Model System:


Reference Type:

Journal article

Accession No.:



Archives of Physical Medicine and Rehabilitation

Year, Volume, Issue, Page(s):

, 101, 5, 797-806

Publication Website:


Study examined the interrelationships between postinjury employment and substance abuse (SA) among individuals with traumatic brain injury (TBI). Structural equation model (SEM) and logistic regression analyses used a merged data from the National Trauma Data Bank (NTDB) and the Traumatic Brain Injury Model Systems (TBIMS) National Database. A total of 2,890 individuals in the TBIMS National Database, aged 18-59 years, with trauma severity, age, sex, employment, and SA data at 1, 2, and/or 5 years post injury, were successfully matched to their NTDB data. The primary outcome measure was employment status (employed/unemployed) and SA (present/absent) at year 1, year 2, and year 5 after TBI. SEM analysis showed older age at injury predicted lower likelihood of employment at all time points post injury, while higher injury severity score (ISS) predicted lower likelihood of employment and SA at year 1. Male sex predicted higher likelihood of SA at each follow-up. Despite associations of preinjury unemployment with higher preinjury SA, postinjury employment at year 1 predicted SA at year 2. Employment and SA during the previous follow-up period predicted subsequent employment and SA, respectively. The results indicate that employment and SA have unique longitudinal interrelationships and are additionally influenced by age, sex, and ISS. These findings suggest 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.


Awan, Nabil |DiSanto, Dominic |Juengst, Shannon B. |Kumar, Raj G. |Bertisch, Hilary |Niemeier, Janet |Fann, Jesse R. |Sperry, Jason |Wagner, Amy K.|

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