The big sell: Managing stigma and workplace discrimination following moderate to severe brain injury

Revisiting the Common Misconceptions About Traumatic Brain Injury Scale (CM-TBI); What Does It Really Measure?

OBJECTIVE

To examine the factor structure and validity of the 40-item common misconceptions in traumatic brain injury (CM-TBI) scale, and to develop and evaluate additional concussion-focussed items to broaden the instrument's scope.

METHOD

A purposive sample of 988 participants from across all habitable continents (M age 43, range 16-90 years, 84% female) completed the CM-TBI and 5 additional concussion items at commencement of an online course on TBI.

RESULTS

Item analysis resulted in the removal of 19 items due to ambiguous wording and poor conceptual integrity, and/or low discrimination and low inter-item correlations. An exploratory factor analysis on the remaining 26 items revealed a 3-factor model had best fit, with an additional 8 items removed due to low or cross-loadings, low communalities, and/or low conceptual relevance, resulting in an 18-item revised scale.

CONCLUSION

There is no psychometric support for the current structure of the CM-TBI. This is likely due to changes in understanding of TBI since the scale's inception, and issues of conceptual ambiguity. It is also proposed that a distinction must be made between knowledge and misconceptions, as these are 2 related but different constructs that are not clearly delineated in the current CM-TBI. Using the revised scale here offers researchers a more modern, focussed, and valid measure, but a new scale to measure knowledge and misconceptions in TBI is urgently needed.

The Anticipated Stigma and Concealment Questionnaire (ASCQ): Psychometric properties of a Spanish version in a Chilean sample of brain injury survivors

Stigma represents a major obstacle in rehabilitation and community reintegration after brain injury. However, appropriate tools to measure stigma in Spanish-speaking countries are lacking. This study examined the psychometric properties of the Spanish version of the Anticipated Stigma and Concealment Questionnaire (ASCQ). An observational cross-sectional study was conducted with 103 participants who completed the ASCQ and other measures. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were performed to assess the scale's structure. Associations between the ASCQ and other mental health measures were explored to establish its nomological validity. All ASCQ items loaded significantly onto a single factor, with factor loadings ranging from .7 to .84. While χ2 (35) = 56.282, p < .05, some fit indices indicated excellent model fit (CFI = .997 and TLI = .996), while others suggested a good fit (RMSEA = .077, 90% CI [.036, .113], and SRMR = .060). Significant associations were found between the ASCQ and measures of loneliness, depressive symptoms, quality of life, and self-esteem. The ASCQ is a valid and reliable tool for assessing anticipated stigma and the motivation to conceal information after acquired brain injury. It can aid rehabilitation professionals in identifying individuals with interpersonal difficulties during community reintegration.

Understanding employee experiences of developing younger onset dementia within the workplace: A scoping review

BACKGROUND

There is limited information focussing on the perspectives of persons with younger onset dementia (YOD) in employment. This poses challenges for supporting this demographic within the workplace and during their transition to retirement.

OBJECTIVE

The aim of this scoping review is to address the identified need to ascertain what is known about the perspectives of employees with YOD.

METHODS

Records were included if they: considered working-aged persons who received a diagnosis of YOD whilst employed or soon after ceasing employment; considered the perspective of the person with YOD; and were published in English. Four databases (CINAHL, PubMed, Embase, Cochrane Library) were systematically searched, and grey literature was sought using the Google Scholar search engine. Using PRISMA-ScR guidelines, two reviewers screened the title/abstract then full text of identified documents. Disagreements were resolved with a third reviewer. Research papers were narratively synthesised, thematically analysed, and critically appraised.

RESULTS

Fourteen peer-reviewed research papers, and nineteen grey literature items were included in the review, with research papers found to be of reasonably high methodological quality. Five themes were identified, describing the experiences of employees with YOD: (1) Trying to manage difficulties prior to diagnosis; (2) Disclosure at the point of diagnosis; (3) Reasonable adjustments; (4) Employment cessation; and (5) Regaining meaningful roles following retirement.

CONCLUSION

Findings revealed evidence for an emerging understanding of the lived experience of developing YOD within the workplace; however, further research is needed regarding the capabilities and support needs for persons with YOD to influence workplace policies and practices.

Disclosing non-visible disabilities in educational workplaces: a scoping review

INTRODUCTION

a sizable proportion of the working population has a disability that is not visible. Many choose not to disclose this at work, particularly in educational workplaces where disability is underrepresented. A better understanding of the barriers and facilitators to disclosure is needed.

