Transitions in Independent Living, Productivity, and Social Relationships Among Individuals Sustaining Traumatic Brain Injury in Adolescence

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.