TY - JOUR
T1 - Interrelationships Between Post-TBI Employment and Substance Abuse
T2 - A Cross-lagged Structural Equation Modeling Analysis
AU - Awan, Nabil
AU - DiSanto, Dominic
AU - Juengst, Shannon B.
AU - Kumar, Raj G.
AU - Bertisch, Hilary
AU - Niemeier, Janet
AU - Fann, Jesse R.
AU - Sperry, Jason
AU - Wagner, Amy K.
N1 - Funding Information:
Supported by the National Institutes of Health (NIH; grant nos. TL1 TR0001858, R21 HD 089075-01) and the NIH Center for Large Data Research and Data Sharing in Rehabilitation (NIH P2C HD065702). The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) supported the collection of original data for this manuscript. The contents of this manuscript were developed under NIDILRR (grant nos. 90DP0031, 90DP0041, 90DPTB0013-01-00, 90DP0044-01, 90DPTB0011-01-00, 90DP0037) and with postdoctoral fellow support by NIDILRR (grant no. 90AR5025). Additional support was received from VA Central Office VA TBI Model System Program of Research, Subcontract from General Dynamics Health Solutions (grant no. W91YTZ-13-C-0015), and the Defense and Veterans Brain Injury Center, US Department of Veterans Affairs Health Services Research and Development Center of Innovation (grant no. 1 I50 HX001233-01).
PY - 2020/5
Y1 - 2020/5
N2 - Objective: To describe the interrelationship of postinjury employment and substance abuse (SA) among individuals with traumatic brain injury. Design: Structural equation model (SEM) and logistic regression analytic approach using a merged database of the National Trauma Data Bank (NTDB) and Traumatic Brain Injury Model Systems (TBIMS) National Database, with acute care and rehabilitation hospitalization data and 1, 2, and 5 year follow-up data. Setting: United States Level I/II trauma centers and inpatient rehabilitation centers with telephone follow-up. Participants: Individuals in the TBIMS National Database successfully matched to their NTDB data, aged 18-59 years, with trauma severity, age, sex, employment, and SA data at 1, 2, and/or 5 years postinjury (N=2890). Interventions: Not applicable. Main Outcome Measure: Employment status (employed/unemployed) and SA (present/absent) at year 1, year 2, and year 5 postinjury. Results: SEM analysis showed older age at injury predicted lower likelihood of employment at all time points postinjury (βYR1=−0.016; βYR2=−0.006; βYR5=−0.016; all P<.001), while higher injury severity score (ISS) predicted lower likelihood of employment (β=−0.008; P=.027) and SA (β=−0.007; P=.050) at year 1. Male sex predicted higher likelihood of SA at each follow-up (βYR1=0.227; βYR2=0.184; βYR5=0.161; all P<.100). Despite associations of preinjury unemployment with higher preinjury SA, postinjury employment at year 1 predicted SA at year 2 (β=0.118; P=.028). Employment and SA during the previous follow-up period predicted subsequent employment and SA, respectively. Conclusions: Employment and SA have unique longitudinal interrelationships and are additionally influenced by age, sex, and ISS. The present work suggests the need for more research on causal, confounding, and mediating factors and appropriate screening and intervention tools that minimize SA and facilitate successful employment-related outcomes.
AB - Objective: To describe the interrelationship of postinjury employment and substance abuse (SA) among individuals with traumatic brain injury. Design: Structural equation model (SEM) and logistic regression analytic approach using a merged database of the National Trauma Data Bank (NTDB) and Traumatic Brain Injury Model Systems (TBIMS) National Database, with acute care and rehabilitation hospitalization data and 1, 2, and 5 year follow-up data. Setting: United States Level I/II trauma centers and inpatient rehabilitation centers with telephone follow-up. Participants: Individuals in the TBIMS National Database successfully matched to their NTDB data, aged 18-59 years, with trauma severity, age, sex, employment, and SA data at 1, 2, and/or 5 years postinjury (N=2890). Interventions: Not applicable. Main Outcome Measure: Employment status (employed/unemployed) and SA (present/absent) at year 1, year 2, and year 5 postinjury. Results: SEM analysis showed older age at injury predicted lower likelihood of employment at all time points postinjury (βYR1=−0.016; βYR2=−0.006; βYR5=−0.016; all P<.001), while higher injury severity score (ISS) predicted lower likelihood of employment (β=−0.008; P=.027) and SA (β=−0.007; P=.050) at year 1. Male sex predicted higher likelihood of SA at each follow-up (βYR1=0.227; βYR2=0.184; βYR5=0.161; all P<.100). Despite associations of preinjury unemployment with higher preinjury SA, postinjury employment at year 1 predicted SA at year 2 (β=0.118; P=.028). Employment and SA during the previous follow-up period predicted subsequent employment and SA, respectively. Conclusions: Employment and SA have unique longitudinal interrelationships and are additionally influenced by age, sex, and ISS. The present work suggests the need for more research on causal, confounding, and mediating factors and appropriate screening and intervention tools that minimize SA and facilitate successful employment-related outcomes.
KW - Brain injuries, traumatic
KW - Employment
KW - Rehabilitation
KW - Substance-related disorders
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U2 - 10.1016/j.apmr.2019.10.189
DO - 10.1016/j.apmr.2019.10.189
M3 - Article
C2 - 31821796
AN - SCOPUS:85077924253
VL - 101
SP - 797
EP - 806
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
SN - 0003-9993
IS - 5
ER -