Depression as a Predictor of Long-term Employment Outcomes Among Individuals With Moderate-to-Severe Traumatic Brain Injury.
Daniel W Klyce, Katharine A Stromberg, William C Walker and 5 others
PMID 31344363WHAT IT FOUND
Depression after moderate-to-severe TBI was associated with lower long-term competitive employment.
People who were depressed at 1 or 2 years were less likely to be employed at 2 or 5 years, even after accounting for injury-related prognosis and current work.
Key findings
01Depression at 1 year after moderate-to-severe TBI was associated with lower adjusted odds of competitive employment at 2 years (OR=1.77; 95% CI: 1.38, 2.27; P<.0001).
02Depression at 1 year and at 2 years was associated with lower adjusted odds of employment at 5 years (1 year: OR=1.88; 95% CI: 1.48, 2.40; P<.0001; 2 years: OR=1.72; 95% CI: 1.36, 2.17; P<.0001).
03Adding depression to prediction models significantly improved prediction of future employment beyond injury-related prognostic subgroup and current employment, and the association was similar across prognostic subgroups.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Only people aged 18 to 60 years with moderate-to-severe TBI who were admitted to a TBIMS inpatient rehabilitation site and had complete data were analysed, so results may not apply to younger, older, or less severe cases, or to people not admitted to inpatient rehabilitation. The supplied text does not state the final number analysed, so the precision of the estimates cannot be judged. Employment was treated as employed or not employed, excluding supported employment, so it does not capture supported work, job quality, hours, income, or reasons for leaving work. Dropout and retention were related to race, drug or alcohol use, age, education, injury type, and discharge disposition, so the analysed sample may differ from all people with TBI. The study is observational and controlled for measured variables, so depression may be a marker of other problems rather than a cause of unemployment.
Declared interests
The paper is marked as supported by NIH extramural and U.S. Government Public Health Service funding. No author disclosure list is included in the supplied text.
The easy way to misread this
Do not conclude that treating depression will improve employment. This was an observational prediction study, not a treatment trial, and it only showed that depression at 1 or 2 years was associated with lower employment at 2 or 5 years.