Psychosocial and Functional Predictors of Depression and Anxiety Symptoms in Veterans and Service Members With TBI: A VA TBI Model Systems Study.

OBJECTIVE: To identify psychosocial and functional predictors of self-reported depression and anxiety symptoms at year 2 following traumatic brain injury (TBI). SETTING: Five Department of Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRCs) within the TBI Model Systems (TBIMS). PARTICIPANTS: A total of 319 service members/veterans enrolled in VA TBIMS who were eligible for and completed both 1- and 2-year follow-up evaluations. DESIGN: Secondary analysis from multicenter prospective longitudinal study. MAIN MEASURES: Demographic, injury-related, military, mental health, and substance use variables. Questionnaires included the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Neurobehavioral Symptom Inventory. Rating scales included the Participation Assessment with Recombined Tools-Objective and Disability Rating Scale. RESULTS: The final sample was largely male (96%) and predominantly White (65%), with a median age of 27 years. In unadjusted analyses, pre-TBI mental health treatment history and year 1 employment status, community activity, sleep difficulties, and self-reported depression and anxiety symptoms were associated with year 2 PHQ-9 scores; pre-TBI mental health treatment history and year 1 community activity, social contact, problematic substance use, sleep difficulties, and self-reported depression and anxiety symptoms were associated with year 2 GAD-7 scores. In multivariable analyses, only year 1 community activity and depression symptoms uniquely predicted year 2 PHQ-9 scores, and only year 1 employment status, community activity, problematic substance use, and anxiety symptoms uniquely predicted year 2 GAD-7 scores. CONCLUSION: Anxiety and depression commonly occur after TBI and are important treatment targets. Some predictors (eg, participation and substance use) are modifiable and amenable to treatment as well. Early identification of anxiety and depression symptoms is key.

Race/Ethnicity and Community Participation Among Veterans and Service Members With Traumatic Brain Injury: A VA Traumatic Brain Injury Model Systems Study.

OBJECTIVE: To examine racial/ethnic disparities in community participation among veterans and active duty service members with traumatic brain injury (TBI). SETTING: Five Department of Veterans Affairs (VA) TBI Model Systems (TBIMS) Polytrauma Rehabilitation Centers (PRCs). Participants: Three hundred forty-two community-dwelling adults (251 White, 34 Black, and 57 Hispanic) with TBI enrolled in the VA TBIMS National Database who completed a 1-year follow-up interview. Mean age was 38.6 years (range, 19-84 years). DESIGN: Cross-sectional analysis of a prospective observational cohort study. Main Measures: Community participation at 1 year postinjury assessed by 3 domains of the Participation Assessment with Recombined Tools-Objective (PART-O): Out & About, Productivity, and Social Relations. RESULTS: Significant differences were observed among race/ethnicity groups in PART-O Productivity and Out & About domains without controlling for relevant participant characteristics; Productivity scores were significantly higher for non-Hispanic Black than for non-Hispanic White participants (t = 2.40, P = .0169). Out & About scores were significantly higher for Hispanic than for non-Hispanic White participants (t = 2.79, P = .0056). However, after controlling for demographic, injury severity, and 1-year follow-up characteristics, only differences in the Out & About domain remained statistically significant (t = 2.62, P = .0094), with scores being significantly higher for Hispanics than for non-Hispanic Whites. CONCLUSIONS: The results, which differ from findings from studies conducted in non-VA healthcare settings where there are greater racial/ethnic disparities in participation outcomes, could reflect differences between military and civilian samples that may reduce disparities.

Postrehabilitation Mental Health Treatment Utilization in Veterans With Traumatic Brain Injury: A VA TBI Model Systems Study.

OBJECTIVE: To identify preinjury variables related to mental health treatment utilization at 2 years post-traumatic brain injury (TBI). SETTING: Veterans Affairs (VA) TBI Model Systems includes 5 VA Polytrauma Rehabilitation Centers. PARTICIPANTS: Veterans and service members enrolled in TBI Model Systems who completed the year 2 follow-up assessment and provided mental health information. Sample was largely male (97%) and White (72%), with median age of 30 years. DESIGN: Participants with elevated mental health symptoms were identified by measures of depression, anxiety, and posttraumatic distress; suicide attempt in the past year; or problematic substance use in the past year. Forty-seven percent of participants had elevated mental health symptoms at 2 years postinjury. Among those with elevated symptoms, comparisons were made between those who sought mental health treatment in past year and those who did not. MAIN MEASURES: Demographic, historic, environmental, psychological/mental health, and injury/rehabilitation variables. RESULTS: Within the sample, 23% denied utilizing mental health services. Nonutilizers were more likely to deny a preinjury mental health treatment history, to report problematic substance use at year 2, and to report lower levels of internalizing symptoms than the treatment utilizers. CONCLUSION: Veterans and service members with elevated mental health symptoms may require tailored tactics to promote treatment utilization post-TBI.

