atrophying of my legs, the new scars, and feeling like a caged animal”. 41 She ultimately received treatment and returned to skiing before retiring. Kenny McKinley played as a wide receiver professionally for the Denver Broncos Football team. He was found dead of a self-inflicted gunshot wound in September of 2010, after growing despondent after a knee injury. He had undergone surgery expected to sideline for a season and had made statements about being unsure what he would do without football and reportedly sharing thoughts that he should kill himself. 41 These case examples demonstrate how injury can often trigger significant depression and suicidal ideation.

Concussion can be particularly challenging for student athletes to handle emotionally, increasingly common in a variety of contact and collision sports; an injury that is occasionally associated with significant time loss or retirement from sport. 42–46 For the athlete with a severe knee injury, such as an ACL tear requiring surgery, one can often provide a predictable timeline and modified exercise (swimming or biking) options early in recovery. Concussion is difficult because a discrete timeline for recovery and return to play is unknown. In addition, the initial management of concussion includes cognitive and physical rest and the latter is something that many athletes often depend on to handle stressors. They are not able to exercise, and given the emotional and cognitive symptoms associated with concussion, often also struggle with academics as well as the emotional response to injury. In addition, depression and anxiety are felt to be modifiers of concussive injury, further prolonging recovery from injury. 43 , 47 There is limited data to suggest an increased incidence of depression in athletes with a higher history of self-reported concussion. 48 , 49 For the concussed athlete it is especially important to watch for problematic response from injury as well as understand the resources for treatment. Finally, with the recent description of chronic traumatic encephalopathy (CTE), with as of yet significantly more unknown than known, 50–52 athletes are often concerned that they may develop CTE even after a mild concussive injury. This fear for what might occur in the future amplifies the importance of recognising and managing concussive injury and addressing these concerns.

Obstacles to seeking care

There are several obstacles to seeking care for mental health issues in athletes. It is important to understand that athletes are less likely to seek help for mental health issues than non-athletes. 53 , 54 For college mental health service providers it is also important to understand that student athletes are often a unique population with specific obstacles to seeking care. Accessibility is important often there is a ‘teaching moment’ where getting an athlete to consider treatment can be challenging and therefore expediting an evaluation can be essential. It is also important to realise that privacy issues can be different; coaches, athletic trainers and team physicians often play an important role in the support network for the athlete. Including these providers in the discussion of significant issues can be helpful in providing care to the athlete.

Athletes may be at greater risk for mental health issues in that they are less likely to seek treatment, may be afraid to reveal symptoms, may see seeking counselling as a sign of weakness, are accustomed to working through pain, may have a sense of entitlement and never had to struggle, and/or may not have developed healthy coping mechanisms to deal with failure. In addition, many athletes have not developed their identity outside of that as an athlete and therefore if this role is threatened by injury or illness, they may experience a significant ‘loss’. As discussed previously, exercise is often an escape or coping mechanism for many athletes, so if injury occurs and they cannot exercise, it can result in a problematic response.

Barriers and facilitators to help seeking (modified from Gulliver et al 54 )

Barriers (ranked from most common to least, top to bottom)

Lack of problem awareness

Difficulty in or not willing to express emotion

Lack of time

Denial of problem

Not sure who to ask for help

Fear of what might happen

Worried about affecting ability to play / train

Belief that it would not help

Not accessible

Facilitators

Education and awareness of mental health issues and/or services

Social support

Encouragement from others

Accessibility (eg, money, transport, location)

Positive relationship with service staff

Confidentiality

Integration into athlete life

Positive past experiences

Ease of expressing emotion and openness

Facilitating treatment and support

As an athletic trainer, team physician or other healthcare provider, it is important to recognise the common signs and symptoms for various mental health concerns and understand the resources available for treatment and management. 55–59 It is a responsibility of the athletic trainer and team physician to do everything possible to ‘demystify’ mental health concerns and help athletes understand that mental health concerns are as important to recognise and treat as other medical and musculoskeletal issues. Underscoring the availability of athletic medicine staffs to provide early referral and management of mental health concerns is essential.

Also essential is a basic understanding of what measures can make a difference in terms of treating mental health concerns as well as improving general wellness and performance. 20 , 55–59 Treatment that can improve resilience and mental toughness can be expected to help mitigate stress and potentially minimise depressive symptoms. 28 , 29 A systematic review evaluated 983 athletes and 15 psychological factors identified that three psychological elements (self-determination theory-autonomy, competence and relatedness) as the factors most important in positive rehabilitation and return to preinjury level of play. 34 In addition, another study demonstrated that there may be a role for internet-based interventions in demystifying mental health issues and providing education regarding common signs and symptoms as well as the benefits for seeking help. 53

It is important for coaches, athletic trainers and team physicians to provide support for injured athletes and keep athletes involved and part of the team. This might include keeping athletes engaged and encouraging athletes to seek help instead of ‘tough it out’. For coaches one of the most powerful actions is to ‘give the athlete permission’ and encourage them to seek care. 53 , 54 Having programmes available to educate athletes as well as athletic medicine and administrative staffs regarding the resources available and the importance of collaborative programming is helpful in providing care. 20 , 21 , 55–58 , 60–62

Including screening questions during the preparticipation examination and interim physicals performed at the high school and college level that address mental health concerns is an opportunity to detect issues early. 55–57 Considering more comprehensive questionnaires such as the Generalized Anxiety Disorder screen (GAD-7) 63 and the Patient Health Questionnaire (PHQ-9) 64 as a screen for anxiety and depression, respectively, may be useful at baseline as well as during return to activity. 65 In addition, by including these measures as part of the sports physical, it can normalise mental health issues as important and potentially decrease the stigma for discussing these issues.

Future directions/conclusions

Injury is a stressor that has physical as well as psychological responses. The psychological response to injury is important and although emotional responses to injury are common, problematic responses can be those that are persistent, worsen or appear excessive. At times, problematic responses can trigger more serious mental health issues including depression, anxiety, eating disorders, substance use.

There are obstacles to treatment of mental health concerns in athletes, and athletic trainers, team physicians and other healthcare providers play an essential role in recognising and identifying athletes at risk for mental health concerns. Having a comprehensive plan in place to screen for, detect and manage student athletes with problematic response to injury is important. Several positive coping mechanisms and interventions can help to manage the student athlete with problematic responses. Understanding the mental health resources available, making timely referrals, and providing support for help-seeking behaviours are essential for the sports medicine team.

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Contributors This article was planned and completed by the sole author, MP.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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Psychological Injuries: Forensic Assessment, Treatment, and Law

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9 Psychological Injury Cases

Author Webpage

  • Published: November 2005
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After their written opinions are in the hands of other professionals, experts often learn something important that they should have known before about the plaintiff or the phenomenon under scrutiny. Then, having to own their opinions with possibly negative consequences, experts may face embarrassment in the witness box or ethics complaints. This chapter presents series of case descriptions to alert forensic assessors to problematic areas of forensic opinion. The cases all illustrate issues in psychological injury assessment that have been addressed in some form in previous chapters. Topics covered include biases and heuristics, breadth of assessment, estimations of functional disability, and inadequate historical data collection.

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Psychosocial issues following serious head injury: a case study of an adolescent girl

  • PMID: 8868757
  • DOI: 10.1002/j.2048-7940.1996.tb00839.x

This article is a case study of an adolescent girl who sustained a serious head injury following an attack by strangers. The head injury caused an epidural hemorrhage that exerted pressure on her brain stem and resulted in spastic quadriplegia. In this case, the major issues in rehabilitation were the patient's ability to learn to communicate and normalize and gain control over various aspects of her life. Because of the lack of a specialized rehabilitation setting for children and adolescents, rehabilitation took place in an acute care setting, which makes this story unusual in many ways. Staff issues were significant because of the nurses' inexperience with rehabilitation issues and because of the setting. This article describes the primary nurse's experience with this patient over several months. During this phase of rehabilitation, psychosocial issues were a major concern. Fifteen months after rehabilitation began, the patient moved back home and returned to high school. She communicates by using a computer and by using her eyes, and she uses a wheelchair. Despite everything, she is determined to get better and to prepare herself for the future.

Publication types

  • Case Reports
  • Adaptation, Psychological*
  • Nurse-Patient Relations
  • Psychology, Adolescent*
  • Quadriplegia / nursing
  • Quadriplegia / psychology*
  • Quadriplegia / rehabilitation*

Henry Gustav Molaison: The Curious Case of Patient H.M. 

Erin Heaning

Clinical Safety Strategist at Bristol Myers Squibb

Psychology Graduate, Princeton University

Erin Heaning, a holder of a BA (Hons) in Psychology from Princeton University, has experienced as a research assistant at the Princeton Baby Lab.

Learn about our Editorial Process

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, Ph.D., is a qualified psychology teacher with over 18 years experience of working in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

On This Page:

Henry Gustav Molaison, known as Patient H.M., is a landmark case study in psychology. After a surgery to alleviate severe epilepsy, which removed large portions of his hippocampus , he was left with anterograde amnesia , unable to form new explicit memories , thus offering crucial insights into the role of the hippocampus in memory formation.
  • Henry Gustav Molaison (often referred to as H.M.) is a famous case of anterograde and retrograde amnesia in psychology.
  • H. M. underwent brain surgery to remove his hippocampus and amygdala to control his seizures. As a result of his surgery, H.M.’s seizures decreased, but he could no longer form new memories or remember the prior 11 years of his life.
  • He lost his ability to form many types of new memories (anterograde amnesia), such as new facts or faces, and the surgery also caused retrograde amnesia as he was able to recall childhood events but lost the ability to recall experiences a few years before his surgery.
  • The case of H.M. and his life-long participation in studies gave researchers valuable insight into how memory functions and is organized in the brain. He is considered one of the most studied medical and psychological history cases.

3d rendered medically accurate illustration of the hippocampus

Who is H.M.?

Henry Gustav Molaison, or “H.M” as he is commonly referred to by psychology and neuroscience textbooks, lost his memory on an operating table in 1953.

For years before his neurosurgery, H.M. suffered from epileptic seizures believed to be caused by a bicycle accident that occurred in his childhood. The seizures started out as minor at age ten, but they developed in severity when H.M. was a teenager.

Continuing to worsen in severity throughout his young adulthood, H.M. was eventually too disabled to work. Throughout this period, treatments continued to turn out unsuccessful, and epilepsy proved a major handicap and strain on H.M.’s quality of life.

And so, at age 27, H.M. agreed to undergo a radical surgery that would involve removing a part of his brain called the hippocampus — the region believed to be the source of his epileptic seizures (Squire, 2009).

For epilepsy patients, brain resection surgery refers to removing small portions of brain tissue responsible for causing seizures. Although resection is still a surgical procedure used today to treat epilepsy, the use of lasers and detailed brain scans help ensure valuable brain regions are not impacted.

