Long-term medical and psychosocial vulnerability after home return following severe traumatic brain injury

OBJECTIVE: To identify a 5-year medical and psychosocial vulnerability profile among adults living at home 1 year after severe TBI and examine associated early characteristics. DESIGN: Retrospective secondary analysis of a multicentre longitudinal cohort. SUBJECTS/PATIENTS: Adults aged 16 years or older with operationally defined severe traumatic brain injury, private residence at 1 year, linked 5-year follow-up, and complete data for 4 profile indicators. METHODS: Latent class analysis used 5-year rehospitalization, PHQ-9, GAD-7, and Satisfaction With Life Scale scores dichotomized with prespecified clinically interpretable thresholds. External rehabilitation outcomes and early associated factors were examined descriptively and with multivariable logistic regression. RESULTS: Among 2,835 participants, a 2-class solution identified a lower-vulnerability profile (n = 2,361) and a multidomain vulnerability profile (n = 474). The latter showed more depressive symptoms, anxiety symptoms, low life satisfaction, and rehospitalization, with poorer 5-year functioning, participation, health, productive status, and higher frequency of non-private residence. Better 1-year global outcome was protective; female sex, preinjury illicit drug use, and living alone at 1 year were associated with assignment to this profile. CONCLUSION: Home return after severe traumatic brain injury should be treated as a transition point for longitudinal rehabilitation surveillance.