SOURCES OF DATA

this scoping review is based on studies published in scientific journals.

AREAS OF AGREEMENT

the reasons underpinning disclosure are complex and emotive-in-nature. Both individual and socio-environmental factors influence this decision and process. Stigma and perceived discrimination are key barriers to disclosure and, conversely, personal agency a key enabler.

AREAS OF CONTROVERSY

there is a growing trend of non-visible disabilities within the workplace, largely because of the increasing prevalence of mental ill health. Understanding the barriers and facilitators to disability disclosure is key to the provision of appropriate workplace support.

GROWING POINTS

our review shows that both individual and socio-environmental factors influence choice and experience of disclosure of non-visible disabilities in educational workplaces. Ongoing stigma and ableism in the workplace, in particular, strongly influence disabled employees' decision to disclose (or not), to whom, how and when.

AREAS TIMELY FOR DEVELOPING RESEARCH

developing workplace interventions that can support employees with non-visible disabilities and key stakeholders during and beyond reasonable adjustments is imperative.

Major discrimination due to stuttering and its association with quality of life

PURPOSE

This study aimed to identify what types of major discrimination have been experienced by adults who stutter throughout their lives, and investigate the association between the number of different types of major discrimination events experienced and quality of life.

METHODS

Measures of quality of life (Kemp Quality of Life Scale) and major discrimination (adapted Major Experiences of Discrimination Scale) were completed by 303 adults who stutter. Correlational and regression analyses were conducted with these variables.

RESULTS

A majority (56%) of the participants had experienced at least one episode of major discrimination due to stuttering during their lives. The major discrimination experiences most commonly reported included not being hired for a job and being discouraged by a teacher or advisor from pursuing certain careers or jobs because of stuttering. There was a significant negative relationship between quality of life and major discrimination. Increased major discrimination predicted lower quality of life even after taking into account demographic variables and severity of physical speech disruption.

CONCLUSIONS

The findings of a negative association between major discrimination and quality of life add support to the notion that reducing societal stigma related to stuttering should be a priority of the field. Discriminatory practices of listeners constitute a social-environmental barrier to communicative participation and quality of life in people who stutter and should be addressed by professionals in the field of speech-language pathology and other stakeholders.

The many faces of stigma after Acquired Brain Injury: a systematic review

Background Stigma after Acquired Brain Injury (ABI) has been described as a significant obstacle for the recovery of survivors. Despite its theoretical and clinical relevance, studies dedicated to stigma after ABI are just starting to emerge. The goal of this systematic review was to integrate the existing scientific evidence and develop a model of stigma after brain injury that can guide interventions at different levels. Method Three electronic databases were employed. A search strategy was adapted for each database. Articles that explored stigma in adult ABI populations were included. All articles used quantitative, qualitative or mixed method designs and were published in English, Spanish or Portuguese. Results A total of 21 articles were selected. They considered three types of stigma after ABI: (1) self-stigma, (2) stigma-by-association and (3) public stigma. It was also found that information can be processed at implicit and explicit levels across all three forms of stigma. Definitions of each type of stigma used with ABIs are provided as well as related concepts and theoretical frameworks employed. Evidence emerging from different forms of stigma after ABI is summarised. Conclusion Research on stigma after ABI is heterogeneous, and existing studies have explored its impact at individual, family and public levels. A model of stigma after ABI should consider all these levels as well as the interactions that can occur between them. Future studies should explore how to incorporate stigma management as part of neuropsychological rehabilitation programs.

Employment and accommodation needs and the effect of COVID-19 on men and women with traumatic brain injury

BACKGROUND

Traumatic brain injury (TBI) impacts an individual's workforce involvement post-injury. Support services and workplace accommodations that can help with work re-integration post-TBI may differ based on a person's sex and gender. The added impact of COVID-19 remains under-explored.

OBJECTIVE

We aimed to investigate the support services and workplace accommodation needs and the impact of COVID-19 on work and mental health for persons with TBI, considering sex and gender.

METHODS

A cross-sectional online survey was distributed. Descriptive and regression analyses were applied to uncover sex and gender differences, along with content analysis for open-ended responses.

