Advertisement

Ten-Year Employment Patterns of Working Age Individuals After Moderate to Severe Traumatic Brain Injury: A National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Study

Published:August 13, 2015DOI:https://doi.org/10.1016/j.apmr.2015.07.020

      Abstract

      Objective

      To describe the 10-year patterns of employment for individuals of working age discharged from a Traumatic Brain Injury Model Systems (TBIMS) center between 1989 and 2009.

      Design

      Secondary data analysis.

      Setting

      Inpatient rehabilitation centers.

      Participants

      Patients aged 16 to 55 years (N=3618) who were not retired at injury, received inpatient rehabilitation at a TBIMS center, were discharged alive between 1989 and 2009, and had at least 3 completed follow-up interviews at postinjury years 1, 2, 5, and 10.

      Interventions

      Not applicable.

      Main Outcomes Measure

      Employment.

      Results

      Patterns of employment were generated using a generalized linear mixed model, where these patterns were transformed into temporal trajectories of probability of employment via random effects modeling. Covariates demonstrating significant relations to growth parameters that govern the trajectory patterns were similar to those noted in previous cross-sectional research and included age, sex, race/ethnicity, education, preinjury substance misuse, preinjury vocational status, and days of posttraumatic amnesia. The calendar year in which the injury occurred also greatly influenced trajectories. An interactive tool was developed to provide visualization of all postemployment trajectories, with many showing decreasing probabilities of employment between 5 and 10 years postinjury.

      Conclusions

      These results highlight that postinjury employment after moderate to severe traumatic brain injury (TBI) is a dynamic process, with varied patterns of employment for individuals with specific characteristics. The overall decline in trajectories of probability of employment between 5 and 10 years postinjury suggests that moderate to severe TBI may have unfavorable chronic effects and that employment outcome is highly influenced by national labor market forces. Additional research targeting the underlying drivers of the decline between 5 and 10 years postinjury is recommended, as are interventions that target influencing factors.

      Keywords

      List of abbreviations:

