Interrelationships Between Post-TBI Employment and Substance Abuse: A Cross-lagged Structural Equation Modeling Analysis

Nabil Awan; Dominic DiSanto; Shannon B Juengst; Raj G Kumar; Hilary Bertisch; Janet Niemeier; Jesse R Fann; Jason Sperry; Amy K Wagner

doi:10.1016/j.apmr.2019.10.189

Interrelationships Between Post-TBI Employment and Substance Abuse: A Cross-lagged Structural Equation Modeling Analysis

Arch Phys Med Rehabil. 2020 May;101(5):797-806. doi: 10.1016/j.apmr.2019.10.189. Epub 2019 Dec 7.

Authors

Nabil Awan¹, Dominic DiSanto², Shannon B Juengst³, Raj G Kumar⁴, Hilary Bertisch⁵, Janet Niemeier⁶, Jesse R Fann⁷, Jason Sperry⁸, Amy K Wagner⁹

Affiliations

¹ Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania; Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh.
² Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania.
³ Department of Physical Medicine & Rehabilitation, University of Texas-Southwestern Medical Center, Dallas, Texas; Department of Rehabilitation Counseling, University of Texas-Southwestern Medical Center, Dallas, Texas.
⁴ Department of Rehabilitation Medicine, Brain Injury Research Center, Icahn School of Medicine at Mount Sinai, New York, New York.
⁵ Department of Psychology, NYU Rusk Rehabilitation, New York, New York.
⁶ Department of Physical Medicine and Rehabilitation, UAB Spain Rehabilitation Center, Birmingham, Alabama.
⁷ Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington; Department of Rehabilitation Medicine, University of Washington, Seattle, Washington.
⁸ Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
⁹ Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania; Safar Center of Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: wagnerak@upmc.edu.

Abstract

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 (β_YR1=-0.016; β_YR2=-0.006; β_YR5=-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 (β_YR1=0.227; β_YR2=0.184; β_YR5=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.

Keywords: Brain injuries, traumatic; Employment; Rehabilitation; Substance-related disorders.

Publication types

Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adult
Age Factors
Brain Injuries, Traumatic / epidemiology*
Databases, Factual
Employment / statistics & numerical data*
Female
Humans
Injury Severity Score
Male
Middle Aged
Models, Statistical*
Sex Factors
Substance-Related Disorders / epidemiology*
United States / epidemiology
Young Adult

Abstract

Publication types

MeSH terms

Grants and funding