In 1953, H.M.’s neurosurgeon did not have these tools, nor was he or the rest of the scientific or medical community fully aware of the true function of the hippocampus and its specific role in memory. In one regard, the surgery was successful, as H.M. did, in fact, experience fewer seizures.

However, family and doctors soon noticed he also suffered from severe amnesia, which persisted well past when he should have recovered. In addition to struggling to remember the years leading up to his surgery, H.M. also had gaps in his memory of the 11 years prior.

Furthermore, he lacked the ability to form new memories — causing him to perpetually live an existence of moment-to-moment forgetfulness for decades to come.

In one famous quote, he famously and somberly described his state as “like waking from a dream…. every day is alone in itself” (Squire et al., 2009).

H.M. soon became a major case study of interest for psychologists and neuroscientists who studied his memory deficits and cognitive abilities to better understand the hippocampus and its function.

When H.M. died on December 2, 2008, at the age of 82, he left behind a lifelong legacy of scientific contribution.

Surgical Procedure

Neurosurgeon William Beecher Scoville performed H.M.’s surgery in Hartford, Connecticut, in August 1953 when H.M. was 27 years old.

During the procedure, Scoville removed parts of H.M.’s temporal lobe which refers to the portion of the brain that sits behind both ears and is associated with auditory and memory processing.

More specifically, the surgery involved what was called a “partial medial temporal lobe resection” (Scoville & Milner, 1957). In this resection, Scoville removed 8 cm of brain tissue from the hippocampus — a seahorse-shaped structure located deep in the temporal lobe .

Bilateral resection of the anterior temporal lobe in patient HM.

Bilateral resection of the anterior temporal lobe in patient HM.

Further research conducted after this removal showed Scoville also probably destroyed the brain structures known as the “uncus” (theorized to play a role in the sense of smell and forming new memories) and the “amygdala” (theorized to play a crucial role in controlling our emotional responses such as fear and sadness).

As previously mentioned, the removal surgery partially reduced H.M.’s seizures; however, he also lost the ability to form new memories.

At the time, Scoville’s experimental procedure had previously only been performed on patients with psychosis, so H.M. was the first epileptic patient and showed no sign of mental illness. In the original case study of H.M., which is discussed in further detail below, nine of Scoville’s patients from this experimental surgery were described.

However, because these patients had disorders such as schizophrenia, their symptoms were not removed after surgery. In this regard, H.M. was the only patient with “clean” amnesia along with no other apparent mental problems.

H.M’s Amnesia

H.M.’s apparent amnesia after waking from surgery presented in multiple forms. For starters, H.M. suffered from retrograde amnesia for the 11-year period prior to his surgery.

Retrograde describes amnesia, where you can’t recall memories that were formed before the event that caused the amnesia. Important to note, current research theorizes that H.M.’s retrograde amnesia was not actually caused by the loss of his hippocampus, but rather from a combination of antiepileptic drugs and frequent seizures prior to his surgery (Shrader 2012).

In contrast, H.M.’s inability to form new memories after his operation, known as anterograde amnesia, was the result of the loss of the hippocampus.

This meant that H.M. could not learn new words, facts, or faces after his surgery, and he would even forget who he was talking to the moment he walked away.

However, H.M. could perform tasks, and he could even perform those tasks easier after practice. This important finding represented a major scientific discovery when it comes to memory and the hippocampus. The memory that H.M. was missing in his life included the recall of facts, life events, and other experiences.

This type of long-term memory is referred to as “explicit” or “ declarative ” memories and they require conscious thinking.

In contrast, H.M.’s ability to improve in tasks after practice (even if he didn’t recall that practice) showed his “implicit” or “ procedural ” memory remained intact (Scoville & Milner, 1957). This type of long-term memory is unconscious, and examples include riding a bike, brushing your teeth, or typing on a keyboard.

Most importantly, after removing his hippocampus, H.M. lost his explicit memory but not his implicit memory — establishing that implicit memory must be controlled by some other area of the brain and not the hippocampus.

After the severity of the side effects of H.M.’s operation became clear, H.M. was referred to neurosurgeon Dr. Wilder Penfield and neuropsychologist Dr. Brenda Milner of Montreal Neurological Institute (MNI) for further testing.

As discussed, H.M. was not the only patient who underwent this experimental surgery, but he was the only non-psychotic patient with such a degree of memory impairment. As a result, he became a major study and interest for Milner and the rest of the scientific community.

Since Penfield and Milner had already been conducting memory experiments on other patients at the time, they quickly realized H.M.’s “dense amnesia, intact intelligence, and precise neurosurgical lesions made him a perfect experimental subject” (Shrader 2012).

Milner continued to conduct cognitive testing on H.M. for the next fifty years, primarily at the Massachusetts Institute of Technology (MIT). Her longitudinal case study of H.M.’s amnesia quickly became a sensation and is still one of the most widely-cited psychology studies.

In publishing her work, she protected Henry’s identity by first referring to him as the patient H.M. (Shrader 2012).

In the famous “star tracing task,” Milner tested if H.M.’s procedural memory was affected by the removal of the hippocampus during surgery.

In this task, H.M. had to trace an outline of a star, but he could only trace the star based on the mirrored reflection. H.M. then repeated this task once a day over a period of multiple days.

Over the course of these multiple days, Milner observed that H.M. performed the test faster and with fewer errors after continued practice. Although each time he performed the task, he had no memory of having participated in the task before, his performance improved immensely (Shrader 2012).

As this task showed, H.M. had lost his declarative/explicit memory, but his unconscious procedural/implicit memory remained intact. Given the damage to his hippocampus in surgery, researchers concluded from tasks such as these that the hippocampus must play a role in declarative but not procedural memory.

Therefore, procedural memory must be localized somewhere else in the brain and not in the hippocampus.

H.M’s Legacy

Milner’s and hundreds of other researchers’ work with H.M. established fundamental principles about how memory functions and is organized in the brain.

Without the contribution of H.M. in volunteering the study of his mind to science, our knowledge today regarding the separation of memory function in the brain would certainly not be as strong.

Until H.M.’s watershed surgery, it was not known that the hippocampus was essential for making memories and that if we lost this valuable part of our brain, we would be forced to live only in the moment-to-moment constraints of our short-term memory .

Once this was realized, the findings regarding H.M. were widely publicized so that this operation to remove the hippocampus would never be done again (Shrader 2012).

H.M.’s case study represents a historical time period for neuroscience in which most brain research and findings were the result of brain dissections, lesioning certain sections, and seeing how different experimental procedures impacted different patients.

Therefore, it is paramount we recognize the contribution of patients like H.M., who underwent these dangerous operations in the mid-twentieth century and then went on to allow researchers to study them for the rest of their lives.

Even after his death, H.M. donated his brain to science. Researchers then took his unique brain, froze it, and then in a 53-hour procedure, sliced it into 2,401 slices which were then individually photographed and digitized as a three-dimensional map.

Through this map, H.M.’s brain could be preserved for posterity (Wb et al., 2014). As neuroscience researcher Suzanne Corkin once said it best, “H.M. was a pleasant, engaging, docile man with a keen sense of humor, who knew he had a poor memory but accepted his fate.

There was a man behind the data. Henry often told me that he hoped that research into his condition would help others live better lives. He would have been proud to know how much his tragedy has benefitted science and medicine” (Corkin, 2014).

Corkin, S. (2014). Permanent present tense: The man with no memory and what he taught the world. Penguin Books.

Hardt, O., Einarsson, E. Ö., & Nader, K. (2010). A bridge over troubled water: Reconsolidation as a link between cognitive and neuroscientific memory research traditions. Annual Review of Psychology, 61, 141–167.

Scoville, W. B., & Milner, B. (1957). Loss of recent memory after bilateral hippocampal lesions . Journal of neurology, neurosurgery, and psychiatry, 20 (1), 11.

Shrader, J. (2012, January). HM, the man with no memory | Psychology Today. Retrieved from, https://www.psychologytoday.com/us/blog/trouble-in-mind/201201/hm-the-man-no-memory

Squire, L. R. (2009). The legacy of patient H. M. for neuroscience . Neuron, 61 , 6–9.

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Psychological injuries in the workplace

Lusk & Anor v Sapwell [2011] QCA 059 Muir JA, Margaret Wilson AJA and Ann Lyons J 1 April 2011

The claimant worked as an optical technician in a small optometry practice on a relatively busy street in Brisbane. The claimant frequently worked alone in the shop.

On 14 January 2005, a 70 year old customer, who was known to the business and staff as he had attended the shop over a number of years, came into the store to have his glasses adjusted. The customer would usually attend the shop with his wife or son, however on this occasion he was alone.

The worker fitted the glasses to the customers face and then went to the workshop out the back of the store to make the necessary adjustments. The workshop area was behind a wall screened from the main reception area and was generally out of sight to customers. The workshop did not have a lockable door.

The customer followed the worker into the workshop, put his hands on her hips and gyrated his body behind her, before touching her breasts. The worker said something to the customer, pushed him away and fled to the front of the shop. The customer followed, engaging in normal conversation as if nothing had happened and then left the shop.

It was later discovered that the customer was suffering from a form of dementia. He was charged with criminal assault but he passed away before the trial.

The worker suffered a significant psychiatric injury and ceased work soon after the assault.

Primary judgement

On 15 September 2010, Justice Atkinson ruled that the employer had breached its duty of care to the worker by not adequately guarding against the risk of an assault when workers were out of the direct view of the public.

The court found that a reasonable employer would have installed a door to the workshop that was capable of being shut and locked. It was said that the worker would have locked the door if it was available and if she was instructed to do so. The court found that in order to prevent the surprise to the worker, and her inability to repel the assault, the employer should have installed an infra-red beam which would have alerted the claimant to the customer's entry into the room.

It was said that the customer only assaulted the worker because there was an opportunity to do so out of the view of the public. The court ruled that the worker was only fit to work five hours per week, and on that basis she was awarded $390,558.2 in damages.

WorkCover Queensland appealed this ruling to the Queensland Court of Appeal.

The appeal was heard on 1 April 2011, in the Queensland Court of Appeal, before Justice Muir, Justice Margaret Wilson and Justice Anne Lyons. The appeal was on the basis that the primary ruling was incorrect on the following findings:

  • That the employer had breached its duty of care to the worker
  • If there was a breach, that it caused the injury claimed by the worker, and
  • In assessing the workers loss and damages.

The Queensland Court of Appeal found that the primary ruling focussed on the circumstances of the incident rather than the response of a reasonable employer considering the likelihood of the injury.

Issues were also raised with the security measures that had been suggested. The Court of Appeal ruled there was no persuasive evidence that any of the precautions suggested were practical or likely to have prevented the assault. Based on these circumstances, it was found that it was not unreasonable that the employer had not taken such precautions. Therefore the employer was not in breach of its duty of care to the worker.

