從社會不平等角度檢視職業傷病勞工的補償經歷及其心理健康影響

Examining injured workers' experiences in worker's compensation systems and their mental health consequences from a social inequality perspective

鍾佩樺(Pei-Hua Chung)

指導教授 ： 鄭雅文

國立臺灣大學/公共衛生學院/健康政策與管理研究所/博士(2016年)

https://doi.org/10.6342/NTU201610491

摘要

目的：勞工在發生職業傷病之後，除了身體病痛與工作能力受損之外，亦面臨經濟困境、勞雇衝突與法律爭議；若社會扶助資源不足與不均，很可能惡化其身心健康。本研究旨在瞭解職業傷病工作者的經驗，以及社經地位與制度經驗對其心理健康之影響。本研究的第一部份乃透過政府調查資料，了解職業傷病經驗的有無對工作者心理健康的影響，並分析社經地位較低的工作者，是否職業傷病經驗與心理健康的相關較強。本研究的第二部分乃透過深入訪談，瞭解職業傷病工作者的災後歷程，包括勞動狀況、經濟補償狀況與其他社會福利取得狀況，並探討上述經驗對其身心健康之影響。

方法：本研究採用混合研究方法，進行方式包括：(1)量性分析：分析勞動部勞動與職業安全衛生研究所於2013年進行的「工作環境安全衛生狀況認知調查」資料，共計男性12,881人與女性9,451人；此調查以問卷詢問受訪者在調查之前的12個月中，是否曾因工作因素而受傷或罹患疾病；問卷亦包含「心理健康簡式症狀題組」(Brief Symptom Rating Scale,BSRS-5)，測量工作者於調查之前一週內的「心理健康」，並收集年齡、教育程度、職業等級等社會人口學變項資料。(2)質性訪談：研究者透過職業傷病防治中心轉介，深度訪談52位職業傷病個案，包括28位男性與24位女性；其中16位屬職業傷害，36位屬職業病。

研究結果：在量性研究方面，不論男女，職業傷病皆好發於低教育程度與藍領工作者。相較於過去一年未曾發生職業傷病事件的工作者，曾於過去一年發生職業傷病的工作者呈現較差的心理健康與自評健康。在控制年齡、職等與教育程度之後，曾於過去一年內發生職業傷病事件的工作者，相較於未發生者，有較高的負面心理健康（OR男性3.08，女性3.19）與負面自評健康（OR 男性5.03，女性6.23）；然而工作者的職等與教育程度，對上述相關的修飾作用並不一致。在質性研究方面，研究發現，職業傷病經歷對多數工作者帶來心理健康衝擊，在52位受訪職業傷病勞工中，共計19位陳述有心理健康問題。本研究歸納，發生職業傷病的工作者，在面臨多重衝突事件之下容易產生心理健康問題，原因包括：身體病痛、工作能力暫時或永久受損、經濟困境、勞雇衝突、復工困難或失業、社會人際關係破裂、生活失序、自尊心受創，以及申請職災補償過程中遭遇挫折。

結論：本研究指出，職業傷病經驗確實對工作者帶來心理健康衝擊；職業傷病勞工面臨多重社會困境，為心理疾病的高風險族群，值得勞動主管機關與社會大眾的重視。

關鍵字

職業相關災害 ； 職業病 ； 職業傷病補償 ； 心理 ； 政策

並列摘要

In addition to physical discomforts, work-related injuries and illnesses often result in various forms of hardships, including impaired ability to work, economic hardships, and conflicts and legal disputes with employers. Workers’ psychological health conditions are likely to be worsened when social supporting systems are fragmented. This study aimed to examine the experiences of injured workers when interacting with the social systems, and the associations between the experience of occupational injury or illness and mental health. In the first part, the researcher utilized existing survey data to examine the association between the experience of occupational injuries or diseases with mental health outcomes. In the second part, the researcher conducted in-depth interviews with injured workers to understand workers’ experiences concerning employment and labor conditions before and after injury, experiences with workers’ compensation system and other social welfare systems, and their physical and psychological consequences.

Methods: Mixed-methods were used in this study. For the quantitative study, data from a national survey of a representative sample of general working people of Taiwan was analyzed, consisting of 12,528 male and 8,396 female workers. A standardized questionnaire was used to obtain information regarding the experiences of occupational injuries or diseases encountered over the previous 12 months. Mental health status was measured by the Brief Symptom Rating Scale (BSRS-5). Also obtained were participants’ age, educational level, and employment grade. For the qualitative study, participants were referred by the Centers for Prevention and Treatment of Occupational Injury and Disease. In-depth interview with52 workers who had experienced occupational injuries and illnesses were conducted, including 28 males and 24 females. Among them, 15 experienced occupational injuries and 37 occupational diseases.
Results: In the survey, the results showed that after controlling for age, employment grades and education level, workers who had experienced occupational injuries over the previous 12 months were at a higher risk for poor mental health (OR men 3.08, women 3.19), poor self-rated health status (OR men 5.03, women 6.23). In the qualitative study, among the 52 participants, 19 workers reported having mental health problems. Reasons for poor mental health can be categorized as the following: physical health problems, impaired work ability, economic hardships, conflicts with employer or management, difficulties in returning back to work or reaming employed, stress in social relationships, disrupted life pace, lower self-esteem, frustration in the workers’ compensation process.

Conclusion: Study findings showed that workers with occupational injuries or diseases experiences multiple hardships and were at high risks for developing mental health problems. Psychosocial consequences of work-related injuries or illnesses deserve further investigation and interventions.

並列關鍵字

occupation-related injuries ； occupation-related diseases ； workers’ compensation ； mental health ； policy

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