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Social Determinants of Health

The Not So Disabled Machinist

A 45-year-old former machinist at a pipe manufacturing company, currently receiving Social Security Disability Insurance (SSDI) income, presents to your clinic.  He fractured his right shoulder 3 years ago after a fall at work, and has been receiving chronic opioid therapy because of daily shoulder and back pain.  He was evaluated by orthopedic surgery and had physical therapy with little improvement.  He feels depressed due to financial insecurity and inability to work.  He is able to earn extra income doing minor maintenance work for a friend who owns an apartment building.  He expresses interest in part-time work but fears losing his benefits.  He previously tried citalopram and fluoxetine without improvement in his mood, pain, or energy level, and does not want to try another medication.  He denies feeling hopeless or suicidal but does endorse insomnia. 


The best next step to help him with depression and financial distress is:

a)      Refer him to self-help or support groups

b)      Refer him to the local Social Security office to inquire about trial work without losing disability benefits

c)       Refer him to a comprehensive pain management program

d)      Suggest a trial of quetiapine for both depression and  insomnia


Fast fact: Social Security rules make it possible for people with disabilities receiving Social Security or Supplemental Security Income (SSI) to work for a limited period of time and still receive monthly payments and Medicare or Medicaid benefits as long as their disability persists.  The trial work period allows a Social Security recipient to test his/her ability to work for at least 9 months.  In 2014, recipients may still retain benefits under an extended period of eligibility if earnings are under $1,070 per month.  Vocational rehabilitation has the potential to enhance the number of injured workers returning to the labor market, prevent illness, and increase well-being.  There is currently no high-level evidence to support or refute the efficacy of such interventions in improving return-to-work outcomes.



  1. Social security administration website on work incentives
  2. Hou WH, Chi CC, Lo HL, Kuo KN, Chuang HY. Vocational rehabilitation for enhancing return-to-work in workers with traumatic upper limb injuries. Cochrane Database Syst Rev 2013; 10

The SDH Fast Fact Team
 Bui, Simonetti, Benson, Malek and Anderson