Psychosocial Factors Affecting Return-to-Work for Patients With Persistent Post Concussive Syndrome
Maria Thereza Paulino1, Amanda Fang1, Stephania Tovar-Vargas2, Maral Sakayan1, Danh Nguyen3, Mark Mapstone4, Sigrid Burruss5, Areg Grigorian5, Jeffry Nahmias5, Michael Lopez1, Bernadette Boden-Albala2, Patrick Chen1
1Neurology Traumatic Brain Injury & Concussion (NTBIC) Program, Department of Neurology, 2Joe C. Wen School of Population & Public Health, 3Department of Medicine, 4Department of Neurology, 5Department of Surgery, University of California, Irvine
Objective:
To identify factors associated with return-to-work (RTW) in patients with persistent post concussive syndrome (PPCS) following mild traumatic brain injury (mTBI).
Background:
RTW is a leading concern for chronic TBI patients but factors influencing RTW in symptomatic patients remain underexplored. We hypothesize that for patients with chronic PPCS, the ability to achieve RTW is influenced by psychosocial factors, rather than injury-related characteristics alone.
Design/Methods:
A single-center retrospective study (7/2024-8/2025) was performed including PPCS patients (defined as mTBI [GCS >13], ≥3 months post-injury with high concussion symptom criteria [score ≥12/64] in the Rivermead Post Concussion scale) who presented to our TBI-clinic. Primary outcome: RTW by index clinic visit. Univariate statistics and logistic regression were performed. Covariates included age, sex, injury severity score (ISS), time from TBI to clinic, psychosocial factors (post-TBI psychiatric diagnosis, marital status), and occupation.
Results:
Of 69 mTBI patients with PPCS (mean age 48 ±15; 49.3% female; median months since injury 8 (IQR: 5–37)), 49.3% achieved RTW status. There were no differences in the RTW and no-RTW cohort regarding mechanism of injury, ISS, and positive head CT findings. However, patients who achieved RTW were more often married (55.9% vs 28.6%, p=0.04), had lower rates of post-TBI psychiatric diagnoses (5.9% vs 28.6%, p= 0.03), and a shorter time from injury to clinic-evaluation (median 5.5 vs 25 months, p=0.002). On multivariable analysis, being married remained an independent predictor of RTW (OR = 5.19, 95% CI 1.52–17.79, p=0.009).
Conclusions:
Less than half of mTBI patients with PPCS achieved RTW, with the only predictive factor being that the patient was married. Intimate social support may have a positive effect on this important patient-centric outcome, with psychiatric vulnerability potentially hindering RTW.
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