Unemployment in the United States After Traumatic Brain Injury for Working-Age Individuals

Abstract

Objective To estimate the prevalence of unemployment and part-time employment in the United States for working-age individuals completing rehabilitation for a primary diagnosis of traumatic brain injury (TBI) between 2001 and 2010. Design Secondary data analysis. Setting Acute inpatient rehabilitation facilities. Participants Patients aged 16 to 60 years at injury who completed inpatient rehabilitation for TBI between 2001 and 2010. Main Outcome Measures Unemployment; Part-time employment. Results The prevalence of unemployment for persons in the selected cohort was 60.4% at 2-year postinjury. Prevalence of unemployment at 2-year postinjury was significantly associated with the majority of categories of age group, race, gender, marital status, primary inpatient rehabilitation payment source, education, preinjury vocational status, length of stay, and Disability Rating Scale. The direction of association for the majority of these variables complement previous research in this area, with only Hispanic ethnicity and the FIM Cognitive subscale demonstrating disparate findings. For those employed at 2-year postinjury, the prevalence of part-time employment was 35.0%. The model of prevalence for part-time employment at 2-year postinjury was less robust, with significant relationships with some categorical components of age group, gender, marital status, primary payment source, preinjury vocational status, and Disability Rating Scale. Conclusions The prevalence of unemployment for patients completing inpatient rehabilitation for TBI was substantial (60.4%). The majority of factors found to associate with 2 years’ unemployment were complementary of previously published research; however, these were often smaller in magnitude than previous reports. The prevalence of part-time employment was also an issue for this cohort and included 35.0% of all employed individuals. In regard to the determination of factors associated with part-time employment, additional analyses that include more fine-grained factors associated with employment, including physical and psychosocial functioning, are recommended.

Accommodating individuals with traumatic brain injury: An analysis of employer-initiated cases handled by the Job Accommodation Network

“…Ponsford and Spitz [11] also noted these challenges impact the capacity for employment among individuals who incur a TBI while they are young. Cuthbert et al [3] likewise stated "the adverse outcomes associated with TBI can have a substantial impact on a person's ability to assume gainful employment after injury." One particular area of difficulty noted by Harris et al [12] involved the inability of individuals with a TBI to accurately recall their previous work history.…”

“…Because these challenges can impact the ability of a person to successfully work after a TBI, employment status is an important measure of successful rehabilitation and recovery [10]. Cuthbert et al [3] found that of 93 participants, the probabilities of being employed 1 year post-injury were 95% lower in participants who were unemployed prior to the injury, 74% lower for participants with more severe damage, and 82% lower for participants with more significant cognitive limitations. The rates of employment vary from study to study, but most researchers agree that the rate of unemployment and underemployment increases after a TBI is sustained and that this trend continues over time.…”

“…In the workplace, challenges faced by people with TBI include the inability to adhere to the structure of a typical work environment, challenges with keeping up with the pace of the environment, and stress from work [3]. Because these challenges can impact the ability of a person to successfully work after a TBI, employment status is an important measure of successful rehabilitation and recovery [10].…”

“…Additionally, there has been a change in perception of TBI to that of a chronic condition, rather than as only an injury with short-term consequences. Thinking of TBI as a condition that requires long-term monitoring and care could result in employment-centered rehabilitation opportunities for people with TBI [3].…”

“…From 2007 to 2013, the number of Emergency Department (ED) TBI related visits increased by 50% [1]. Outpatient clinics and doctors' offices saw nearly 1.2 million visits that included a TBI diagnosis from 2007 through 2009 [3], and between 2001 and 2012, there were approximately 3.42 million ED visits for sports and recreation-related TBI incidences [4]. Of these, approximately 70% were among people 19 years and younger.…”