The Court of Appeal also ruled that there was no evidence that the claimant would have actually used security measures if they were available, as the customer was known to her.

It was also found that if there had been a breach of duty of care, it did not cause the claimant's injury. Psychiatric evidence confirmed that the customer's assault was impulsive rather than premeditated, and it would have made no difference if the claimant was in the back room or the front of the shop at the time of the assault.

On the matter of inconsistencies in the worker's report of her injuries and history, the Court of Appeal found that her evidence needed to be treated with considerable caution—in particular, the worker's failure to disclose a job interview reflected poorly on her credit. The Court of Appeal found that the primary judge failed to appreciate the full implications of the worker's conduct and it was ruled that the worker was capable of working up to 16 hours per week.

In a unanimous decision, the Court of Appeal overturned the primary trial decision, and ordered the worker pay WorkCover's costs of the proceeding.

The worker lodged an application with the High Court to appeal the decision on 28 July 2011. The application for leave to appeal was not allowed on 12 August 2011.

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A win for science, and patients, against brain injury ‘nihilism’.

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Alvin Powell

Harvard Staff Writer

Hope for progress even after a 450-foot fall, trial shows, defying pessimism that hurts research and families

New research may upend the widely held view of traumatic brain injury as a permanently debilitating condition. The findings indicate that electrical stimulation can reawaken quiescent brain circuitry, leading to functional improvements that have the potential to restore work and social activities to patients’ lives. 

There were approximately 214,000 hospitalizations related to traumatic brain injury in 2020 and 69,000 deaths, according to the CDC.

The early stage trial, by investigators at Harvard-affiliated Spaulding Rehabilitation Hospital and colleagues at institutions around the country, including Weill Cornell Medicine, Stanford University, the Cleveland Clinic, and the University of Utah, was completed by five of the six enrolled patients. It yielded improvements of between 15 percent and 52 percent on a standard test of executive function, which involves attention, inhibition, reasoning, problem-solving, and other key aspects of mental processing.  

Examples of executive function

psychological injury case studies

The  study , published in December in Nature Medicine, relied on “deep brain stimulation,” in which a battery-powered device is implanted under a patient’s skin. Electrodes extend from the device to a part of the thalamus, which routes signals from one section of the brain to another. 

“There’s a lot of ways to shut parts of the system down,” said  Joseph Giacino , Spaulding’s director of rehabilitation neuropsychology and a professor of physical medicine and rehabilitation at Harvard Medical School, who helped design the study. “One is by direct damage to specific structures. Then you have the more common situation where I can damage the pathways that connect those structures and I get the same effect. 

“If the thalamus — this key relay station and signaling system — is damaged, it can’t activate or upregulate those circuits that are relatively spared and could work and perform their role if they had the right input.”

Diagram of brain.

The volunteers had suffered moderate to severe brain injury from either a motor vehicle accident or a fall — one from 450 feet and another from roughly 60 feet. The accidents occurred between three and 18 years earlier, long enough that the victims were considered past the immediate post-injury phase when most healing takes place. Each had recovered enough to perform the activities of daily living — personal hygiene, dressing, and feeding themselves — but had not regained pre-injury levels of work, study, and social activities. 

A common view of brain injury, held by both laypeople and the medical community, is that the affected cells cannot regrow, leading to permanent disability. In this case, investigators tested an alternate theory: The idea that some — perhaps many — injuries disrupt signaling between parts of the brain, and it is the loss of communication, rather than cell death, that causes much of the decline in function. If that’s the case, they say, then it’s possible that stimulating brain regions important in communication can restore some function.

The five volunteers received deep-brain stimulation for 12 hours a day for three months. To gauge results, the researchers selected a standard test of executive function called the “trail making test part B” and established 10 percent improvement as a clinically relevant threshold.

By the study’s end, all five patients had exceeded the 10 percent threshold, producing an average improvement of 31.75 percent. The greatest gains, more than 40 percent, were seen in the two who had suffered falls and had the deepest initial deficits. But even those with mild impairment improved by more than 20 percent. Two participants, one injured in a car accident and a second hit by a car while riding a bicycle, regained the ability to work, albeit at reduced capacity, and socialize. The functional status of the other volunteers remained stable.

How does the device work?

psychological injury case studies

The stimulator is placed under the skin in the pectoral region.

psychological injury case studies

Current reaches the electrodes via wires threaded under the skin of the chest and neck and then into the skull.

psychological injury case studies

The electrodes are placed on the brain (central lateral nucleus of the thalamus).

psychological injury case studies

The electrodes stimulate the thalamus.

One mother called her daughter’s improvement “profound” and “a miracle.” None of the participants were “cured,” however. Rather, the implant plays a long-term role analogous to that of a cardiac pacemaker. Even though the trial’s experimental phase concluded years ago, all five participants still have their devices. Some have had new batteries installed.

The researchers don’t understand precisely how deep-brain stimulation improves functioning, but they are skeptical that the artificial signals replace neural messages. The team’s favored explanation, Giacino said, is that the stimulation serves to activate the thalamus, which in turn upregulates viable downstream parts of the brain, restoring at least some signaling capacity.

“I think what it’s doing is putting the brain into a state of readiness, so when the demands are there to engage a particular network or subsystem, it can do that,” he said. 

Patients in the study saw improvements to capabilities that had been considered set in stone for as long as 18 years. This doesn’t mean that deep-brain stimulation is likely to be a universal answer, Giacino noted. And though the work suggests that not all loss of function is due to cell death in specific parts of the brain, some of it undoubtedly is. But overall, the results suggest that it’s time to rethink the idea that brain injury is permanent, he said. A Phase 2 study, set to involve about 50 people, is now in the planning stages.

“The degree of nihilistic belief that exists, both among the lay public and clinicians who see persons with severe brain injury, is remarkable and hugely problematic,” Giacino said. “This belief that if you have a severe brain injury you’re fated to do poorly — you’ll get some period of time in which your brain will naturally try to heal itself and then you’re at your final outcome — has been a problem for clinical practice, for research, for funding, and for people who have severe brain injury and their families.”

The progress of patients in the trial, he added, “helps chip away at the nihilism that really makes our work so much more difficult.”

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Case Studies

Our client was a young girl who was the victim of two armed robberies at her workplace. Although there were no physical injuries she suffered post-traumatic stress disorder and developed schizophrenia. She was unable to cope with normal daily activities and became socially isolated and dependent upon medication.

Our client consulted lawyers who failed to bring a claim for damages against her employer for failing to provide a safe work place and so we pursued a late claim against the employer and a claim against the previous lawyers for the compensation of which our client was deprived as a result of their delay. The claim proceeded to the Court of Appeal and a very favourable settlement was negotiated.

Our client was a young man employed as a safety officer on a major construction site. He was earning a good salary and had great career prospects.

A young apprentice sustained fatal injuries and our client arrived at the scene shortly afterwards and rendered assistance but was unable to save the life of the young apprentice. Our client suffered catastrophic psychological injuries and developed major depression and became addicted to alcohol and gambling. His relationship broke down and he was unable to return to any form of work.

A claim for damages for loss of earnings was made against his employer in the Supreme Court and settlement was achieved. We also successfully claimed substantial lump sum payments for total and permanent disability under our client’s superannuation policies.

Our client was subjected to bullying and inappropriate behaviour by his manager and a fellow employee and suffered psychological injury.  He received weekly compensation payments and we successfully claimed a lump sum payment for permanent impairment.  We then proceeded to claim work injury damages resulting in a successful settlement with a substantial payment to our client.

Our client was an experienced and dedicated police officer expose to numerous horrific events during the course of his employment as a result of which he sustained psychological injury and was medically retired. We successfully pursue lump sum claims for permanent impairment.

Liability for work injury damages was denied but we successfully pursued this claim through the court resulting a substantial settlement in our client’s favour. We also successfully pursued claims for total and permanent disablement benefits through our client’s superannuation fund.

Our client was subjected to a number of comments by his supervisor which was quite distressing and demoralising. His supervisor would walk around his work station calling another worker and our client, Tweedledee and Tweedledum and would then  ask ” Who is Dee and who is Dum ?”

Our client ultimately had to cease work as the situation and conduct of his supervisor’s comments were intolerable. His workers compensation claim was rejected by the insurer.

Our client subsequently put in a Review, which was rejected by the insurer, despite our client providing further support from his doctors.

After seeking legal advice we were able to commence proceedings in the Workers Compensation Commission and resolve his claim for lost wages and incurred medical expenses.

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I could write a book as to how the last 4 years would have been different if not for Tom and his team. The support, assistance, advice from the first conversation till even after the settlement was second to none from the team at Stacks Goudkamp. Four years on and after many downs, my children and I have our lives back. We are unable to THANK YOU enough, but know that you have changed our lives for the better in so many ways since the accident. - Andrew and Family

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psychological injury case studies

East Coast Injury Lawyers

Secondary Psychological Injuries: A Personal Injury Case Study on Depression

When a worker is injured during the course of their employment, they may suffer more than just the physical injuries afflicting their body. Psychological injuries such as stress and depression are conditions that may arise as secondary injuries caused by the employer’s negligence and the worker’s incapacity.

However, this can be a complicated aspect to prove because the worker must establish that the secondary injury was caused, or at least materially contributed, by the accident at work due to the employer’s negligence.

A Specialist in Personal Injury is professionally trained to handle the complexities of these cases and should be consulted for advice if an accident at work has led to psychological injuries that require the care of a medical professional.

Harris v State of Queensland [2014] QDC 35

This case involves an admissions clerk, Rosemaree Harris, at the Maryborough Correctional Centre who was hit by a trolley from behind. The trolley was being pushed by another employee at the centre and caused Ms Harris to sustain ruptured ligaments in her left ankle.

The injury required surgery, but she continued to feel severe pain that prevented her from returning to work. As a result of the injury and her circumstances, she also developed depression.

Liability was not an issue in this case. There was an issue regarding the amount of compensatory damages for her injuries. The defendant argued that her depression was the result of factors separate from the workplace accident including the break-up of her marriage that had incidents of domestic violence.

The court was satisfied that Ms Harris’ psychological injury was caused by the accident and the employer’s negligence.

Damages were assessed based on the consideration that Ms Harris would be able to return to work after undertaking rehabilitation, albeit never as a prison officer.

The court awarded Ms Harris damages in the amount of $311,708.91.

If you have suffered an injury that has led to depression, stress, phobia or any other psychological/psychiatric injury, it is important that you seek advice from a  Specialist in Personal Injury  in order to be properly informed of your rights.

