TY  - JOUR
PY  - 2019//
TI  - Interrelationships between post-TBI employment and substance abuse: a cross-lagged structural equation modeling analysis
JO  - Archives of physical medicine and rehabilitation
A1  - Awan, Nabil
A1  - DiSanto, Dominic
A1  - Juengst, Shannon B.
A1  - Kumar, Raj G.
A1  - Bertisch, Hilary C.
A1  - Niemeier, Janet P.
A1  - Fann, Jesse R.
A1  - Sperry, Jason
A1  - Wagner, Amy K.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - OBJECTIVE: To describe the interrelationship of post-injury employment and substance abuse (SA) among individuals with traumatic brain injury (TBI). <br><br>DESIGN: Structural equation model (SEM) and logistic regression analytic approach using a merged database of the National Trauma Data Bank (NTDB) and TBI Model Systems National Database (TBIMS-NDB), with acute care and rehabilitation hospitalization data and 1, 2, and 5-year follow-up data. SETTING: United States Level I/II trauma centers and inpatient rehabilitation centers with telephone follow-up. PARTICIPANTS: Individuals in the TBIMS-NDB successfully matched to their NTDB data, aged 18-59 years, with trauma severity, age, sex, employment, and SA data at 1, 2, and/or 5 years post-injury (n=2,890). INTERVENTIONS: Not applicable MAIN OUTCOME MEASURE: Employment status (employed/unemployed) and SA (present/absent) at year-1, year-2, and year-5 post-injury RESULTS: SEM analysis showed older age at injury predicted lower likelihood of employment at all time-points post-injury (β<sub>YR1</sub>=-0.016; β<sub>YR2</sub>=-0.006; β<sub>YR5</sub>=-0.016; all p<0.001), while higher injury severity score (ISS) predicted lower likelihood of employment (β=-0.008, p=0.027) and SA (β=-0.007; p=0.050) at year-1. Being male predicted higher likelihood of SA at each follow-up (β<sub>YR1</sub>=0.227; β<sub>YR2</sub>=0.184; β<sub>YR5</sub>=0.161; all p<0.10). Despite associations of pre-injury unemployment with higher pre-injury SA, post-injury employment at year-1 predicted SA at year-2 (β=0.118, p=0.028). Employment and SA during the previous follow-up period predicted subsequent employment and SA respectively. <br><br>CONCLUSIONS: Employment and SA have unique longitudinal interrelationships and are additionally influenced by age, sex, and ISS. The present work suggests the need for more research on causal, confounding, and mediating factors and appropriate screening and intervention tools that minimize SA and facilitate successful employment related outcomes.<br><br>Copyright © 2019. Published by Elsevier Inc.<p />  <p>Language: en</p>
LA  - en
SN  - 0003-9993
UR  - http://dx.doi.org/10.1016/j.apmr.2019.10.189
ID  - ref1
ER  -