Impact of Frontal Neurobehavioral Symptoms on Employment in Individuals With TBI

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Abstract

Objective: To explore the contribution of frontal systems behavioral dysfunction on employment outcomes in individuals with traumatic brain injury (TBI), in the context of relevant predictors of work status. Method: Forty-two participants with history of moderate-to-severe TBI were classified as either “Employed” or “Unemployed.” Groups did not differ on most demographic or injury variables, although the Unemployed sample reported greater symptoms of depression, pain, and fatigue (ps < 0.05). Participants completed a neuropsychological evaluation emphasizing frontal systems and Frontal Systems Behavior Scale (FrsBe; self- and informant-rated forms). Results: T tests using cognitive indicators of frontal dysfunction revealed no significant differences between groups (ps > 0.05). T tests using neurobehavioral indicators of frontal dysfunction (i.e., FrSBe) revealed differences between groups on both self- (Hedge’s g = 0.71; p = .046) and informant-rated (g = 1.12; p = .001) FrSBe total T scores. Two logistic regressions for each FrSBe score were conducted, including relevant variables on which samples differed as covariates. Only the informant-rated FrSBe score remained a significant predictor of employment (FrSBe-informant: p = .038; R-squared change = 0.177). Self- and informant-rated FrSBe scores were significantly correlated in the Unemployed group (r = .403; p = .037) but not in the Employed sample (r = .102; p = .717). Conclusions: These results suggest that behavioral indicators of frontal systems dysfunction are predictive of employment status in individuals with TBI. Future work should aim to test the efficacy of strategies to reduce dysfunctional frontal behaviors as a means to gain and maintain employment.

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