      NDB (National Database), PTA (posttraumatic amnesia), TBI (traumatic brain injury), TBIMS (Traumatic Brain Injury Model Systems)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • U.S. Department of Labor
        Bureau of Labor Statistics. Glossary.
        (Available at:) (Accessed September 1, 2014)
        • Argyle M.
        Causes and correlates of happiness.
        in: Diener E. Schwarz N. Well-being: the foundations of hedonic psychology. The Russell Sage Foundation, New York1999
        • Carlier B.E.
        • Schuring M.
        • Lötters F.J.
        • Bakker B.
        • Borgers N.
        • Burdorf A.
        The influence of re-employment on quality of life and self-rated health, a longitudinal study among unemployed persons in the Netherlands.
        BMC Public Health. 2013; 13: 503
        • Lucas R.E.
        • Clark A.E.
        • Georgellis Y.
        • Diener E.
        Unemployment alters the set point for life satisfaction.
        Psychol Sci. 2004; 15: 8-13
        • Bornstein M.H.
        • Davidson L.
        • Keyes C.L.
        • Moore K.A.
        Well-being: positive development across the life course.
        Lawrence Erlbaum Associates, Mahwah2003
        • McKee-Ryan F.
        • Song Z.
        • Wanberg C.R.
        • Kinicki A.J.
        Psychological and physical well-being during unemployment: a meta-analytic study.
        J Appl Psychol. 2005; 90: 53-76
        • Montgomery S.M.
        • Cook D.G.
        • Bartley M.J.
        • Wadsworth M.
        Unemployment pre-dates symptoms of depression and anxiety resulting in medical consultation in young men.
        Int J Epidemiol. 1999; 28: 95-100
        • Soares J.J.
        • Macassa G.
        • Grossi G.
        • Viitasara E.
        Psychosocial correlates of hopelessness among men.
        Cogn Behav Ther. 2008; 37: 50-61
        • Winefield A.H.
        • Tiggemann M.
        • Winefield H.R.
        The psychological impact of unemployment and unsatisfactory employment in young men and women: longitudinal and cross-sectional data.
        Br J Psychol. 1991; 82: 473-486
        • Walsh F.
        Family resilience: a collaborative approach in response to stressful life challenges.
        in: Southwick S.M. Litz B.T. Charney D. Friedman M.J. Resilience and mental health: challenges across the lifespan. Cambridge Univ Pr, New York2011: 149-161
        • Westman M.
        • Etzion D.
        • Horovitz S.
        The toll of unemployment does not stop with the unemployed.
        Hum Relat. 2004; 57: 823-844
        • Broman C.L.
        • Hamilton V.L.
        • Hoffman W.S.
        Unemployment and its effects on families: evidence from a plant closing study.
        Am J Community Psychol. 1990; 18: 643-659
        • National Center for Injury Prevention and Control, Centers for Disease Control and Prevention
        What are the potential effects of TBI?.
        (Available at:) (Accessed December 1, 2013)
        • National Institute of Neurological Disorders and Stroke
        National Institutes of Health. NINDS traumatic brain injury information page.
        (Available at:) (Accessed September 1, 2014)
        • Keyser-Marcus L.A.
        • Bricout J.C.
        • Wehman P.
        • et al.
        Acute predictors of return to employment after traumatic brain injury: a longitudinal follow up.
        Arch Phys Med Rehabil. 2002; 83: 635-641
        • Wagner A.
        • Hammond F.
        • Sasser H.
        • Wiercisewski D.
        Return to productive activity after traumatic brain injury: relationship with measures of disability, handicap, and community integration.
        Arch Phys Med Rehabil. 2002; 83: 107-114
        • Sander A.
        • Krentzer J.
        • Rosenthal M.
        • Delmonico R.
        • Young M.
        A multicenter longitudinal investigation of return to work and community integration following traumatic brain injury.
        Arch Phys Med Rehabil. 1996; 11: 70-84
        • Corrigan J.D.
        • Bogner J.A.
        • Mysiw W.J.
        • Clinchot D.
        • Fugate L.
        Life satisfaction after traumatic brain injury.
        J Head Trauma Rehabil. 2001; 16: 546-555
        • Tsaousides T.
        • Warshowsky A.
        • Ashma T.A.
        • Cantor J.B.
        • Spielman L.
        • Gordon W.A.
        The relationship bewteen employment-related self-efficacy and quality of life following traumatic brain injury.
        Rehabil Psychol. 2009; 54: 299-305
        • Franulic A.
        • Carbonell C.G.
        • Pinto P.
        • Sepulveda I.
        Psychosocial adjustment and employment outcome 2, 5 and 10 years after TBI.
        Brain Inj. 2004; 18: 119-129
        • Corrigan J.D.
        • Lineberry L.A.
        • Komaroff E.
        • Langlois J.A.
        • Selassie A.W.
        • Wood K.D.
        Employment after traumatic brain injury: differences between men and women.
        Arch Phys Med Rehabil. 2007; 88: 1400-1409
        • Gary K.W.
        • Arango-Lasprilla J.C.
        • Ketchum J.M.
        • et al.
        Racial differences in employment outcome after traumatic brain injury at 1, 2 and 5 years postinjury.
        Arch Phys Med Rehabil. 2009; 90: 1699-1707
        • Gary K.W.
        • Ketchum J.M.
        • Arango-Lasprilla J.C.
        • et al.
        Differences in employment outcomes 10 years after traumatic brain injury among racial and ethnic minority groups.
        J Vocat Rehabil. 2010; 33: 65-75
        • Grauwmeijer E.
        • Heijenbrok-Kal M.H.
        • Haitsma I.K.
        • Ribbers G.M.
        A prospective study on employment outcome 3 years after moderate to severe traumatic brain injury.
        Arch Phys Med Rehabil. 2012; 93: 993-999
        • Shigaki C.L.
        • Johnstone B.
        • Schopp L.H.
        Financial and vocational outcomes 2 years after traumatic brain injury.
        Disabil Rehabil. 2009; 31: 484-489
        • Cuthbert J.P.
        • Harrison-Felix C.
        • Corrigan J.D.
        • Bell J.M.
        • Haarbauer-Krupa J.K.
        • Miller A.C.
        Unemployment in the United States after traumatic brain injury for working-age individuals: prevalence and associated factors 2 years postinjury.
        J Head Trauma Rehabil. 2015; 30: 160-174
        • Fraser R.
        • Machamer J.
        • Temkin N.
        • Dikmen S.
        • Doctor J.
        Return to work in traumatic brain injury (TBI): a perspective on capacity for job complexity.
        J Vocat Rehabil. 2006; 25: 141-148
        • Andelic N.
        • Stevens L.F.
        • Sigurdardottir S.
        • Arango-Lasprilla J.C.
        • Roe C.
        Assocations between disability and employment 1 year after traumatic brain injury in a working age population.
        Brain Inj. 2013; 26: 261-269
        • Ketchum J.M.
        • Getachew M.A.
        • Krch D.
        • et al.
        Early predictors of employment outcomes 1 year post traumatic brain injury in a population of hispanic individuals.
        NeuroRehabilitation. 2012; 30: 13-22
        • Forslund M.V.
        • Roe C.
        • Arango-Lasprilla J.C.
        • Sigurdardottir S.
        • Andelic N.
        Impact of personal and environmental factors on employment ouctome two years after moderate-to-severe traumatic brain injury.
        J Rehabil Med. 2013; 45: 801-807
        • Wehman P.
        • Targett P.
        • West M.
        • Kregel J.
        Productive work and employment for persons with traumatic brain injury: what have have we leared after 20 years?.
        J Head Trauma Rehabil. 2005; 20: 115-127
        • Dawson D.R.
        • Schwartz M.L.
        • Winocur G.
        • Stuss D.T.
        Return to productivity following traumatic brain injury: cognitive, psychological, physical, spiritual, and environmental correlates.
        Disabil Rehabil. 2007; 29: 301-313
        • Forslund M.V.
        • Arango-Lasprilla J.C.
        • Roe C.
        • Perrin P.
        • Sigurdardottir S.
        • Andelic N.
        Multi-level modelling of employment probability trajectories and employment stability at 1, 2 and 5 years after traumatic brain injury.
        Brain Inj. 2014; 28: 980-986
        • Ponsford J.
        • Spitz G.
        Stability of employment over the first 3 years following traumatic brain injury.
        J Head Trauma Rehabil. 2015; 30: E1-E11
        • Kreutzer J.S.
        • Marwitz J.H.
        • Walker W.C.
        • et al.
        Moderating factors in return to work and job stability after traumatic brain injury.
        J Head Trauma Rehabil. 2003; 18: 128-138
        • Machamer J.
        • Temkin N.
        • Fraser R.
        • Doctor J.
        • Dikmen S.
        Stability of employment after traumatic brain injury.
        J Int Neuropsychol Soc. 2005; 11: 807-816
        • Pretz C.
        • Ketchum J.
        • Cuthbert J.
        An introduction to analyzing dichotomous outcomes in a longitudinal setting: a NIDRR Traumatic Brain Injury Model Systems communication.
        J Head Trauma Rehabil. 2014; 29: E65-E71
        • Kozlowski A.
        • Pretz C.
        • Dams-O'Connor K.
        • Kreider S.
        • Whiteneck G.G.
        Applying individual growth curve models to evaluate change in rehabilitation.
        Arch Phys Med Rehabil. 2013; 94: 589-596
      1. The Traumatic Brain Injury Model Systems National Data and Statistical Center. TBI Model Systems presentation 2014. Available at: https://www.tbindsc.org/. Accessed September 1, 2014.