Provider perceptions of the assessment and rehabilitation of sexual functioning after Traumatic Brain Injury.

OBJECTIVE: To explore how health care professionals who work with individuals with TBI address issues related to the assessment and treatment of sexuality after TBI. METHODS: A survey composed of 53 questions was developed to evaluate professional training, assessment of sexuality in individuals with TBI and attitudes towards sexuality. The sample consisted of 324 self-identified TBI health care professionals. RESULTS: Ninety seven per cent of participants believed that sexuality should be discussed during rehabilitation; however, 36% reported talking about it. Seventy nine per cent reported that their patients have asked about sexuality after TBI, with 60% feeling calm and competent addressing the topic. The main reason for not discussing the topic was that patients do not ask for information (42%). Assessment (87%) and treatment of sexuality (82%) in individuals with TBI are considered a part of their professional responsibility. CONCLUSION: Despite recognition of the importance of addressing the topic and the belief of it being their professional responsibility, many professionals reported lack of training. Working to increase comfort with the topic and providing comprehensive education on treating sexuality may be beneficial.

Comparison of the VA and NIDILRR TBI Model System Cohorts.

OBJECTIVE: Within the same time frame, compare the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and VA Traumatic Brain Injury Model System (TBIMS) data sets to inform future research and generalizability of findings across cohorts. SETTING: Inpatient comprehensive interdisciplinary rehabilitation facilities. PARTICIPANTS: Civilians, Veterans, and active duty service members in the VA (n = 550) and NIDILRR civilian settings (n = 5270) who were enrolled in TBIMS between August 2009 and July 2015. DESIGN: Prospective, longitudinal, multisite study. MAIN MEASURES: Demographics, Injury Characteristics, Functional Independence Measures, Disability Rating Scale. RESULTS: VA and NIDILRR TBIMS participants differed on 76% of comparisons (18 Important, 8 Minor), with unique differences shown across traumatic brain injury etiology subgroups. The VA cohort was more educated, more likely to be employed at the time of injury, utilized mental health services premorbidly, and experienced greater traumatic brain injury severity. As expected, acute and rehabilitation lengths of stay were longer in the VA with no differences in death rate found between cohorts. CONCLUSIONS: Substantial baseline differences between the NIDILRR and VA TBIMS participants warrant caution when comparing rehabilitation outcomes. A substantive number of NIDILRR enrollees had a history of military service (>13%) warranting further focused study. The TBIMS participant data collected across cohorts can be used to help evidence-informed policy for the civilian and military-related healthcare systems.

Predictors of Satisfaction With Life in Veterans After Traumatic Brain Injury: A VA TBI Model Systems Study.

OBJECTIVE: To identify predictors of satisfaction with life in Veterans 1 year after traumatic brain injury (TBI). SETTING: The VA TBI Model Systems (TBIMS) project includes 5 Veterans Affairs (VA) Polytrauma Rehabilitation Centers. PARTICIPANTS: Veterans enrolled in the VA TBIMS study who completed the Satisfaction With Life Scale at year 1 follow-up. The sample is largely male (96%) and Caucasian (72%), with a median age of 27 years upon enrollment. DESIGN: Prospective observational cohort study measuring including demographics (eg, education), preinjury variables (eg, mental health history and employment), and military variables (eg, injury during deployment and injury during active duty status). MAIN OUTCOME MEASURE: Satisfaction With Life Scale. RESULTS: Multivariate regression analyses revealed that age, marital status, preinjury employment status, preinjury mental health history, and active duty status at the time of injury were significant predictors of life satisfaction at year 1 follow-up. CONCLUSIONS: Results of this study suggest that satisfaction with life in Veterans with TBI is mediated by several factors that might inform rehabilitation interventions and discharge recommendations. Preinjury variables and active duty status (a unique aspect of the Veteran population) influence life satisfaction at 1 year postinjury. Limitations and future clinical implications will be discussed.

