Transitions in Independent Living, Productivity, and Social Relationships Among Individuals Sustaining Traumatic Brain Injury in Adolescence: A TBI Model Systems Investigation.

OBJECTIVE

To characterize transitions in independent living, productivity, and social relationships over the first 5 years postinjury among adolescents sustaining complicated mild to severe traumatic brain injury (TBI) between ages 16 and 18.

SETTING

Community following discharge from inpatient rehabilitation.

Participants

584 individuals ages 16 to 18 in the traumatic brain injury model systems (TBIMS) national database who completed follow-up at 1, 2, and/or 5 years postinjury.

DESIGN

Multicenter longitudinal observational study.

MAIN MEASURES: Independent living, employment/school/homemaking, having a close friend/confidant, and involvement in a romantic relationship.

RESULTS

Hidden Markov models were used to identify trajectories of participation, with the optimal number of hidden states (groups) selected using the Bayesian information criterion (BIC). Three states/groups were the best fit for the data and were labeled as: At Risk, On Track , and Partially Transitioned . About 57.5% of participants started as Partially Transitioned , 30% started as At Risk , and 12.5% were On Track . Most in the On Track group had a close friend/confidant and were involved in a romantic relationship. Most in the Partially Transitioned group had a close friend/confidant but were not involved in a romantic relationship. Around 16.7% of individuals in the Partially Transitioned group and only 6.5% of the At Risk group transitioned to On Track , and 98.5% of those in the On Track group remained in the same status. Factors associated with transition to the On Track group included female sex and problem alcohol/substance use. However, further analysis showed that the significant effect of problem alcohol/substance use became nonsignificant after accounting for within-person correlation.

Conclusions

Many who sustain a TBI in late adolescence transition to independent living and employment/school/homemaking activity over the first 5 years postinjury; however, a subset remain At Risk or Partially Transitioned in major life roles. Rehabilitation services, beyond the acute period, are needed to ensure maximal independence, social relationships, and community participation.