        • Walker W.C.
        • Marwitz J.H.
        • Kreutzer J.S.
        • Hart T.
        • Novack T.A.
        Occupational categories and return to work after traumatic brain injury: a multicenter study.
        Arch Phys Med Rehabil. 2006; 87: 1576-1582
        • Levin H.S.
        • O'Donnell V.M.
        • Grossman R.G.
        The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury.
        J Nerv Ment Dis. 1979; 167: 675-684
        • Bode R.K.
        • Heinemann A.W.
        • Semik P.
        Measurement properties of the Galveston Orientation and Amnesia Test (GOAT) and improvement patterns during inpatient rehabilitation.
        J Head Trauma Rehabil. 2000; 15: 637-655
        • Jackson W.T.
        • Novack T.A.
        • Dowler R.N.
        Effective serial measurement of cognitive orientation in rehabilitation: the Orientation Log.
        Arch Phys Med Rehabil. 1998; 79: 718-720
        • Dempster A.P.
        • Laird N.M.
        • Rubin D.B.
        Maximum likelihood from incomplete data via the EM algorithm.
        J R Stat Soc. 1977; 39: 1-38
        • Corrigan J.D.
        • Bogner J.
        • Lamb-Hart G.
        Technical report on problematic substance use variables.
        The Center for Outcome Measurement in Brain Injury, 2003 (Available at: http://www.tbims.org/combi/subst. Accessed September 1, 2014.)
        • Pretz C.
        • Kozlowski A.
        • Dams-O'Connor K.
        • et al.
        Descriptive modeling of longitudinal outcome measures in traumatic brain injury: a National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems study.
        Arch Phys Med Rehabil. 2013; 94: 579-588
        • Langdon D.
        • McMenamin T.
        • Krolik T.
        US labor market in 2001: economy enters a recession.
        Mon Labor Rev. 2002; 125: 3-33
        • U.S. Department of Labor
        Bureau of Labor Statistics. The recession of 2007-2009.
        2012 (Available at: http://www.bls.gov/spotlight/2012/recession/. Accessed September 1, 2014.)
        • Thompkins A.
        • Honeycutt T.
        • Gill C.
        • Mastrianni J.
        • Bailey M.
        To apply or not apply: the employment and program participation of social security disability insurance applicants and non-applicants.
        Mathematica Policy Research, Princeton2014
        • Rotman D.
        How technology is destroying jobs.
        MIT Technology Review, Cambridge2013
        • Masel B.E.
        • DeWitt D.S.
        Traumatic brain injury: a disease process, not an event.
        J Neurotrauma. 2010; 27: 1529-1540