Relationship Stability After Traumatic Brain Injury Among Veterans and Service Members: A VA TBI Model Systems Study.

OBJECTIVE: To explore stability of relationships and predictors of change in relationship status 2 years following TBI/polytrauma. SETTING: Five Department of Veterans Affairs Polytrauma Rehabilitation Centers (VA PRCs). PARTICIPANTS: A total of 357 active duty service members and Veterans enrolled in the Veterans Affairs Polytrauma Rehabilitation Centers Traumatic Brain Injury Model Systems database with complete marital status information at 2 years postinjury. DESIGN: Prospective, longitudinal, multisite. MAIN MEASURES: Relationship status change was defined as change in marital status (single/never married; married; divorced/separated) at 2-year follow-up, compared with status at enrollment. RESULTS: At the time of enrollment, 134 participants (38%) were single/never married; 151 (42%) were married, and 72 (20%) were divorced/separated. Of those married at enrollment, 78% remained married at year 2 while 22% underwent negative change. Multivariable analyses revealed that age and education at the time of injury and mental health utilization prior to injury were significant predictors of relationship change. Among those who were single/divorced/separated at the time of enrollment, 87% remained so at year 2 while 13% underwent positive change. Injury during deployment significantly predicted positive relationship change. CONCLUSIONS: The unmalleable, preinjury characteristics identified may be used as potential triggers for education, prevention, surveillance, and couples therapy, if needed.

Pilot Study of a Newly Developed Intervention for Families Facing Serious Injury.

Background: There is a need to develop interventions that address the entire family after spinal cord injury (SCI), especially in Latin America, where rehabilitation resources are limited and little is known about family adjustment to SCI. Objective: To evaluate the short-term (post-intervention) and longer term (6-month) effectiveness of the newly developed, 8-session manualized family intervention for individuals with SCI and their family members compared to a control group. Methods: In this clinical demonstration project, longitudinal self-report data were collected from 8 individuals with SCI and their family members in Colombia, South America. The 8 families were randomly assigned to either the SCI intervention group or the waitlist control group. The intervention group included 10 individuals from 4 different families, with a mean age of 41.40 years (SD = 14.18). The control group was composed of 13 individuals from 4 different families with a mean age of 44.38 years (SD = 14.76). All participants completed Spanish versions of instruments that assessed depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), burden (Zarit Burden Interview), and perceived problem-solving skills (Problem-Solving Inventory). Results: Results provide preliminary evidence that symptoms of depression, anxiety, and burden as well as problem-solving appraisals improved significantly for individuals who participated in the intervention, whereas no change in symptoms was observed among those in the waitlist control group. Conclusions: Findings suggest that this newly developed intervention for families facing SCI can be beneficial; however, this pilot study represents only the first step in the examination of the efficacy and effectiveness of this intervention.

The Relationship between Training and Mental Health among Caregivers of Individuals with Polytrauma.

This was a hypothesis-generating exploration of relationships between caregiver training during TBI/polytrauma rehabilitation and caregiver mental health. In this cross-sectional study, 507 informal caregivers to US service members with TBI who received inpatient rehabilitation care in a Veterans Affairs' Polytrauma Rehabilitation Center from 2001 to 2009 completed a retrospective, self-report survey. Embedded in the survey were measures of caregiver mental health, including the National Institutes of Health's Patient Reported Outcome Measurement Information System (PROMIS) Anxiety and Depression Short Forms, the Rosenberg Self-Esteem scale, and the Zarit Burden Short Form. Though no groups endorsed clinical levels, mental health symptoms varied by caregiver training category (Trained, Not Trained, and Did Not Need Training). Caregivers who did not receive training on how to navigate healthcare systems endorsed higher depression and burden and lower self-esteem than those who did. Caregivers who did not receive training in supporting their care recipients' emotions endorsed higher anxiety, depression, and burden and lower self-esteem than those who did. Analyses also suggested a different association between training and mental health based on caregivers' relationship to the care recipient and the intensity of care recipient needs. Potential hypotheses for testing in future studies raised by these findings are discussed.

Factor analysis of the Spanish Multidimensional Attitudes Scale Toward Persons with Disabilities.

