title: Postconcussive complaints, anxiety, and depression related to vocational outcome in minor to severe traumatic brain injury.
abstract: OBJECTIVE
  To investigate the relation of postconcussive complaints, anxiety, and depression with vocational outcome in patients with traumatic brain injury (TBI) of various severities and to assess sex differences.
  
  
  METHODS
  A prospective cross-sectional cohort study.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  Adults (N=242) with TBI of various severity.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Extended Glasgow Outcome Scale, return to work (RTW), Head Injury Symptom Checklist, and Hospital Anxiety and Depression Scale.
  
  
  RESULTS
  In 67% of the patients, complaints were present; 22% were anxious, and 18% were depressed. The frequency of complaints increased significantly with injury severity, in contrast to anxiety and depression. Frequencies of patients with anxiety and depression (9% and 5%) were lower with complete RTW than with incomplete RTW (42% and 37%; P<.001). Patients with minor TBI with complaints were more anxious (50% vs 27%; P<.05) and depressed (46% vs 23%; P<.05) compared with patients with other severity categories and patients with incomplete RTW (67% vs 36% and 60% vs 30%, respectively). A higher percentage of women with minor TBI were depressed (45% vs 13%; P=.01) and had incomplete RTW (50% vs 18%; P<.05) compared with men. Multiple regression analysis showed that injury severity, complaints, anxiety, and depression were all predictive of RTW (explained variance 45%). In all severity categories, anxiety and depression were predictive of RTW, complaints, and sex only for minor TBI.
  
  
  CONCLUSIONS
  Anxiety and depression are related to vocational outcome after TBI, with a different profile in the minor TBI category, partly due to sex differences.
authors.affiliation: Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Harm J
authors.initials: HJ
authors.lastname: van der Horn
authors.forename: Jacoba M
authors.initials: JM
authors.lastname: Spikman
authors.forename: Bram
authors.initials: B
authors.lastname: Jacobs
authors.forename: Joukje
authors.initials: J
authors.lastname: van der Naalt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology*; D001930:Brain Injuries / Q000150:complications / Q000523:psychology*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology*; D004651:Employment / Q000523:psychology*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D038223:Post-Concussion Syndrome / Q000209:etiology / Q000523:psychology; D011446:Prospective Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires; D055815:Young Adult