This study assessed the impact of traumatic brain injury (TBI) upon specific behavioral and psychosocial factors related to employability. This descriptive study was a retrospective chart review of the records of TBI patients, returning military service members, between 2003 and 2010. Some long term residual effects for TBI patients with blast or non-blast head injuries include cognitive deficits, memory problems, chronic pain, post-traumatic stress disorder, all of which impact recovery and function. The 4 research questions relate to (a) global assessment of functioning, (b) employment challenges, (c) the impact of blast versus non blast TBI upon global assessment of functioning and employment challenges, (d) type of treatment provided, and (e) what interventions seem promising for helping those patients maintain self-sufficiency. Only 186 TBI patient charts met criteria for inclusion. The mean GAF was 55.2, which is typical for major depressive disorder. The majority was perceived by clinicians as having moderate difficulty in social, occupational, or school functioning. Approximately half of the subjects were unemployed. The lowest GAF scores belong to subjects with blast injury. The highest GAF scores belong to both blast and non-blast subjects. Only 6% of the blast group showed GAF score stability (48%), and approximately the same number of patients were seen to have worsened symptoms as had alleviated symptoms at a later date. A greater percentage of subjects with non-blast TBI were unemployed than those with blast TBI. As an indication of emotional lability, 34% of subjects exhibited emotional outbursts. Over three-fourths of the subject group reported symptoms leading to the diagnosis of depression, and a similar proportion was diagnosed with PTSD. Of those with depression, most (74%) were prescribed depression medication, but had no indication of utilizing available services such as individual or group counseling. TBI patients were much less employable than the general population, with employment difficulties that are likely to persist without intensive and long-term treatment. The study indicates paucity of treatments recommended in the literature for this population, namely CBT, psychoeducation, and intensive occupational rehabilitation. Patient-centered individualized care, incorporating these modalities, is recommended as a model because TBI results in heterogeneous symptoms.

Library of Congress Subject Headings

Dissertations (EdD) -- Organizational leadership

Date of Award


School Affiliation

Graduate School of Education and Psychology



Degree Type


Degree Name


Faculty Advisor

Schmieder-Ramirez, June;