PURPOSE/OBJECTIVE: To study the psychometric properties of a Spanish version of the Multidimensional Attitudes Scale toward Persons with Disabilities (MAS) and examine its factor structure using confirmatory and exploratory factor analyses on data from a Colombian collegiate sample. RESEARCH METHOD/DESIGN: Five hundred students from Sur Colombia University in Neiva, Colombia, completed the Multidimensional Attitudes toward People with Disability scale. Forty-eight percent were male, and the average age for the entire sample was 21.25 years (SD = 3.50). Ninety-eight percent were undergraduates, 23% of whom were business majors and 33% of whom were education majors. RESULTS: An exploratory factor analysis (EFA) of data from half of participants suggested the retention of 4 factors and the deletion of 4 items. A confirmatory factor analysis (CFA) on the data from the second half of participants using the 30 retained items and 4-factor structure suggested that the 4-factor model fit adequately with the remaining 30 items. High internal consistency was found for the overall scale (α = .77, .78) and for the 4 resulting subscales: Affect (α = .88, .87), Cognition (α = .92, .90), Behavior (α = .88, .88), and Calm (α = .90, .89). CONCLUSIONS/IMPLICATIONS: This study modified the MAS to assess attitudes toward persons with disabilities in Colombia. The adequate reliability and fit of the factor structure of the Spanish MAS suggests that it holds promise to help researchers investigate attitudes toward persons with disabilities in Latin America, an important topic to the global disability community.

The influence of TBI impairments on family caregiver mental health in Mexico.

PURPOSE: This study examined the influence of five types of impairments in individuals with traumatic brain injury (TBI)-and caregiver stress due to these impairments-on the mental health of family caregivers in Guadalajara, Mexico. METHOD: Ninety caregivers completed measures of TBI impairments and of their own mental health. The majority were female (92.20%) with a mean age of 47.12 years (SD = 12.67). Caregivers dedicated a median of 50 hours weekly to caregiving and had spent a median of 11 months providing care. RESULTS: Two canonical correlation analyses suggested that these two sets of variables were broadly related, such that more severe impairments in individuals with TBI and more caregiver stress due to those impairments were associated with lower caregiver mental health. Across both analyses, social impairments were most associated with increased caregiver burden. Follow-up analyses also uncovered that caregiver stress due to cognitive impairments was uniquely associated with caregiver burden and anxiety. CONCLUSIONS: These results are the first to provide evidence that social and cognitive impairments in individuals with TBI from Latin America are the impairments most associated with caregiver mental health and highlight the need for interventions that target social and cognitive functioning.

Just how bad is it? Comparison of the mental health of Mexican traumatic brain injury caregivers to age-matched healthy controls.

OBJECTIVE: To compare the mental health of family caregivers of individuals with Traumatic brain injury (TBI) to an age-matched healthy control from Guadalajara, Mexico. SETTING: Hospital Civil Fray Antonio Alcade, a public medical facility in Guadalajara, Mexico. PARTICIPANTS: Ninety family caregivers of individuals with TBI and 89 healthy controls (n = 179) did not differ with respect to age, sex, marital status, education, or household income. MAIN OUTCOME MEASURES: Outcome measures assessed satisfaction with life (Satisfaction with Life Scale), depression (Patient Health Questionnaire-9), social support (Interpersonal Support Evaluation List), self-esteem (Rosenberg Self-Esteem Scale), and anxiety (State-Trait Anxiety Inventory). RESULTS: A multivariate analysis of variance found that in comparison to controls, TBI caregivers reported substantially lower mental health scores across all indices, as well as lower social support in two out of three comparisons. The effect sizes of the social support differences were small; two out of five mental health differences reached medium-sized effects; and the other three reached large-sized effects. CONCLUSIONS: Because TBI caregivers' mental health influences the quality of informal care they can provide, mental health interventions for family caregivers are an extremely important part of TBI rehabilitation in Latin America, especially considering familism as a core value in Latino culture.

Examining the influence of three types of social support on the mental health of mexican caregivers of individuals with traumatic brain injury.

