Long-term medical and psychosocial vulnerability after home return following severe traumatic brain injury.
Andrea Calderone, Carmela Rifici, Donatella Bonaiuti and 6 others
Among adults with severe TBI living at home one year after injury, 16.7% carried a five-year pattern of depression, anxiety, low life satisfaction, and repeated hospital visits.
Home return did not mean recovery was complete.
Key findings
1A distinct 5-year multidomain vulnerability profile was identified in 474 of 2,835 participants (16.7%), characterized by high depressive symptoms (91.4% vs 4.2%), anxiety (75.1% vs 4.2%), low life satisfaction (64.1% vs 11.1%), and rehospitalization (32.3% vs 15.0%) compared with the lower-vulnerability group.
2The vulnerability profile was associated with markedly poorer 5-year outcomes: only 16.8% achieved a high global outcome (GOS-E 7–8) versus 52.0% in the lower-vulnerability group, and productive status was present in 31.6% versus 52.2%.
3Better 1-year Glasgow Outcome Scale–Extended score was the strongest protective factor (adjusted odds ratio 0.73 per point, 95% CI 0.68–0.79). Female sex, preinjury illicit drug use, living alone at 1 year, and age 36–55 years were associated with higher odds of the vulnerability profile.
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What it does not show
Only 2,835 of 10,123 otherwise eligible home-dwelling participants had complete data on all four indicators; those retained were systematically younger, more educated, more often productive before injury, and less disabled, so the 16.7% figure is likely a conservative underestimate of true long-term burden. Affective and life-satisfaction data were self-reported; people with severe TBI who have impaired insight, cognitive impairment, aphasia, or other communication limitations may have been less able to complete these measures and are underrepresented. All associations are observational and should not be read as causal; the model had modest explanatory fit (McFadden pseudo-R² 0.082) and was not intended as a clinical prediction tool. The study used a US multicentre public-use dataset with no neuropsychological assessment, no post-injury substance-use trajectory data, and no information on pain-medication exposure or behavioural-health service use after discharge. The severe TBI definition was pragmatic (at least one of three markers) and may capture heterogeneous severity pathways rather than a single biological state.
Declared interests
The authors declared no conflicts of interest. The study was supported by Current Research Funds 2026, Ministry of Health, Italy.
The easy way to misread this
Do not read the 16.7% figure as the true prevalence of long-term vulnerability among all home-dwelling severe TBI survivors — it comes from 2,835 of 10,123 eligible participants who had complete data, and those retained were systematically younger, more educated, and less disabled, so the real burden is likely higher. Also do not use the profile as a screening or prediction tool: the authors state the model was descriptive, had modest fit, and was not validated for clinical prediction.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →