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

Objective: 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.

Method: 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.

Results: 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.

Conclusion: 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.