Psychosocial adjustment and employment outcome 2, 5 and 10 years after TBI

A patient's return to work has been considered a good indicator of his/her overall adaptation after suffering from TBI. A study has been designed at the Hospital del Trabajador to evaluate patients' psycho-pathological and social situations and to describe evolution and return-to-work predictors. Particular attention was paid to subjects' employment situations 2, 5 and 10 years after TBI.

TBI patients who had also suffered spinal cord injuries, amputations and other physical impairments were excluded. A total of 202 individuals were evaluated by a psychologist and an occupational therapist during clinical interviews using the Hamilton Anxiety and Depression Rating Scale and the Neurobehavioural Rating Scale (NRS-R). Work situations were evaluated by interviewing the subjects and family members and, whenever possible, a patient's immediate supervisor at his or her place of employment.

Unemployed patients presented more severe symptoms of anxiety and depression than those who were working. Significant differences were observed in the NRS-R between employed and unemployed patients. There was no change in the marital status for at least 10 years after TBI.

Factors determining a poor prognosis for adaptation and re-insertion into the workplace are age, a low educational level, a lack of job qualifications and greater cognitive impairments. The significant differences found between the NRS-R of employed and unemployed patients suggest that this variable may be used to predict a subject's ability to return to work.