Research Reports - Post-concussive complaints, anxiety and depression related to vocational outcome in minor to severe traumatic brain injury

Arch Phys Med Rehabil. 2012 Dec 6

van der Horn HJ, Spikman JM, Jacobs B, van der Naalt J

OBJECTIVE: To investigate the relationship of post-concussive complaints, anxiety
and depression with vocational outcome in patients with traumatic brain injury
(TBI) of various severity and to assess sex differences. DESIGN: A prospective
cross-sectional cohort study. SETTING: Level I trauma center. PARTICIPANTS:
Adults (n=242) with TBI of various severity. INTERVENTIONS: Not applicable. MAIN
OUTCOME MEASURES: Extended Glasgow Outcome Scale (GOS-E), Return to Work (RTW),
Head Injury Symptom Checklist (HISC), Hospital Anxiety and Depression Scale
(HADS). RESULTS: In 67% of patients complaints were present, and 22% were anxious
and 18% depressed. Frequency of complaints increased significantly with injury
severity, in contrast to anxiety and depression. Frequencies of patients with
anxiety and depression (9 and 5%) were lower with complete RTW than with
incomplete RTW (42% and 37%; P<0.001). Patients with minor TBI with complaints
were more anxious (50% vs. 27%; P<0.05) and depressed (46% vs. 23%; P<0.05)
compared to other severity categories, also for patients with incomplete RTW (67%
vs. 36% and 60% vs. 30% respectively). A higher percentage of women with minor
TBI was depressed (45% vs. 13%; P=0.01) and had incomplete RTW (50% vs. 18%;
P<0.05) compared to men. Multiple regression analysis showed injury severity,
complaints, anxiety and depression all predictive of RTW (explained variance
45%). In all severity categories, anxiety and depression were predictive of RTW,
complaints and sex only for minor TBI. CONCLUSIONS: Anxiety and depression are
related to vocational outcome after TBI, with a different profile in the minor
TBI category, partly due to sex differences.

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