DOI
https://doi.org/10.25772/P53V-D306
Author ORCID Identifier
https://orcid.org/0000-0003-3325-5424
Defense Date
2024
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Psychology
First Advisor
Shawn C.T. Jones
Second Advisor
Paul P. Perrin
Abstract
The onset of traumatic brain injury (TBI) begins a chronic health pathway that contributes to various impairments and comorbidities across the lifespan. Common consequences of TBI include mental health issues, cognitive impairments, and reduced functional independence, all of which impact how an individual integrates into their community. Community integration is a primary goal for rehabilitation after TBI. Studies show that racially/ethnically minoritized individuals have a higher incidence of TBI, higher rates of mortality, and report poorer functional and community integration outcomes. Limited studies have explored longitudinal outcomes of community integration in a Black-only sample of individuals with TBI. Additionally, no research has explored intersecting demographic and injury-related predictors of community integration outcomes over the 10 years after TBI. The purpose of this study was to examine the longitudinal trajectories of community integration for Black individuals with TBI over the 10 years after sustaining injury, as well as the demographic and injury-related predictors of those trajectories. This study utilized hierarchical linear modeling (HLM) to assess community integration and global functioning across 1-, 2-, 5-, and 10-years post-injury. Participants comprised of 2,523 Black individuals enrolled in the national longitudinal TBI Model Systems database and had Glasgow Outcome Scale-Extended (GOS-E) and Participation Assessment with Recombined Tools-Objective (PART-O) outcome scores on at least 1 time point. Finding suggested that age, education, PTA, and insurance type were significant predictors of GOS-E trajectories, where individuals who were younger at time of injury, had higher educational level, private insurance, and shorter days in PTA had higher GOS-E trajectories 10-years after TBI. For the PART-O Out and About subscale, age and education emerged as significant predictors, with Black individuals who were younger at baseline, Black individuals with higher education reported greater Out and About scores 10 years after TBI. Age, sex, education, insurance and PTA were significant predictors of PART-O productivity subscale, suggesting that Black individuals who was young, female, had higher education, private insurance, and had shorter days in PTA reported higher productivity trajectories 10 years after TBI. Lastly, for the PART-O social subscale, age, partnership status, insurance type, and PTA, were significant predictors, suggesting that Black individuals who were younger, partnered, had private insurance, and had shorter days in PTA reported higher social trajectories scores 10 years after TBI. The sociodemographic and injury severity characteristics identified in this study as predictors of Global functioning and community integration in Black individual with TBI may serve patients and care providers by heightening awareness of the need for attention to these factors in treatment planning and long- term rehabilitation. These findings emphasize the necessity of further research within this population to explore additional socioeconomic, cultural, and systemic factors that may better explain rehabilitation trajectories
Rights
© The Author
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
7-17-2025
Included in
Clinical Psychology Commons, Counseling Psychology Commons, Disability Studies Commons, Health Psychology Commons, Multicultural Psychology Commons, Other Rehabilitation and Therapy Commons