OBJECTIVE: The aim of this study was to examine the influence of three types of social support (appraisal, belonging, and tangible) on caregiver mental health (anxiety, burden, depression, and satisfaction with life) among Mexican caregivers of individuals with traumatic brain injury. DESIGN: This is a cross-sectional study of 90 family caregivers from Hospital Civil Fray Antonio Alcade in Guadalajara, Mexico. RESULTS: More months spent caregiving was associated with decreases in all three types of social support. Older age and fewer years of education were associated with lower appraisal social support. More hours per week spent caregiving was associated with lower caregiver state anxiety and greater satisfaction with life. Appraisal, belonging, and tangible social support were all significantly correlated with more salubrious caregiver mental health outcomes, except satisfaction with life. Appraisal social support independently predicted lower caregiver depression. CONCLUSIONS: Particularly in Latin America, strong social support networks and family connections seem closely tied to key mental health outcomes such as depression. Rehabilitation interventions aimed at strengthening perceptions of social support of caregivers of individuals with traumatic brain injury that specifically target availability of advice may improve mental health and contribute to more optimal informal care for individuals with traumatic brain injury.

Factors associated with depression and burden in Spanish speaking caregivers of individuals with traumatic brain injury.

OBJECTIVE: To determine which factors are highly associated with burden and depression in a group of caregivers of persons with Traumatic Brain Injury (TBI) in Colombia, South America. DESIGN: Prospective. PARTICIPANTS: Fifty-one pairs of individuals with TBI and their caregivers from two major cities in Colombia completed a comprehensive psychosocial evaluation that included information related to patient and caregiver sociodemographic factors, patient factors, and caregiver estimation of patient neurobehavioral functioning. OUTCOME MEASURES: Caregiver burden (Zarit Burden Interview) and caregiver depression (PHQ-9). RESULTS: Generalized linear models revealed that patient language problems and caregiver perception of patient functioning on six neurobehavioral domains were related to caregiver burden. Caregiver socioeconomic status and caregiver perception of patient functioning on six neurobehavioral domains were related to caregiver depression. These variables were then selected as candidates for the multiple regression models, which were fit separately for caregiver depression and burden, and revealed that caregivers' perception of patient depression was the only factor associated with both caregiver burden and depression. CONCLUSION: Caregivers' perception of patient depression was the single best predictor of both caregiver burden and depression. Implications for treatment based on these preliminary findings are discussed.

Health-related quality of life of individuals with traumatic brain injury in Barranquilla, Colombia.

OBJECTIVE: To assess health-related quality of life (HRQoL) of individuals with traumatic brain injury (TBI) in Barranquilla, Colombia. PARTICIPANTS/METHODS: Thirty-one individuals with TBI and 61 healthy controls completed the SF-36, a self-report HRQoL measure composed of eight component areas: physical health problems, pain, role limitations due to physical problems or due to emotional problems, emotional well-being, social functioning, energy/fatigue and general health perceptions. RESULTS: The samples were statistically similar with respect to age, gender and education and statistically different with respect to depression, SES, social support and cognition. Compared to healthy controls, individuals with TBI had significantly lower means on all SF-36 sub-scales. However, after adjusting for depression, SES, social support and cognitive performance, significant differences remained on three of the SF-36 sub-scales. Specifically, individuals with TBI had lower adjusted means on Role-Physical (p-value < 0.005), Role-Emotional (p-value < 0.005) and Bodily Pain (p-value < 0.05). CONCLUSION: Even after controlling for depression, SES, social support and cognitive performance, individuals with TBI living in Barranquilla Colombia report having poorer quality of life across various domains, including Role-Physical, Role-Emotional and Bodily Pain. These findings suggest the need for rehabilitation health professionals to develop and implement culturally-appropriate interventions to improve quality of life in Colombian individuals with TBI.

Associations between disability and employment 1 year after traumatic brain injury in a working age population.

OBJECTIVE: To investigate associations between disability and employment 1 year after traumatic brain injury (TBI) using the International Classification of Functioning, Disability and Health (ICF) as a conceptual model. DESIGN AND METHODS: A prospective study including 93 patients with moderate-to-severe TBI (aged 16-55 year). Disability components of the ICF model (impairments, activity limitations and participation restrictions) and personal factors (age, gender, pre-injury employment status) were used as independent variables. The outcome measure was employment at 1 year post-injury categorized into unemployed and employed groups. RESULTS: Personal factors, impairments (brain injury severity, overall trauma severity and number of impaired body functions) and activity limitations (motor and cognitive abilities) accounted for 57% of the variance in employment outcome. Multivariate analyses showed that the probabilities of being employed 1 year post-injury were 95% lower for patients who were unemployed pre-injury (OR = 0.05), 74% lower for those with more severe brain injury (OR = 0.26) and 82% lower for those with more cognitive limitations (OR = 0.18). CONCLUSION: Rehabilitation professionals should take into account the importance of the ICF model when planning vocational rehabilitation interventions for individuals with TBI and focus on targeting modifiable aspects related to employment outcome, such as the individual's cognitive ability.