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psychological injury case studies

Sean Delpopolo

Sean Delpopolo

Sean is a Queensland Law Society Accredited Specialist in Personal Injury Law.*

Sean specialises in work injury claims, workplace injury claims, motor vehicle accident injury claims, motorcycle accident injury claims, other road accident injury claims, brain and head injury claims, spinal injury claims, public liability injury claims, death and fatal injury claims, psychiatric and psychological injury claims and total and permanent disability claims.

He has been running personal injury claims in Queensland for over 25 years. Sean founded our firm in 2004 and the firm has grown and gone from strength to strength on the background of outstanding service, incredible results and charging really fair fees.

With an innate sense of fairness and justice, this motivates Sean and his team to do everything they can to ensure that the results they achieve for their clients are something that they can all be proud of. In Sean’s mind, the interests of the firm’s clients come first, before anything else, and this value has flowed on through to the entire team.

As a father of two daughters, Sean understands that his clients’ personal injury claims can make a huge difference to their lives and the lives of those around them. This is why he has made it his life’s work to fight for the “little guy” to obtain the compensation they deserve.

* To find out more about what it takes to become an Accredited Specialist click here .

psychological injury case studies

Helen Ashton

Helen Ashton

Helen is a Queensland Law Society Accredited Specialist in Personal Injury Law.*

As an Accredited Specialist in Personal Injury Law, having been awarded the highest achiever award for the course in 2015, Helen has a high level of knowledge and technical expertise. Admitted as a Solicitor of the Supreme Court of Queensland in 2001, she also has extensive experience in running all types of personal injury claims.

Helen specialises in work injury claims, workplace injury claims, motor vehicle accident, motorcycle accident injury claims, other road accident injury claims, medical negligence claims, construction accident claims, mining accident claims, public liability injury claims, death and fatal injury claims, psychiatric and psychological injury claims and total and permanent disability claims.

Helen has a friendly and approachable personality and strives to ensure that her clients are kept well informed and are provided with quality and practical legal advice.

As a mother of three young children, Helen understands the impact events can have on a family unit and works proactively to achieve the right result for her clients in the shortest possible timeframe. Helen has the ability and the experience to assist clients with a wide variety of claims, including any personal injury claims with a high level of complexity and those that have had catastrophic consequences.

psychological injury case studies

Nickelle Morris

Nickelle Morris

Nickelle is an expert in personal injury claims and has been recognised by the Queensland Law Society as an Accredited Specialist in Personal Injury Law.* She was awarded the highest achiever award for the accreditation course which she completed in 2022. Nickelle was also a finalist in the Special Counsel of the Year category in the Australian Law Awards in 2019.

Nickelle has been practising exclusively in personal injury litigation for over 20 years. She has extensive experience in catastrophic claims and fatality claims across all practice areas.

Nickelle specialises in catastrophic injury claims (including traumatic brain injuries, acquired brain injuries and other head injuries, amputations, severe burns and spinal cord injuries resulting in tetraplegia, paraplegia and the like), National Injury Insurance Scheme (NIISQ) claims, work injury claims, workplace injury claims, motor vehicle accident injury claims, motorcycle accident injury claims, other road accident injury claims, public liability injury claims, medical negligence claims, death and fatal injury claims, psychiatric and psychological injury claims and total and permanent disability claims.

Nickelle prides herself on being a technical, yet practical and compassionate lawyer. She takes her time to understand her client’s situation and to ensure that they have an understanding of their rights and entitlements. Nickelle is a tenacious and passionate advocate for her clients and is dedicated to being proactive in ensuring her client’s needs are met and achieving the best outcome for her clients.

Outside of work, Nickelle is a mother of two children and is a member of a number of committees both within the legal industry and community.

psychological injury case studies

Barry Mcgee

Barry has always loved a spirited debate, and, with over 20 years specialising exclusively in personal injury litigation, his passion, skill and ability to assist his clients is well known throughout the Queensland profession.

Barry specialises in work injury claims, workplace injury claims, motor vehicle accident injury claims, motorcycle accident injury claims, other road accident injury claims, construction accident claims, mining accident claims, public liability injury claims, death and fatal injury claims, psychiatric and psychological injury claims and total and permanent disability claims.

Barry’s legal career began in his native Scotland, where he qualified as a Solicitor in 1998. Upon qualifying, he worked for a boutique practice, and then a top-tier national firm, representing a number of different insurers across a variety of industries. With years of working for insurers under his belt, Barry is able to see matters through the eyes of his legal opponents. Forewarned is forearmed, as they say!

He was admitted to practice by the Supreme Court of Queensland in 2007. In Australia, he commenced working for a large national firm, where he spent 15 years practicing in personal injury litigation. He was made a Partner of the firm in 2011 and spent 11 years as the firm’s dedicated in-house Special Counsel. As Special Counsel, Barry provided expert advocacy and strategical advice and assistance to the firm’s personal injury lawyers and clients of the firm alike.

Barry has significant and extensive experience across a wide variety of personal injury claims. He is compassionate, personable and straightforward, with a keen sense of what is fair and just and a reputation for not settling for anything less than his client deserves.

Outside of work he enjoys surfing, the outdoors, music and spending time with his wife and 3 young children.

psychological injury case studies

Charlotte Evans

Charlotte has practised exclusively in personal injury compensation litigation for over 20 years.

Charlotte specialises in sexual abuse claims, work injury claims, workplace injury claims, motor vehicle accident injury claims, motorcycle accident injury claims, other road accident injury claims, construction accident claims, mining accident claims, public liability injury claims, death and fatal injury claims, psychiatric and psychological injury claims and total and permanent disability claims.

She is committed to fighting for the rights of plaintiffs and helping her clients through the legal maze, to achieve outcomes that put people back in control of their lives. She has had experience in taking a number of personal injury cases to Trial and winning hard fought cases for her clients and she does not shy away from a challenge.

Charlotte has a friendly and approachable personality and strives to cut through the legal jargon to make the personal injury claim process understandable for her clients whilst ensuring that her clients are also kept well informed throughout their claim.

Out of the office Charlotte is a busy Mum, who now enjoys the privileges of living in beautiful Queensland and making the most of all it has to offer.

psychological injury case studies

Prue Prescott

Prue has been running personal injury claims for nearly 20 years. This has involved acting for injured claimants in most areas of personal injury law including workers’ compensation injury claims, motor vehicle accident injury claims, public liability injury claims, death and fatality claims, psychiatric injury claims, National Injury Insurance Scheme (NIISQ) claims and total and permanent disability claims.

Prue enjoys handling the more complex claims, such as traumatic brain injury, fatal injury and nervous shock claims, as well as claims involving complex legal principles. Prue seeks to use her Masters qualification in writing and literature to tell each and every client’s individual story, ensuring they are treated fairly by insurers and that they obtain the compensation they deserve.

In 2019, Prue was nominated by the Women Lawyers Association of Queensland Inc as an Inspirational Lawyer.

Outside of work, Prue is a busy mum of boys but also tries to find the time to read, write and explore nature.

psychological injury case studies

Julie Hollonds

Julie is a highly dedicated and experienced office manager who has been an integral part of our team for the past 14 years. Bringing a wealth of knowledge with over 35 years of experience in administration, Julie keeps our office running smoothly and efficiently.

Outside of work, Julie loves to walk, snorkel, spend time with friends and explore the beautiful Northern Rivers region of New South Wales.

psychological injury case studies

Aleisha Harrigan

Having worked as a legal assistant for over five years, Aleisha has a wealth of experience in the field of personal injury. Since joining East Coast Lawyers, she has been an essential part of providing invaluable support to solicitors and our clients. Her abilities extend beyond legal matters with Aleisha providing training to our assistants and administrative team, and streamlining processes and procedures, ensuring that the workflows operate smoothly and effectively.

Outside of work, Aleisha has a passion for reading and music. She can often be found immersed in a good book or a live concert. She values spending quality time with her family, friends and her beloved dog, Kevin.

psychological injury case studies

Kym Arrowsmith

Kym is a knowledgeable legal assistant with fifteen years of expertise in the field of personal injury law. She is passionate about supporting clients through the process and obtaining the best possible outcome for them. As a valued member of our team, Kym takes pride in her work and is committed to sharing her extensive experience and knowledge with our other team members.

When Kym is not busy with work, she loves spending time with her family and friends, and enjoys discovering new places, whether it be through the pages of a biography or on her push bike.

psychological injury case studies

Alece Turner

Alece is a law student who is extremely motivated and passionate about personal injury law. She is hardworking, and always strives to produce the best possible results for our clients.

Her dedication and eagerness to learn more about the law makes Alece a great addition to our team.

When not working or studying, she loves spending time with her son at the beach or at one of our amazing theme parks.

psychological injury case studies

Georgia Ryan

Georgia recently joined the team in February 2023 and has been working within the industry for the last three years. She is enthusiastic about helping new and existing clients, and with her bubbly personality and can-do approach makes her an excellent addition to our team.

Raised in Tasmania, Georgia moved to Queensland in early 2017 and hasn’t regretted it since. She loves the warm weather and lifestyle. Outside of work, Georgia loves travelling, dining out and spending time with family and friends.

psychological injury case studies

Claire Rezny

Claire is one of our hard working and devoted Legal Assistants. With over 25 years’ administrative experience, her attention to detail, willingness to help others, and calm demeanour makes her a real asset to our team.

Claire is well travelled and, during her time in the USA, Claire discovered a newfound love for reading, which led her to become a proofreader for several published novels. Claire also enjoys landscape and wildlife photography and spending time with her family and puppy.

psychological injury case studies

Ella Donnelly

Meet Ella, our receptionist and administrative assistant, with a passion for law and criminology. She is currently working towards a career in the police force. Ella is always eager to help others and is dedicated to providing excellent customer service to our clients.

Ella’s bubbly and outgoing personality shines, making her a perfect receptionist. Despite her busy timetable with working and studying, Ella finds time to pursue her love of acting. Being a performer at heart, Ella has had a chance to showcase her natural flair for the arts in theatre productions.

psychological injury case studies

Shayla Riley

Shayla is the newest member of our administration team and has an extensive background in customer service.

Shayla’s bubbly personality and can-do attitude makes her the perfect person for her administration support role.

She has a passion for the Law and has completed her Diploma of Justice Studies with aspirations to further her career by studying a Bachelor of Laws.

When Shayla is not in the office you will find her at the beach with her two dogs, Bear and Ella or at home reading a good book.

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Psychological readiness to return to sports practice and risk of recurrence: Case studies

Veronica gomez-espejo.

