Original research| Volume 100, ISSUE 10, P1837-1843, October 2019

Depression as a Predictor of Long-term Employment Outcomes Among Individuals With Moderate-to-Severe Traumatic Brain Injury



      To examine the predictive ability of depression when considering long-term employment outcomes for individuals with moderate-to-severe traumatic brain injury (TBI) after controlling for key preinjury and injury-related variables.


      Secondary data analysis.


      Community follow-up after discharge from an inpatient rehabilitation center.


      Individuals between 18 and 60 years old with moderate-to-severe TBI enrolled in the Traumatic Brain Injury Model Systems database.


      Not applicable.

      Main Outcome Measures

      Employment status.


      The prevalence of employment at 2 and 5 years post injury was 40.3% and 44.5%, respectively. Individuals identified as depressed at 1 year were more likely to be unemployed at 2 years post injury (odds ratio [OR], 1.77; 95% CI, 1.38-2.27; P<.0001). Similar relations between current depression and future employment were observed from 1- and 2-year depression status predicting 5-year employment (1-year: OR, 1.88; 95% CI, 1.48-2.40; P<.0001: 2-year: OR, 1.72; 95% CI, 1.36-2.17; P<.0001).


      After controlling for baseline predictors variables, the experience of postinjury depression—a modifiable condition—contributes predictive ability to future employment outcomes. Incorporating assessments and/or interventions for depression into postacute rehabilitation programs could promote favorable employment outcomes after TBI.


      List of abbreviations:

      AUC (area under the receiver operating curve), OR (odds ratio), PHQ-9 (Patient Health Questionnaire-9), PTA (posttraumatic amnesia), TBI (traumatic brain injury), TBIMS (Traumatic Brain Injury Model Systems)
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