Balancing act: the influence of adaptability and cohesion on satisfaction and communication in families facing TBI in Mexico.

Much of what is known about family functioning in the face of traumatic brain injury (TBI) is based on research conducted in the United States. The purpose of this study was to (1) describe the levels of family adaptability, cohesion, communication, and satisfaction as reported by Mexican TBI survivors and their family caregivers, (2) test the hypothesis of the Circumplex Model that balanced families would exhibit better communication and greater satisfaction, and (3) explore how TBI survivors' and their family caregivers' perceptions of family adaptability and cohesion influenced their own and the other's perceptions of family communication and satisfaction. In the majority of dyads, both the TBI survivor and the family caregiver endorsed balanced family adaptability and cohesion. Both TBI survivors and their family caregivers reported a relatively high level of family communication and satisfaction. TBI survivors and family caregivers who reported greater levels of family adaptability and cohesion also endorsed better family communication and greater family satisfaction. In addition, individuals with TBI whose family caregiver endorsed balanced family adaptability and cohesion reported better family communication. Further, family caregivers of TBI survivors who reported balanced family adaptability and cohesion reported better family communication. Implications for research and practice are discussed.

Do racial/ethnic differences exist in post-injury outcomes after TBI? A comprehensive review of the literature.

PRIMARY OBJECTIVES: (1) To describe demographic and injury characteristics that are prominent among African Americans and Hispanics with TBI; (2) To determine if racial differences exist in regard to post-injury outcomes; (3) To highlight potential causes of racial/ethnic disparities in TBI rehabilitation and post-acute services; (4) To suggest recommendations to equalize outcomes; and stimulate future TBI research. METHODS AND PROCEDURES: Using MEDLINE, PyschINFO, CINAHL and InfoTrac databases, 39 peer-reviewed journal articles were found that met the following inclusion criteria: research studies that reported data for African Americans and Hispanics with TBI, outcomes from both primary and secondary analyses including paediatric patients with TBI and caregivers. MAIN OUTCOME AND RESULTS: African Americans and Hispanics have worse functional outcomes and community integration and are less likely to receive treatment and be employed than Whites post-TBI. Emerging research detects racial and ethnic differences in marital stability, emotional/neurobehavioural complications and QOL outcomes; however, more research is needed to corroborate significant findings. African American and Hispanic caregivers express more burden, spend more time in caregiving role, have fewer needs met and use different types of coping strategies than White counterparts. CONCLUSION: The racial and ethnic differences noted in this literature review are an indicator that minorities are at disproportionate risk for poorer outcomes. Post-acute interventions should specifically target minorities to diminish inequities that exist.

Ethnicity/racial differences in employment outcomes following spinal cord injury.

OBJECTIVE: To examine differences in employment outcomes among Hispanics and Caucasians with Spinal Cord Injuries at one year post-injury. DESIGN: Retrospective study. SETTING: Longitudinal dataset of the SCI Model Systems. PARTICIPANTS: 11,424 Individuals diagnosed with spinal cord injury (1369 Hispanics and 10055 Caucasians) that were enrolled in the National Spinal Cord Injury Statistical Center (NSCISC) database and interviewed during their scheduled one-year post-injury follow-up evaluation between 1975 and 2006. MAIN OUTCOME MEASURES: Employment status (competitively employed, unemployed and other). RESULTS: After adjusting for age, gender, marital status, education level, employment status at admissions, cause of injury, category of neuro-impairment, and ASIA impairment scale, race/ethnicity has a significant effect on employment status at 1 year post-injury. Specifically, the odds of unemployment versus employment were 1.864 times greater for Hispanics than for Caucasians (95% CI = 1.478, 2.349) and the odds of unemployment versus other were 1.980 times greater for Hispanics than for Caucasians (95% CI = 1.625, 2.413). CONCLUSIONS: Racial disparities do exist in successful employment after 1 year post SCI, particularly between Caucasians and Hispanics. Future research should focus on what factors contribute to this disparity, along with forming new education and rehabilitation strategies to improve return-to-work outcomes for Hispanics after SCI.