Return-to-work in patients with acquired brain injury and psychiatric disorders as a comorbidity: A systematic review

To explore the association between psychiatric disorders as a comorbidity and return-to-work (RTW) in individuals with acquired brain injury (ABI).

A systematic review was performed. The search strategy (2002-2012) contained terms related to ABI, psychiatric comorbidity and keywords adapted to the outcome measure RTW. Selection and review were performed by two authors independently. In the case of uncertainty, a third author was consulted to reach consensus on inclusion or exclusion. The methodological quality of included studies was determined and evidence was classified.

Seven studies were included. Strong evidence was found for a negative association between psychiatric disorders as a comorbidity (like depression, anxiety and post-traumatic stress disorder) and RTW of patients with ABI. Patients with a previous history of psychiatric disorders were at considerably higher risk for a new episode and lower RTW rates following ABI.

Psychiatric disorders as a comorbidity after ABI are strong negatively associated with RTW. The heightened frequency of psychiatric disorders as a comorbidity after ABI and more important their amenability to treatment implicates that more attention should be paid to diagnosing and treating psychiatric disorders as a comorbidity in patients with ABI in order to further improve re-integration in work.