RESULTS

Thirty-two persons with TBI (62% women, 38% men) participated. Physiotherapy, occupational therapy, and counselling services were indicated as the most needed services by women and men. Modified hours/days and modified/different duties were the most needed workplace accommodations. Mental challenges impacting well-being was a highlighted concern for both men and women. Women scored poorer on the daily activity domain of the Quality of Life after Brain Injury - Overall Scale (p = 0.02). Assistance with daily activities was highlighted by women for a successful transition to work, including housekeeping and caregiving. Men were more likely than women to experience change in employment status because of COVID-19 (p = 0.02). Further, a higher percentage of men expressed concern about the inability to pay for living accommodations, losing their job, and not having future job prospects.

CONCLUSION

Findings reveal important differences between men and women when transitioning to work post-TBI and emphasize the need for sex and gender considerations.

The experience of employers of individuals with traumatic brain injury

OBJECTIVES

To understand the experience of employers of individuals with traumatic brain injury (TBI) who have received comprehensive vocational rehabilitation (VR), the factors involved in supporting an individual with TBI to return to work (RTW), and the support needs of employers.

METHODS

12 employers completed semi-structured interviews, which were recorded, transcribed, and analysed thematically.

RESULTS

Five main themes were identified: challenges and impact on employer, managing employee post-injury changes, looking after employee wellbeing, managing conflicting emotions, and utilizing sources of support. Although employers received support with operational challenges, findings suggest they were not prepared for the emotional journey. While they struggled to support employees through the difficult process of realizing they could no longer perform at their pre-injury level, employers strove to find appropriate roles and ensure wellbeing for their injured employees. Despite employers' endeavours, they felt this process was demoralizing for some employees.

CONCLUSIONS

Advising employers on operational as well as emotional support needs of both employees and employers is an ongoing challenge for VR providers. Although unsupportive employers were not well-represented in this sample, the study highlights the challenges faced and strategies used by employers who have a strong personal investment in the successful RTW of their employees.

In What Ways Does Health Related Stigma Affect Sustainable Employment and Well-Being at Work? A Systematic Review

PURPOSE

Studies are increasingly showing that health related stigma is a barrier to employment, but it is not known how. The aim of this systematic review is to identify, appraise and analyse studies that have directly or indirectly addressed ways in which stigma affects sustainable employment and well-being at work of people with disabilities.

METHODS

Using a multiphase screening process, this review is based on a comprehensive literature search (2000-2019) carried out in six electronic databases: Embase, Web of Science, Medline Ovid, Cochrane CENTRAL, PsycINFO and Google Scholar.

RESULTS

7.263 publications were identified; 96 studies were found eligible to be included in the review. 72% of the studies were conducted in North America or Europe. Few studies directly assessed how stigma affects the employment of people with disabilities. Most studies highlighted that attitudes and behaviour of employers formed a barrier to employment, as well as anticipated stigma and self-stigma in people with health problems. However, the findings also showed that the attitudes and behaviour of co-workers, health care professionals, reintegration professionals, customers, and family and friends could act as a barrier to employment although these influences are under-researched. Although many similarities were seen in the relevant findings of studies about both physical and mental disabilities, several nuances were found.

CONCLUSION

Stigma hampers sustainable employment and well-being in multiple ways. Whereas the number of publications on this topic is rapidly increasing, the roles of health care professionals, reintegration professionals, co-workers, customers, and family and friends particularly warrant more attention.

The impact of employment on quality of life for adults with brain injury

BACKGROUND: Employment is associated with greater quality of life (QOL) for people with disabilities. Yet, for individuals with traumatic brain injury (TBI), the benefits of work are not often realized given high rates of unemployment. OBJECTIVE: This study examined the unique impact of psychosocial variables and employment status (working vs. not working) on self-reported QOL among adults with TBI. METHODS: Participants included 116 adults with TBI between the ages of 18-65, recruited through state brain injury associations in the United States to complete an anonymous online survey. Hierarchical regression analysis was used to examine the incremental impact of psychosocial variables (sense of community, social support, social network, and problem-solving confidence) and employment status on QOL controlling for age and symptom severity. RESULTS: In the final model, employment status, informal and formal support network ties, problem-solving confidence, sense of community, and emotional support explained 59% of the variance in QOL, which is considered a large effect size. Employment status uniquely explained 5% of the variance in QOL. CONCLUSIONS: Findings support the positive benefits of work for adults with TBI. Rehabilitation services that emphasize vocational considerations and employment supports are needed to impact work status and ultimately QOL for individuals with TBI.