1 Department of Psychology, University of Murcia, Murcia, Spain

Aurelio Olmedilla

2 Department of Personality, Evaluation and Psychological Treatment, University of Murcia, Murcia, Spain

Lucia Abenza-Cano

3 Faculty of Sport, Catholic University of Murcia, Murcia, Spain

Alejandro Garcia-Mas

4 Grupo de Investigación en Ciencias de la Actividad Fisica (GICAFE) (Research Group of Sports Sciences), University of the Balearic Islands, Palma de Mallorca, Spain

Enrique Ortega

5 Department of Physical Activity and Sport, Campus of Excellence Mare Nostrum, University of Murcia, Murcia, Spain

Associated Data

The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/ Supplementary material .

Returning to sport after the sports injury is a difficult decision because it’s multicausal and the fact that a rash decision can result in numerous negative consequences. Given the importance of psychological variables for the correct rehabilitation of the injured athlete and his or her optimal return to sports practice, there seems to be little information on this subject. In this sense, the objective is to determine the relationship between the subjective psychological disposition of the athlete in the process of Return to Play (RTP) with the type of mood profile and his mental health. This is based on the fact that each athlete evaluates his or her recovery differently and has different levels of anxiety, depression, and stress. For this purpose, four athletes participated in the study. Two males and two females from the sports of indoor soccer and soccer, who had just returned to sports after a moderate or severe injury. The average age was 24.25 years. Various measurements were taken after practices and after matches, to assess mood, psychological readiness, anxiety, stress, and depression. The results confirm Morgan’s iceberg profile and the influence that subjective psychological perceptions and assessed emotional states have on athletes’ incorporation into their sports practice with a guarantee of success.

Introduction

Sports injuries have a negative emotional impact on the health and performance of the affected athlete and result in high health and sports economic cost ( Palmi, 2014 ; Emery and Pasanen, 2019 ; O’Brien et al., 2019 ; Kvist and Silbernagel, 2022 ). After a sports injury, the athlete undergoes a physical rehabilitation process ( Baez et al., 2020 ; Goddard et al., 2020 ; Kvist and Silbernagel, 2022 ). Thanks to technological and medical advances, 90% of athletes undergo rehabilitation regain normal function of the injured area; but only 63% of them return to pre-injury levels and 44% return to competition ( Ardern et al., 2011 ). These results suggest that factors other than the physical play a role in a successful return to sport. In this sense, after the rehabilitation process is completed, the decision is made whether the injured athlete can return to sport ( Conti et al., 2019 ; Green et al., 2020 ).

For years, researchers have pointed out the importance of psychological factors in sports injury susceptibility ( García-Mas et al., 2014 ; Ganz, 2018 ; Slimani et al., 2018 ) and their recovery ( Casáis, 2008 ; Arvinen-Barrow and Clement, 2016 ; Salim et al., 2016 ; Roy-Davis et al., 2017 ; Olmedilla et al., 2018a ; Gennarelli et al., 2020 ). Several theoretical models suggest that personality, coping resources and emotional state influence sports injuries ( Andersen and Williams, 1988 ; Olmedilla and García-Mas, 2009 ; Johnson and Ivarsson, 2011 ; Assa et al., 2018 ; Meierbachtol et al., 2018 ; Arroyo del Bosque et al., 2020 ).

There are numerous references that establish relationships between sports injury and the athlete’s psychological predisposition to resume sports practice ( Chomiak et al., 2000 ; Forsdyke et al., 2017 ; Zarzycki et al., 2018 ; Kunnen et al., 2019 ; Cheney et al., 2020 ). For this reason, based on the emotional pattern “U” experienced during the injury process, which maintains the occurrence of negative responses both at the beginning and at the end of the process ( Morrey et al., 1999 ; Ardern et al., 2017 ), numerous authors have emphasized the importance of a good psychological predisposition before Return to Play (RTP) ( Christino et al., 2016 ; Burland et al., 2018 ; Caron et al., 2018 ; Kitaguchi et al., 2019 ; Ashton et al., 2020 ). In this sense, lack of psychological preparation has been identified as a factor preventing proper RTP ( Risberg et al., 2007 ; Ardern et al., 2014 ; Nwachukwu et al., 2019 ) and may persist even when physical disabilities have been resolved ( Ross, 2010 ; Lentz et al., 2015 ; Gennarelli et al., 2020 ).

The Sports Medicine Council (2002) defines Return to Play as the point at which the injured athlete makes the decision to safely return to training and competition ( Herring, 2002 ). Some authors ( Hammond et al., 2013 ; Haitz et al., 2014 ; Burland et al., 2018 ; Rollo et al., 2021 ), caution that the RTP can sometimes be “unreal” as external variables such as environmental pressures coach request, fan demand or the injured athlete’s urge to not lose status can lead to a hasty decision. For this reason, any sports injury should be considered from the global framework of the athlete.

The emotional states experienced by the injured athlete during this period of recovery from the sports injury will help determine RTP in one way or another. Specifically, some studies suggest that stress can lead to increased risk of injury and influence their recovery ( Nippert and Smith, 2008 ; De la Vega et al., 2013 ; Heidari et al., 2016 ; Olmedilla and García-Mas et al., 2017 ; Olmedilla et al., 2018b ; Leguizamo et al., 2021 ). Similarly, depression and “low” mood have received particular attention ( Purcell et al., 2019 ). However, knowledge about the relationship between psychological factors and sports injuries is still limited ( Olmedilla et al., 2018b ; Gouttebarge et al., 2019 ; Rice et al., 2019 ). Therefore, it’s likely that injured athletes with positive emotional responses achieve better rehabilitation, which would positively correlate with a correct RTP ( Sabato et al., 2016 ; Gomez-Espejo et al., 2018 ; Nwachukwu et al., 2019 ; Rollo et al., 2021 ). Therefore, athletes who are ready for the RTP are more likely to have better emotional responses. Therefore, any apprehension the athlete feels while preparing for the RTP may indicate that rehabilitation is incomplete ( Cheney et al., 2020 ). Conversely, athletes who are not psychologically prepared for the RTP are less likely to return to sport. And those who do return to sport may be at increased risk for recurrence, poor athletic performance and lower-quality of the sport experience ( Ardern et al., 2013 , 2014 ; Czuppon et al., 2014 ; Podlog et al., 2015 ; Baugh et al., 2017 ; Brewer, 2017 ; Green et al., 2020 ). Therefore, the fact of suffering a sports injury is particularly relevant as it not only represents a physical problem, but also implies a change in the psychological disposition of the athlete. For this reason, Morgan developed his own Mental Health Model ( Morgan, 1980 ), according to which successful athletes have more positive and less negative mental health characteristics than less successful athletes and the general population. The iceberg profile would essentially be the profile of a mentally healthy person ( Andrade et al., 2016 , 2019 ; Terry and Parsons-Smith, 2021 ).

Thus, when returning to sport, athletes express concerns about the prospect of recurrence ( Ardern et al., 2013 ; Flanigan et al., 2013 ; Czuppon et al., 2014 ; Brewer, 2017 ; Meierbachtol et al., 2018 ; McPherson et al., 2019 ), have decreased performance or execution ability ( Podlog et al., 2013 ), have deficits in intrinsic motivation to return to their sport ( Brewer, 2010 , 2017 ; Ardern et al., 2013 ; Czuppon et al., 2014 ; Hamrin-Senorski et al., 2017 ; Slagers et al., 2017 ), and they appear physically unable to return to sport ( Ardern et al., 2013 ; Podlog et al., 2013 ; Czuppon et al., 2014 ; Brewer, 2017 ; Hamrin-Senorski et al., 2017 ; Slagers et al., 2017 ).

In this sense, RTP and the potential risk of recurrence are often as emotional events as the injury itself and are identified as potential limiting factors for rehabilitation and successful RTP ( Creighton et al., 2010 ; Milewski et al., 2016 ; Cheney et al., 2020 ). Although psychological interventions improve sports injury function, it is unknown how psychological preparation influences the risk of a second injury ( Lentz et al., 2018 ). Several studies ( Paterno et al., 2012 ; Webster et al., 2014 ; Wiggins et al., 2016 ; Zhang et al., 2022 ) have shown that many athletes who return to their previous activity level sustain a second injury, demonstrating the importance of psychological health ( McPherson et al., 2019 ). Therefore, it’s necessary to develop specific strategies to facilitate decision making about the ideal time for an injured player to the return to sport ( Gómez-Piqueras et al., 2013 ; O’Brien et al., 2017 ; Tjong et al., 2017 ; Webster et al., 2017 ; Gómez-Espejo et al., 2018 ; McCrory et al., 2018 ; McPherson et al., 2019 ), understanding this as an ongoing decision-making process that needs to be dynamic and personalized ( Ekstrand and Gillquist, 1983 ; Pruna, 2016 ; Cheney et al., 2020 ). Although there is currently consensus on the need to examine the physical and psychological factors surrounding RTP ( Feller and Webster, 2013 ; Ivarsson et al., 2013 ; Takeshita et al., 2016 ; Forsdyke et al., 2017 ; Webster et al., 2017 , 2018 ; Lai et al., 2018 ; Welling et al., 2018 ; Werner et al., 2018 ; Baez et al., 2019 ; Kaplan and Witvrouw, 2019 ), existing criteria do not comprehensively consider psychological preparation for competition.

For this reason, it is necessary to include strategies for the correct follow-up of the injured that allow to objectify the decisions of the professionals ( Gómez-Piqueras et al., 2014 , 2020 ), since, according to Glazer (2009) and Webster et al. (2008) , it has been noted that today there are not enough instruments that evaluate in a specific way the psychological predisposition of the injured in the moment before the reappearance, and that include specific questions about this phase and the specifics of the injury. In this sense, Gómez-Piqueras et al. (2014) developed an instrument that measures the perception of the injured athlete in relation to his return to training after an injury, which proved to be effective for this purpose.

The aim of this study is to determine the relationship between pre-RTP subjective psychological disposition and mental health indicators in four cases of injured soccer and futsal players before a pandemic and lockdown situation.

Materials and methods

Participants.

The following inclusion criteria were established for participation in the study: Athletes had to have been discharged by a physician less than one week ago, have sustained a severe or moderate sports injury, not have a chronic physical or mental illness.

Considering all the inclusion criteria and the athlete population that meets them, the work was carried out with 4 soccer players (2 soccers and 2 futsal players) from different sports categories belonging to sports clubs. The average age of the athletes was 24.25 years, with an age range between 18 and 28 years. The average number of years they practiced their sport in the highest category was 2.5 years, while the average number of years they practiced the sport continuously was 11 years.

In terms to to the type of sports injury sustained, the inclusion criteria for the study were: that it was a recently rehabilitated sports injury (return to sport two days prior to the initial evaluation), that it was new (no recurrences or relapses) and that it was medically diagnosed as moderate or severe. That is, they were a sports injury with an estimated recovery time of at least 15 days of treatment. The characteristics of the remaining participating subjects to be included in the study are listed below:

Subject 1 : 18-year-old male, professional soccer player. He plays as a goalkeeper. He trains 3 days a week, averaging 5 h a week. He suffered a knee sprain that forced him to miss 17 training sessions and 6 games in a row.

