OBJECTIVES: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. DESIGN:A prospective cross-sectional cohort study. SETTING:Level I trauma center. PARTICIPANTS:Adults (N=242) with TBI of various severity. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES: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.

译文

目的:探讨各种严重程度的脑外伤(TBI)患者脑震荡后主诉,焦虑和抑郁与职业结局的关系,并评估性别差异。
设计:一项前瞻性横断面队列研究。
地点:一级创伤中心。
参与者:成人(N = 242),患有各种严重程度的TBI。
干预措施:不适用。
主要观察指标:扩大格拉斯哥结果量表,重返工作时间(RTW),头部受伤症状清单以及医院焦虑症和抑郁量表。
结果:在67%的患者中,有主诉。 22%的人感到焦虑,而18%的人感到沮丧。与焦虑和抑郁相比,随着严重程度的增加,投诉的频率显着增加。完全RTW的焦虑和抑郁患者的频率(9%和5%)低于不完全RTW的频率(42%和37%; P <.001)。与其他严重程度类别和RTW不完全的患者(67%)相比,患有轻微TBI症状的患者更焦虑(50%vs 27%; P <.05)和抑郁(46%vs 23%; P <.05)。分别为36%和60%与30%)。与男性相比,患有轻度TBI的女性患抑郁症的比例更高(45%比13%; P = .01),RTW不完全(50%比18%; P <.05)。多元回归分析表明,损伤的严重程度,主诉,焦虑和抑郁都是RTW的预测因素(解释方差为45%)。在所有严重程度类别中,焦虑和抑郁仅可预测较小的TBI患者的RTW,主诉和性别。
结论:焦虑和抑郁与TBI后的职业结局有关,在次要TBI类别中的情况有所不同,部分原因是性别差异。

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