Interrelationships Between Post-TBI Employment and Substance Abuse: A Cross-lagged Structural Equation Modeling Analysis.
Nabil Awan, Dominic DiSanto, Shannon B Juengst and 6 others
PMID 31821796WHAT IT FOUND
After moderate-to-severe traumatic brain injury, adults employed one year after injury were more likely to report substance abuse at two years.
This is an association, not proof employment caused it.
Key findings
01Individuals employed at year 1 had a greater likelihood of substance abuse at year 2.
02Employment at years 1, 2, and 5 was associated with substance abuse at the same time point.
03At year 5, individuals with stable employment had the highest prevalence of substance abuse.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study was observational, so it cannot show that employment caused substance abuse. Participants reported their own employment and substance use, so answers may be inaccurate. The main model required complete data at years 1, 2, and 5, and excluded individuals were less educated and unemployed. Students and adults over 60 were excluded, so the findings may not apply to them. Only people who survived their injury and received inpatient rehabilitation at model-system centers were included. The unemployment category included retirees, homemakers, volunteers, and unpaid work, which may mix different life situations. Substance abuse combined illicit drug use, binge drinking, and heavy drinking, so separate patterns were not the main outcome. Post-hoc analyses examined drug abuse, alcohol abuse, and functional independence separately, but these were not the primary models.
Declared interests
The supplied metadata lists NIH and U.S. government research support. The article text provided does not report a conflicts-of-interest statement.
The easy way to misread this
Do not conclude that employment causes substance abuse. The study was observational, and the main link from employment at year 1 to substance abuse at year 2 was a small association by the paper's thresholds (β=0.118, p=0.028).