Subject 2 : 26-year-old female, professional soccer player. She plays as a striker. She trains 3 days per week with an average of 6 h per week. She suffered a dislocated shoulder that forced her to miss 15 training sessions and 5 games in a row.

Subject 3 : 25-year-old male, futsal player. He plays in the position of goalkeeper. He trains 3 days per week, averaging 6 h per week. He suffered from shoulder tendinitis, which forced him to miss 12 training sessions and 3 games in a row.

Subject 4 : 28-year-old female, futsal player. She plays as a wing player. He trains 4 days per week, averaging 8 h per week. He suffered a torn meniscus, which forced him to miss 22 training sessions and 6 games in a row.

Instruments and materials

The psychological assessment instruments used for the study were:

Personal and sports variables questionnaire. Ad hoc questionnaire to collect the athlete’s socio-demographic data (see Annex I).

History of sports injuries . Ad hoc created questionnaire, based on an injury protocol ( Olmedilla and García-Mas et al., 2017 ). It captures the number of sports injuries sustained in the last two seasons and specific data about them (see Annex II).

Profile of Mood States (POMS, McNair et al., 1971 ). In its Spanish version adapted and validated by Fuentes et al. (1995) . It is a self-report questionnaire for measuring mood. The short version was used, with 29 items answered on a Likert-type scale with 5 response options. It includes 5 dimensions: Tension (α = 0.83); Depression (α = 0.78); Anger (α = 0.85); Vigor (α = 0.83); Fatigue (α = 0.82).

Depression, Anxiety and Stress Scale-21items (DASS-21, Lovibond and Lovibond, 1995 ). In its version adapted and validated in Spanish ( Fonseca-Pedrero et al., 2010 ). Has been used to measure general symptoms of depression, anxiety and stress. This scale has three subscales: depression, anxiety and stress, each consisting of 7 items, for a total of 21. In a Likert-type response scale, each item has four response options. It has a Cronbach’s Alpha of 0.81.

Psychological Readiness of Injured Athlete to return to sport (PRIA, Gómez-Piqueras et al., 2014 ). The assessment instrument consists of 10 questions/items that include statements about self- confidence, individual status, uncertainty and fear of relapse. Scores range from 1 to 5, with higher scores corresponding to better psychological disposition.

Prior to the psychological assessment, the rehabilitation staff Football Federation of the Region of Murcia (FFRM) was contacted directly, thanks to a collaboration agreement in place at the time between the University of Murcia (UMU) (an organization in which the psychologist in charge of the study worked) and the FFRM. The rehabilitators served as a link between the psychologist and the athletes, providing the contact details of those athletes who met the inclusion criteria. The purpose of the study and the procedure were explained to the rehabilitators and later to the participating injured athletes (via telephone). In addition, all participants were informed of the purpose of the study and the confidentiality of both their responses and previously collected data. Informed consent and the privacy document were obtained from all participants. The entire evaluation process and subsequent contact was conducted online.

The study was approved under research ethics by the Ethics Committee of the University of Murcia (Spain), with reference number CEI-2623-2019. The moment the athletes were medically discharged from the FFRM, the psychological evaluation by the psychologist in charge of the project began. The evaluation was done online and consisted of three different moments related to the return to play (RTP), so the psychological evaluation process was as follows:

Initial assessment. It’s conducted immediately after medical discharge. At this time, an assessment battery consisting of personal and sports variables, PRIA questionnaire and POMS questionnaire was used. For this purpose, an assessment battery was sent online via email, which could be completed directly by clicking on the link.

Monitoring of training. Completed once a week after practices. Recording the date and time of training, as well as the POMS.

Tracking of games. Completed after each match in which the athlete was used. Recorded the POMS, the DASS-21 and the PRIA.

It should be noted that the evaluation process was interrupted earlier than planned when competitions and training were interrupted due to the state of alert and lockdown declared by the Spanish Government because of the Covid-19 pandemic.

Data analysis

Descriptive statistics were used for data analysis, employing counts, sums, percentages and measurements. The results of the POMS questionnaire were converted to a scale of 0 to 100 points, with 50 being the mean. Participants’ pre-competition mood profile were analyzed and described. The graphs of the pre-competition and pre-training mood profiles were created. Likewise, the graphs were made with the results of the PRIA questionnaire. The statistical program SPSS 22.0 was used.

Subject 1 results

Figure 1 shows the scores obtained in the Questionnaire of psychological predisposition of the injured athlete (PRIA) during the evaluation. Scores above 40 indicate that the athlete’s psychological disposition is sufficient to return to play with some degree of confidence. The lowest value of 42 points means that the athlete is psychologically ready to return to play. Moreover, it can be observed that the psychological predisposition increases progressively until the third game and then stabilizes.

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Subject 1 PRIA scores.

Table 1 shows the values that Subject 1 obtained on the POMS factors in the seven shots evaluated after the matches.

Values in the POMS factors of Subject 1 after the matches.

Figure 2 shows the mood profiles of Subject 1 at the evaluation time points after the competition (Match 1 to Match 7).

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POMS profiles of subject I after matchs.

The results of these figures correspond to the iceberg profile described by Morgan (1980) , which shows no change in mood states before the competition. In this sense, the profile obtained by Subject 1 is characterized by low scores in Tension, Anger, Fatigue and Depression and a level in the Vigor factor above the central value (50).

Table 2 shows the values obtained by Subject 1 in the POMS factors in the seven shots evaluated weekly after training.

Values in the POMS factors of Subjetc 1 after training.

Figure 3 shows the profiles of Subject 1 in the first three assessment time points after training (Training Week 1 to Training Week 7). As can be seen, Subject 1 shows an ideal pre-competition mood profile, consistent with the iceberg profile, where the Vigor factor is higher than the other factors and above the central value (50 points).

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POMS profiles of subject I after training weeks.

Finally, Figure 4 shows the scores obtained by Subject 1 in the DASS-21 subscales. It shows indicators of adequate mental health, with punctual severe anxiety peaks.

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Scores of subject 1 to the subscales of the DASS-21.

Subject 2 results

Figure 5 shows the scores obtained by Subject 2 on the PRIA throughout the assessment. The results show that until Match 3, the athlete’s predisposition to return to sport was not sufficient or other types of complementary testing should be considered. From Match 4, the scores show adequate psychological predisposition to return to sport with some guarantees.

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Subject 2 PRlA scores.

Table 3 shows the values of the POMS factors of Subject 2 in the nine recordings evaluated after the matches.

Values in the POMS factors of Subject 2 after the matches.

Next, Figure 6 shows the mood profiles of Subject 2 after the competition (Match 1 to Match 9). The results of Figure 6 show that Subject 2 gradually adopts an iceberg mood profile throughout the evaluation period. In this sense, the profile is characterized by low scores on the Tension, Anger, Fatigue and Depression factors. Vigor shows values above 50 (mean) in all the evaluated recordings.

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POMS profile of subject 2 after matchs.

Table 4 shows the scores that Subject 2 obtained on the POMS factors in the nine shots evaluated weekly after training.

Values in the POMS factors of Subjetc 2 after training.

Figure 7 shows the profiles of Subject 2 after training (Training week 1 to Training week 8). The results of the following Figure show that Subject 2 has a good pre-competitive mood profile, which is consistent with the iceberg profile. It shows an adequate state of coping with the competition, where the Vigor factor is above the central value (50 points) and the other factors are perfectly leveled for a correct athletic performance.

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POMS profile of subject 2 after training weeks.

Finally, Figure 8 shows the scores obtained by Subject 2 on the DASS-21 subscales. The score profile shows indicators of adequate mental health, with slight expressions in all factors.

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Scores of subject 2 to the subscales of the DASS-21.

Subject 3 results

Figure 9 shows the scores obtained by Subject 3 at PRIA throughout the assessment. The results indicate that the psychological predisposition to return to sport was not sufficient in the first assessment, and although it has higher scores in Matches 1 and 2, the psychological predisposition of this athlete is uncertain and additional testing is needed to determine it.

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Subject 3 PRlA scores.

Table 5 shows the values of the POMS factors of Subject 3 in the two recordings evaluated after the matches.

Values in the POMS factors of Subject 3 after the matches.

Figure 9 shows the profiles of Subject 3 in the three evaluation time points after the competition (Match 1 to Match 3).

Figure 9 shows a pre-competitive mood profile suitable for coping with competition. It shows an adequate iceberg profile in Matches 2 and 3. However, the mood profile of Match 1 is very inconsistent and shows almost an inverted iceberg profile, with a Vigor value lower than that of the other variables.

Table 6 shows the values of the POMS factors of Subject 3 in the two weekly post-training recordings evaluated.

Values in the POMS factors of Subjetc 3 after training.

Figure 10 shows the profiles of Subject 3 at the two post-training evaluation times (Training Week 1 and Training Week 2). The results of Training Week 1 show a profile of pre-competitive mood suitable for competition, while Training Week 2 shows a Fatigue level higher than expected.

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POMS profile of subject 3 after training weeks I and 2.

Finally, the scores obtained by Subject 3 on the DASS-21 subscales show a score of 2 points in Anxiety in Match 1 and 6 points in Match 2. In Depression, it shows a score of 5 in Match 1 and 2 points in Match 2. In stress, the athlete gets 5 points in Match 1 and 0 points in Match 2. The data show signs that this athlete’s mental health is not adequate, as the depression, anxiety, and stress scores increase as the evaluation progresses.

Subject 4 results

Figure 11 shows the scores obtained by Subject 4 at PRIA. Scores above 40 indicate that the athlete is ready to return to sports with confidence.

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Subject 4 PRIA scores.

Table 7 shows the scores of the POMS factors of Subject 4 in the seven recordings evaluated after the matches.

Values in the POMS factors of Subject 4 after the matches.

Next, Figure 12 shows the mood profiles of Subject 4 in Match 1 (Match 1 to Match 6). The pre-competitive mood profile from Matches 2 to 6 shows that it’s consistent with the iceberg profile. Here, the Vigor factor is above the mean (50 points). However, the mood profile for Match 1 deviates slightly from the iceberg profile.

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POMS profiles of subject 4 after matchs.

Table 8 shows the values of the POMS factors of Subject 4 in the seven shots evaluated weekly after training.

Values in the POMS factors of Subject 4 after training.

Figure 13 shows the mood profiles of Subject 4 in Training Weeks (Training Week 1 to Training week 7). Subject 4 shows an adequate pre-competitive mood profile in which the Tension, Anger, Fatigue and Depression factors have low values, while the Vigor factor has high values. Characteristic scores of the iceberg profile indicating an appropriate state of mind for the competition.

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POMS profiles of subject 4 after training weeks.

