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

Arch Phys Med Rehabil. 2013 May;94(5):867-74

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

OBJECTIVES: To investigate the relation of postconcussive complaints, anxiety,
and depression with vocational outcome in patients with traumatic brain injury
(TBI) of various severities 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, return to work (RTW), Head
Injury Symptom Checklist, and Hospital Anxiety and Depression Scale.
RESULTS: In 67% of the patients, complaints were present; 22% were anxious, and
18% were depressed. The 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<.001). Patients with minor TBI with complaints
were more anxious (50% vs 27%; P<.05) and depressed (46% vs 23%; P<.05) compared
with patients with other severity categories and patients with incomplete RTW
(67% vs 36% and 60% vs 30%, respectively). A higher percentage of women with
minor TBI were depressed (45% vs 13%; P=.01) and had incomplete RTW (50% vs 18%;
P<.05) compared with men. Multiple regression analysis showed that injury
severity, complaints, anxiety, and depression were 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

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