School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Australia.
School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.
Disabil Rehabil. 2020 May;42(10):1414-1422. doi: 10.1080/09638288.2018.1527954. Epub 2019 Jan 22.
To examine the nature of occupational gaps and desired re-engagement following severe traumatic brain injury (TBI), and the relationship to mood, self-discrepancy, and psychosocial functioning. Fifty-nine adults with severe TBI (73% male, age = 36.50, = 12.54) were administered measures of past, current, and desired occupations (Occupational Gaps Questionnaire), mood (Depression Stress and Anxiety Scale - 21), and self-discrepancy (Head Injury Semantic Differential Scale - version 3). Psychosocial functioning was rated by relatives on the Sydney Psychosocial Reintegration Questionnaire. Participants reported that they engaged in significantly fewer occupations than prior to their injury ( < 0.001). Further, they participated in fewer occupations than they desired ( < 0.001). Desired re-engagement was identified for 18 of the 30 occupations (e.g., working, sports, managing personal finances, and supporting others). A higher number of these re-engagement gaps was significantly related to greater anxiety ( = 0.30, < 0.05) and lower psychosocial functioning ( = -0.29, < 0.05). A mediation analysis revealed that re-engagement gaps were indirectly related to self-discrepancy through an association with anxiety. Occupational gaps are commonly experienced after severe traumatic brain injury. Lack of engagement in desired occupations is associated with greater anxiety and poorer psychosocial functioning. Anxiety regarding these gaps may contribute to negative comparisons between one's pre-injury and post-injury self. Identification of occupational gaps and their psychological impact may guide the focus of client-centred rehabilitation approaches.Implications for RehabilitationGaps between current activity engagement (i.e., post injury) and desired activity engagement are commonly experienced after severe traumatic brain injury.Greater desired re-engagement gaps (i.e., when individuals report they are not completing activities that they would like to do) are associated with greater anxiety and poorer psychosocial functioning.Individuals who are unable to re-engage in desired activities are more likely to experience anxiety, which in turn may contribute to negative self-discrepancy.It may be beneficial to explore the personal meaning of changes in occupation after traumatic brain injury.
为了探究严重创伤性脑损伤（TBI）后职业差距和重新参与职业的本质，以及与情绪、自我差异和心理社会功能的关系。59 名严重 TBI 成年人（73%为男性，年龄=36.50，=12.54）接受了过去、当前和期望职业（职业差距问卷）、情绪（抑郁、压力和焦虑量表-21）和自我差异（头部损伤语义差异量表-第 3 版）的评估。心理社会功能由亲属在悉尼心理社会再融入问卷上进行评估。参与者报告说，他们从事的职业明显少于受伤前（<0.001）。此外，他们参与的职业少于他们期望的（<0.001）。30 种职业中有 18 种（如工作、运动、管理个人财务和支持他人）被确定为期望重新参与的职业。这些重新参与差距的数量与更大的焦虑（=0.30，<0.05）和较低的心理社会功能（=−0.29，<0.05）显著相关。中介分析显示，重新参与差距通过与焦虑的关联，与自我差异呈间接关系。严重创伤性脑损伤后，职业差距普遍存在。未能参与期望的职业与更大的焦虑和较差的心理社会功能相关。对这些差距的焦虑可能导致对个体受伤前后自我的负面比较。识别职业差距及其心理影响可能指导以客户为中心的康复方法的重点。
严重创伤性脑损伤后，目前的活动参与（即受伤后）和期望的活动参与之间存在差距。
更大的期望重新参与差距（即个体报告他们没有从事他们希望从事的活动）与更大的焦虑和较差的心理社会功能相关。
无法重新参与期望活动的个体更容易出现焦虑，而焦虑反过来可能导致自我差异的负面评价。
探讨创伤性脑损伤后职业变化的个人意义可能是有益的。
