To characterize neurobehavioral and substance abuse problems distinguishing between employed and unemployed persons with brain injury and to propose relevant vocational rehabilitation interventions.
A quasi-experimental, fixed effects factorial design was used. T-tests were used to compare employed and unemployed persons regarding neurobehavioral factor scale scores. Chi-square analyses were used to compare alcohol use and rate of mental health treatment for the two groups. Fisher's Exact Test was used to compare drug use for the two groups.
Outpatient rehabilitation clinic at a large urban medical center.
Patients with traumatic brain injury who received acute medical care and inpatient rehabilitation at a level I trauma center. Patients were evaluated an average of 16 months after injury. The employed (33%) and unemployed (67%) groups were similar regarding age and chronicity, but unemployed persons had more severe injuries. Main Outcome Measures: Neurobehavioral Functioning Inventory (NFI), Quantity Frequency Variability Index (QFVT), General Health and History Questionnaire.
Unemployed persons reported a greater frequency of difficulties on the NFI Depression, Attention/Memory, Aggression, Communication, and Motor scales. The most common difficulties among unemployed persons related to mood, personality, and slowness. Also, more unemployed persons had received mental health services. A substantially higher proportion of employed persons were classified as moderate or heavy drinkers, whereas there were more abstainers among the unemployed group. A low rate of drug use was reported and differences between groups were not observed.
The unique neurobehavioral difficulties of unemployed persons should be carefully considered when developing empirically based preplacement training, job matching, and postplacement interventions. The high rate of alcohol use among employed persons indicates the need for follow-along that emphasizes education and prevention.
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