Finally, Figure 14 shows the scores obtained by Subject 4 on the DASS-21 subscales. The results show indicators of adequate mental health, although it is necessary to pay special attention to anxiety, which has high peaks at times.

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Scores of subject 4 to the subscales of the DASS-21.

The aim of this study was to determine the relationship between the subjective psychological disposition of the athlete who has just overcome a sports injury and the nature of the mood profile and mental health in order to predict the risk of recurrence.

Subject 1 discussion

The obtained results showed that Subject 1 had the correct psychological disposition to resume sports. These results are consistent with other studies ( Prapavessi, 2000 ; Neal et al., 2013 ; Clement et al., 2015 ; Caron et al., 2021 ) showing that athletes who adequately manage their emotions ( Brewer et al., 2007 ; Glazer, 2009 ; García et al., 2015 ; Webster et al., 2018 ; Cools et al., 2021 ) are more successful in their athletic performance and return to RTP ( De la Vega et al., 2013 ; Díaz et al., 2015 ; Horvath and Rothlin, 2018 ; Rollo et al., 2021 ). Similarly, the emotional profile of the iceberg described by Morgan (1980) has been gradually adopted, which is consistent with similar studies by other authors ( Díaz et al., 2015 ; Andrade et al., 2016 ; Moreno-Tenas, 2018 ; Arroyo del Bosque et al., 2020 ; Palomo, 2020 ). Together with the low anxiety, stress and depression scores, this suggests that these are emotional scores associated with an effective mental health model to predict athletic success. Based on the existing literature indicating that a timely return to sports practise, a correct psychological predisposition to RTP, and appropriate emotional management prevent the possible ocurrence of recurrences, the data obtained were favorable for RTP and avoid future recurrences ( Lu and Hsu, 2013 ; Neal et al., 2013 ; Roy et al., 2015 ; Gomez-Espejo et al., 2018 ; Moreno-Tenas, 2018 ; Green et al., 2020 ; Zhang et al., 2022 ).

Subject 2 discussion

The results indicated that further testing was needed to determine if the athlete was psychologically prepared for the RTP. However, the mood profile was consistent with the iceberg profile, which states that mood did not change prior to the competition because it was a healthy psychological state that was maintained both after the competition and after practices. These results are consistent with other studies ( De la Vega et al., 2011 ; Díaz et al., 2015 ; Andrade et al., 2016 ; Moreno-Tenas, 2018 ; Arroyo del Bosque et al., 2020 ; Palomo, 2020 ). On this basis, and with low levels of anxiety, depression, and stress, it seems to show indicators of good mental health. Different studies have shown that negative emotions tend to decrease as the return to sport process progresses, while positive emotions tend to increase as the RTP process progresses ( Lalín, 2009 ; Mainwaring et al., 2010 ; Olmedilla et al., 2014 ; García et al., 2015 ; Rossi et al., 2021 ). Therefore, it is possible that she did not return to the sport with complete certainty, but that her perceptions changed as the competition evolved.

Subject 3 discussion

The results of the PRIA indicated that the athlete felt psychologically unable to return to sport or that further complementary testing was needed to confirm this. In addition, the inverted iceberg profile he showed in Game 1, along with the increase in anxiety and stress scores over the course of the evaluation, indicated that the athlete was not ready to return to the sport. With this in mind, and considering that positive mood states serve as indicators of protection against sports injuries and recurrences ( Rozen and Horne, 2007 ), the likelihood of this athlete relapsing is high.

Subject 4 discussion

He demonstrated adequate psychological predisposition to return to sport safely and showed a good mood profile consistent with the iceberg profile. The mood profile for Match 1 and Training Week 1 did not show the iceberg profile as strongly. In the first case, high scores were shown in the Tension, Anger and Fatigue factors (without exceeding the central point), whereas in training, high scores were reported in the Fatigue factor. These results are consistent with those of Alzate et al. (2004) , who demonstrated that athletes increasingly adopted an iceberg profile as the recovery process progressed ( Abenza et al., 2009 ), highlighting that the emotional response to sports injury is not a static phenomenon and that the effectiveness of sports rehabilitation treatments can be enhanced by formal or informal assessments of changes in the athlete’s mood during the rehabilitation period ( Arroyo del Bosque et al., 2020 ). Finally, the low scores of the depression factor decreased as the assessment progressed, while, the scores for anxiety and stress fluctuated. These results may be due to the fact that, as suggested by Walker et al. (2010) , the term anxiety or stress in relation to a new injury would be more appropriate to refer to the emotional response traditionally known as fear of a new injury, because from a psychological perspective, the RTP phase can be particularly challenging as anxiety and stress may resurface once the athlete has been cleared for RTP ( Clement et al., 2015 ; Green et al., 2020 ).

Previous literature has shown that returning athletes to sport before they are psychologically ready can lead to fear, anxiety, stress, recurrence, second injuries, depression, and decreased performance ( Ahern and Lohr, 1997 ; Clement et al., 2013 ; Rossi et al., 2021 ).

Future lines of research

This study has some limitations that should be considered. First, the sample is insufficient and geographically very limited, since it was conducted only in one autonomous community. The fact that a sample of soccer players from different areas (11-a-side soccer and futsal) was studied. While there are enough studies for 11-a-side soccer, this is not the case for futsal, so it could be very interesting to open a line in this field. In this sense, it seems reasonable to use samples as homogeneous as possible. Also, the exceptional situation imposed by COVID-19, which forced the interruption of competitions and training, forced to stop the evaluation process. In conclusion and considering these limitations, it would be necessary to consider in future researches the continuity of this work and try to expand the study population and its homogeneity. In addition, it would be interesting to monitor the athlete during his RTP process to ensure an adequate return to sports practice and to check if recurrences occur.

At an applied level, the results presented provide new information for the design of intervention programs aimed at coaches ( Sousa et al., 2007 ; Soriano et al., 2014 ) and psychologists ( De la Vega et al., 2011 ; Díaz et al., 2015 ; Moreno-Tenas, 2018 ; Arroyo del Bosque et al., 2020 ; Caron et al., 2021 ). Proper reading of moods as well as anxiety, stress, depression, and psychological predisposition can help sport professionals determine the right time for RTP. In this way, this work calls for the attention of technicians, coaches and clubs to integrate the psychological variables in their training programs, just as they train the physical, conditioning, technical and tactical aspects and take measures that help the injured athlete to develop a realistic and positive attitude toward rehabilitation as a guarantee for a successful recovery.

Data availability statement

Ethics statement.

The studies involving human participants were reviewed and approved by Ethics Committee of the University of Murcia. The patients/participants provided their written informed consent to participate in this study.

Author contributions

VG-E, AO, and EO designed the study as a whole. AO designed the questionnaires’ protocol and VG-E adapted them in the online version. VG-E prepared the draft of the introduction, with all the coauthors contributing to the revision and final version. VG-E carried out the data collection. EO was in charge of the statistical analyzes. LA-C and AG-M prepared the first draft of the discussion, with all the co-autothors contributing to the final version and revisions. All authors contributed to the article and approved the submitted version.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2022.905816/full#supplementary-material

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Your complete guide to compensation payouts for psychological injury

A psychological injury can look very different between individuals, however Health Direct found that 20% of Australians have some kind of mental illness that affects their thoughts, mood, behaviour or perception of the world. These mental health problems commonly result in depression, anxiety and even substance abuse. 

If you’ve found yourself with psychological injuries after a car accident, workplace bullying or any other situation where you are not at fault, you have the right to file a psychological injury claim. This article will explore the causes of this type of damage, how to prove you have it and how we helped a client earn $500,000 in compensation. 

What is considered a psychological injury?

No one goes to work expecting trauma to hit. Some forms of workplace psychological abuse can occur that would cause mental injury and therefore qualify you for compensation for treatment:

  • Harassment.
  • Intense bullying.
  • Sexual harassment.
  • Poor physical working conditions.
  • Threatened job security.
  • Denial of personal or vacation time off.

There is no single answer as to why mental stress occurs in some and not in others. In the previously mentioned article, Health Direct highlighted that it could be due to factors ranging from genetic mutation, your childhood environment or your life experiences.

While the cause of psychiatric injury isn’t exactly clear, the signs that you do have it are becoming more researched and supported. Some signs that you may be suffering from an undiagnosed mental illness include:

  • The persistent feeling of sadness and loss of interest in things you once loved.
  • The inability to set aside worry and restlessness despite the impact of the event ahead.
  • The constant need for items and patterns to align in a particular way or a growing fear of germs.
  • The avoidance or flashbacks of unwanted memories related to an event or series of events that caused you trauma.
  • The consistent shift in moods without explanation from high energy to depressive dissociation from reality.

Mental health treatment for emotional distress can come in the form of therapy sessions, lifestyle changes or medical treatment. If you were injured in an accident you did not cause, the bill for treatment should not be on your shoulders to bear, instead — file a claim.

How do you prove psychological injury?

To qualify for a psychological injury compensation claim, you’ll need to be assessed as having a Whole Person Impairment (WPI) of 15% or more. 

Proving injury is the most important part of earning compensation to cover your medical expenses. The first step to filing a claim is gathering medical evidence outlining your diagnosis and treatment plan from reputable health professionals. Receiving treatment from a psychologist for 3 months can not only help your mental recovery, but it will also allow you to prove psychological injury as part of your compensation claim. 

If you take your psychological injury compensation claim to court, the judge will need to see that you are pursuing treatment for your emotional distress. Taking on management action for your psychological trauma means setting up your future for success and committing to a long and happy life.

Filing a psychological injury claim

As an employee you have the right to claim any pain and suffering you may be going through as a result of your job. To make a claim for psychological injury at work, you must:

  • Inform your employer that you are experiencing a work-related mental injury and fill in any forms they give you to document your experience. 
  • Prepare to give details about your situation at work that has resulted in mental damage, including symptoms, to your employer. 
  • Seek medical attention from a private physician to get a professional opinion on your symptoms. 
  • Provide your employer with a copy of the notice for their documentation. 
  • Contact your insurance if your employer hasn’t already done so to get a worker’s compensation claim started. 

If you are experiencing a psychological injury or emotional damages as a result of an accident such as a car crash, you would follow similar steps. In this case you would contact your insurer and lawyer directly. 

You have six months after seeking professional help to file a claim. From there, it usually takes between 12 to 18 months to receive compensation, however it may take up to three years if the claim goes to court. Your common law solicitors at Gerard Malouf & Partners are here to support your journey toward compensation so you can focus on recovery. Make sure to gather the following information to help support your claim:

  • Background information on how much you need to be covered regarding your current psychological condition. 
  • Written details of your injury and mental impairments you’re experiencing.
  • Facts of the event that lead to your injury.
  • Medical permanent impairment report from an assessor.
  • Work history that could be relevant to your psychological injury.
  • Records of any previous injury or condition that could have played a role in your current injury. 
  • Documentation regarding compensation payouts related to previous injuries or conditions.
  • Information on how your employer may have breached their duty of care to you. 

