Concussion Injury in Working-Aged Canadian Adults: Influences on Life and Livelihood
Abstract
This thesis investigated the consequences of concussion injuries on various aspects of adults’ lives from a Canadian perspective. Study one investigated the influence concussion injury has on future employment income. Latent growth curve analysis using structural equation modeling was used to assess if income trajectory changed three years after injury. We compared the income trajectories of working-aged adults with a history of concussion against balanced cohorts of those who did not have a history of a concussion and those who experienced an ankle or foot injury. The model results demonstrated a year-over-year loss of income for the respective concussion-injured cohorts: -0.9% for the male non-concussion comparison, -1.1% for the male ankle-injured comparison, -0.53% for the female non-concussion comparison, and -0.9% for the female ankle-injured comparison. These values have economic significance as they represent negative changes year-over-year after adjusting for inflation. In study two, both a time-to-first-event analysis and a parametric shared frailty recurrent event survival analysis were used to investigate the relative risk of subsequent injury following a concussion in working-aged adults. The time-to-first event (i.e., first reinjury after concussion) revealed that females who have a history of concussion injury had a 2% lower survival probability at the 500-day mark compared to females who did not have a history of concussion. Females with a history of concussion injury demonstrated a 110% increased relative risk of injury (recurrence of injury). Males did not demonstrate a significant difference in relative risk of injury recurrence. The third study was a feasibility study to assess the ability to perform a randomized control trial evaluating the remote delivery of a breath control and mindfulness intervention for treating persisting symptoms of anxiety and depression in concussed adults. Our assessment determined that the study is feasible with consideration of factors related to the time needed for participant recruitment. Overall, this thesis demonstrated that there are financial implications and risks of subsequent injury for working-aged adults who suffer concussions.