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Workers’ Risk of Unemployment after Traumatic Brain Injury: A Normed Comparison

Categories: Outcomes

The Question

Is the risk of unemployment higher for persons who sustain traumatic brain injury than for the general population?

Past Studies

Past Studies have not compared the risk of unemployment for individuals after traumatic brain injury with individuals in the general population nor was status of employment at time of injury considered as compared with those working in the general population. There is lack of generalized information about how prior work history and demographic (age, level of education, gender) factors influence unemployment rates in either population.

This Study

This Study examines, at one year after injury, the risk of unemployment for individuals with traumatic brain injury who were working pre-injury, with risk of unemployment in the general (normed comparison) population of the United States. Criteria for the study include calculating risks of unemployment in the general population using demographic factors. A risk factor is assigned to each TBI study participant (using demographic profile and prior work status) and, notation made about unemployment rates of the TBI population one year after injury. The risk factors of each group are then compared, followed by a comparison of the general population risk to observed risk of unemployment for persons with TBI.

The first hypothesis of the study says ‘TBI is a risk factor for unemployment.’ The second hypothesis says that ‘particular variables put individuals with TBI at different levels of risk for unemployment after injury’ .Demographic factors, level of injury, early functional abilities (ability to be involved in daily activities), and neurobehavioral behavior (nervous system behaviors) are all indicators for future employment among those working prior to injury. The sample consists of 418 survivors from a Level 1 trauma center with mild to severe injury, who were working prior to injury and were followed one year post-injury. Four investigations were done using information on participants receiving services from 1980-1994. All participants fit the following criteria: positive evidence of TBI, experiencing a brain injury serious enough to require hospitalization, and survival for at least one month. A structured interview was used at one month and one year after injury to determine employment status of participants. (It should be noted that the questions used in these investigations were equivalent but worded slightly differently from ones used with the general population). Severity of traumatic brain injury was evaluated with several different scales and outcomes rated on a 5-point scale: death, persistent vegetative state, severe disability, moderate disability, and good recovery.

Forty-four of the 418 participants were not available for follow-up one- year post-injury. Being male, age 25 to 39 years, and having at least a high school education were associated with greater relative risk of unemployment. With respect to education, the excess risk was smaller among those more highly educated, but the unemployment rate in the more highly educated in the general population was sufficiently small to yield a larger relative risk.

This study shows that even when demographic factors and prior years of employment are used for comparison, persons with TBI are at substantial risk for unemployment .This is the first study, after making adjustments for the general population, to address the issue of unemployment of persons working at the time of injury. It shows how this information can be a possible factor in how TBI has an economic effect on the unemployment in the workforce. Authors believe this information should be useful to persons with TBI, their families, and healthcare providers, in making plans for future financial security, and helping to design plans to improve employment outcomes. Considering all factors in the study, it appears that there is a higher rate of unemployment with poorly educated people with TBI, than those with more education. This appears true in the general population, as well. As might be expected, participants whose injury precluded testing at one month, had the greatest risk for unemployment.

Who May Be Affected By These Findings

Individuals with brain injury, their families, caregivers, health providers, community providers, researchers.


Limitations of this study are the fact that the questions asked of the TBI patients and the general population was equivalent, but worded differently, and there was only slight overlapping of data in terms of years studied. The data obtained for the general population was from 1992-2000, while the data for the TBI population was from 1980-1994; however, later studies showed that the data for the TBI population from later years was not significantly different from data used in this study.

Bottom Line

TBI has a significant effect on future employment. Comparing the TBI population with the general population, persons with TBI had significantly higher risk for unemployment than the general population, even when compared to persons with TBI who were employed at the time of injury .This study showed that demographic factors, severity of brain injury, early functional outcome and neurobehavioral indicators were predictors of future employment.

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Find This Study


Doctor, J.N., Castro, J., Temkin, N.R. , Fraser, R.T. , Machamer, J.E., Dikmen, S.S.
(2005). Workers’ Risk of Unemployment after Traumatic Brain Injury. Journal of the International Neuropsychological Society, 11; 747-752.

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