What is the average compensation payout for psychological injury?

The average compensation payout will depend on your level of injury. The goal of compensation is to cover your needs while you recover from the injury. For psychological injury, this could mean permanent impairment compensation which would usually result in a lump sum. 

For a successful psychological claim, you could receive any one or a combination of the following:

  • For 15% or less whole person impairment, your lump sum compensation payment could fall anywhere between $22,480 and $631,360.
  • If you miss work for 13 weeks or more, you will receive 95% of your pre-injury wages, which decreases to 80% starting week 14. As of June 2022, your weekly earnings will max at $2,318.10. 
  • Reimbursement of your eligible medical and recovery expenses. 
  • An additional lump sum based on your past and future lost earnings. This payment is added on top of any other impairment compensation you have earned. 

Book an appointment with our expert team

Call 1800 004 878, case summary: successful psychological injury claim, worker receives over $500,000 for psychological injuries arising from workplace bullying and harassment., our approach.

Our client sustained a psychological injury during the course of his employment as a result of workplace bullying and harassment. Under the current Workers Compensation Scheme , a minimum threshold of 15% whole person impairment (WPI) is required to seek lump sum compensation for a psychological injury arising from a workplace incident. 

This threshold is much higher and more difficult to achieve compared to a physical injury, which requires only 11% whole person impairment.

For this particular client, his quality of life following this psychological injury took a major impact and rendered him effectively unemployable for the foreseeable future.

Following his entitlements for lump sum compensation, where he satisfied the impairment threshold of 15% whole person impairment, we were able to commence a work injury damages claim (common law negligence claim). This was only possible because the minimum threshold requirement of 15% whole person impairment for a lump sum claim is the exact same threshold required in order to pursue a work injury damages claim.

Having already satisfied the impairment rating required, we knew the claim had merits in a work injury damages claim.

After ongoing negotiations with the insurer, the parties ultimately agreed to a settlement that resulted in our client receiving over half a million dollars in payments for economic loss.

Our client placed his trust in Gerard Malouf & Partners to achieve a maximised compensation. For our client, the outcome, coupled with the fact that the process had concluded after many years of turmoil, put him at ease. With this now behind him, he hopes for a brighter future.

You're in Expert Hands

Have you suffered a workplace injury call us for free advice., working with gmp law to build a successful psychological injury claim.

Working with the right lawyer is essential to ensure you receive the compensation you deserve.  At Gerard Malouf & Partners our experienced lawyers will work closely with you to help you build the strongest case possible. 

From listening to the details of your case to gathering information and working toward getting you a lump sum compensation payout, Gerard Malouf & Partners are here to support you every step of the way. We offer our legal services on a no-win, no-fee basis, so you don’t need to worry about the legal costs until you’ve won compensation.

Contact us today for a no-obligation consultation .

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  1. Psychological Intervention in Traumatic Brain Injury Patients

    1. Introduction Traumatic brain injury (TBI) is a disruption in normal brain function caused by external mechanical force, such as rapid acceleration or deceleration, a bump or jolt to the head, or penetration by a projectile.

  2. Mental health consequences of traumatic brain injury

    The nature and etiology of mental health manifestations of TBI (including a combination of brain dysfunction and psychological trauma and interrelationships between cognitive, affective, and physical symptoms) are complex and have been a focus of recent epidemiologic and mechanistic studies.

  3. A case of "Borrowed Identity Syndrome" after severe traumatic brain injury

    Case Report We describe progressive deterioration in personal identity in a former physician who had sustained a serious head injury (1998), resulting in focal injuries to the right frontal and temporal areas.

  4. Psychosocial hazard case studies

    CASE STUDY 1 - Poor organisational change management Poor change management can lead to psychological injuries and other adverse health outcomes, as well as reduced productivity. It is identified as a common hazard in the Model Code of Practice: Managing psychosocial hazards at work. CASE STUDY 2 - Work demands

  5. Phineas Gage: Biography, Brain Injury, and Influence

    Phineas Gage: His Accident and Impact on Psychology By Kendra Cherry, MSEd Updated on January 17, 2024 Fact checked by Emily Swaim Author unknown / Wikimedia Commons Table of Contents Phineas Gage's Accident Change in Personality Severity of Brain Damage Impact on Psychology What Happened to Phineas Gage After the Brain Damage?

  6. Evaluating the Effects of Repeated Psychological Injury: an

    Psychological Injury and Law - Given the complexity of cumulative trauma exposure (Briere, Dietrich, & Semple, 2016; Briere, Kaltman, & Greene, 2008), survivors of repeated interpersonal trauma may appear to be feigning or exaggerating symptoms on common psychological measures, even when they are not (Brown, 2009).For example, research has demonstrated how a history of complex trauma and ...

  7. Introducing Psychological Injury and Law

    Psychology injury and law is a specialized forensic psychology field that concerns reaching legal thresholds for actionable negligent or related injuries having a psychological component, such as for posttraumatic stress disorder, chronic pain, and mild traumatic brain injury. The presenting psychological injuries have to be related causally to the event at issue, and if pre-existing injuries ...

  8. Effectiveness of psychological intervention following sport injury

    Psychosocial risk factors and sport injury: psychological risk factors including goal setting, stress, mood, coping strategies. ... Rock and Jones 40 conducted a series of case studies in the United Kingdom among three competitive athletes who had ACL damage but no history of surgical treatment. The participants received a microcounseling ...

  9. The psychological response to injury in student athletes: a narrative

    Injuries: antecedents and the emotional response. Injuries are common in athletes and the psychological response to injury can include normal as well as problematic responses,.19-22 Preinjury factors, including biological, physical, psychological sociocultural, and most importantly stress, can increase an athlete's risk of injury and poor recovery.19-23 After injury, several factors such ...

  10. A new look at self-injury

    A new look at self-injury. Self-injury is a well-recognized clinical phenomenon, but its causes — and therefore its cures — have been somewhat elusive. Two clinical researchers have compelling and complementary views on why people engage in this harmful behavior. DeAngelis, T. (2015, July 1). A new look at self-injury.

  11. Psychological distress after physical injury: a one-year follow-up

    Conclusion: One-third of conscious physical injured patients had post-traumatic stress symptoms at a possible clinical case level one year after the traumatic event, and one-third of these had delayed onset. Symptoms of peritraumatic dissociation and perception were mutually independent predictors of psychological distress.

  12. Psychological Responses to Sport Injury

    Britton W. Brewer https://doi.org/10.1093/acrefore/9780190236557.013.172 Published online: 24 May 2017 Summary In addition to the disruptive impact of sport injury on physical functioning, injury can have psychological effects on athletes.

  13. The impact of psychological factors on recovery from injury: a

    This study investigated the role of psychological predictors 1 month post-injury in subsequent self-reported recovery from injury in working-aged adults. Methods A multicentre cohort study was conducted of 668 unintentionally injured adults admitted to five UK hospitals followed up at 1, 2, 4 and 12 months post-injury.

  14. 9 Psychological Injury Cases

    Case 5. Dr. Rear-End Heuristic sees a patient who suffered a severe whiplash injury following a rear-end collision, and who also reported fear of motor vehicle travel, becoming upset when traveling near the MVA scene, becoming less interested in her social and recreational activities, and being easily startled, among other psychological ...

  15. Psychosocial issues following serious head injury: a case study of an

    This article is a case study of an adolescent girl who sustained a serious head injury following an attack by strangers. ... the major issues in rehabilitation were t … Psychosocial issues following serious head injury: a case study of an adolescent girl Rehabil Nurs. Sep-Oct 1996;21(5):258-61. doi: 10.1002/j.2048-7940.1996 ... Psychological*

  16. Patient H.M. Case Study In Psychology: Henry Gustav Molaison

    Henry Gustav Molaison, known as Patient H.M., is a landmark case study in psychology. After a surgery to alleviate severe epilepsy, which removed large portions of his hippocampus, he was left with anterograde amnesia, unable to form new explicit memories, thus offering crucial insights into the role of the hippocampus in memory formation.

  17. Psychological injuries in the workplace

    Psychological injuries in the workplace Lusk & Anor v Sapwell [2011] QCA 059 Muir JA, Margaret Wilson AJA and Ann Lyons J 1 April 2011 Background The claimant worked as an optical technician in a small optometry practice on a relatively busy street in Brisbane. The claimant frequently worked alone in the shop. The facts

  18. A win for science, and patients, against brain injury 'nihilism'

    The study, published in December in Nature Medicine, relied on "deep brain stimulation," in which a battery-powered device is implanted under a patient's skin.Electrodes extend from the device to a part of the thalamus, which routes signals from one section of the brain to another. "There's a lot of ways to shut parts of the system down," said Joseph Giacino, Spaulding's director ...

  19. Severe Traumatic Brain Injury: A Case Report

    Case Report: In this case report, we demonstrate the unanticipated recovery of a 28-year-old male patient who presented with a severe traumatic brain injury after being in a motorcycle accident without wearing a helmet. He presented with several exam and imaging findings that are statistically associated with increased mortality and morbidity.

  20. Psychology's 10 greatest case studies

    Phineas Gage One day in 1848 in Central Vermont, Phineas Gage was tamping explosives into the ground to prepare the way for a new railway line when he had a terrible accident. The detonation went...

  21. Psychological & Bullying Claim Cases

    Case Studies STRESS CLAIM Our client was a young girl who was the victim of two armed robberies at her workplace. Although there were no physical injuries she suffered post-traumatic stress disorder and developed schizophrenia. She was unable to cope with normal daily activities and became socially isolated and dependent upon medication.

  22. Secondary Psychological Injuries: A Personal Injury Case Study on

    Thursday, May, 22, 2014 When a worker is injured during the course of their employment, they may suffer more than just the physical injuries afflicting their body. Psychological injuries such as stress and depression are conditions that may arise as secondary injuries caused by the employer's negligence and the worker's incapacity.

  23. Psychological readiness to return to sports practice and risk of

    For years, researchers have pointed out the importance of psychological factors in sports injury susceptibility ( García-Mas et al., 2014; Ganz, 2018; Slimani et al., 2018) and their recovery ( Casáis, 2008; Arvinen-Barrow and Clement, 2016; Salim et al., 2016; Roy-Davis et al., 2017; Olmedilla et al., 2018a; Gennarelli et al., 2020 ).

  24. Your complete guide to compensation payouts for psychological injury

    A psychological injury can look very different between individuals, however Health Direct found that 20% of Australians have some kind of mental illness that affects their thoughts, mood, behaviour or perception of the world. These mental health problems commonly result in depression, anxiety and even substance abuse.