PURPOSE:To examine the nature of occupational gaps and desired re-engagement following severe traumatic brain injury (TBI), and the relationship to mood, self-discrepancy, and psychosocial functioning. MATERIALS AND METHODS:Fifty-nine adults with severe TBI (73% male, M age = 36.50, SD = 12.54) were administered measures of past, current, and desired occupations (Occupational Gaps Questionnaire), mood (Depression Stress and Anxiety Scale - 21), and self-discrepancy (Head Injury Semantic Differential Scale - version 3). Psychosocial functioning was rated by relatives on the Sydney Psychosocial Reintegration Questionnaire. RESULTS:Participants reported that they engaged in significantly fewer occupations than prior to their injury (p < 0.001). Further, they participated in fewer occupations than they desired (p < 0.001). Desired re-engagement was identified for 18 of the 30 occupations (e.g., working, sports, managing personal finances, and supporting others). A higher number of these re-engagement gaps was significantly related to greater anxiety (r = 0.30, p < 0.05) and lower psychosocial functioning (r = -0.29, p < 0.05). A mediation analysis revealed that re-engagement gaps were indirectly related to self-discrepancy through an association with anxiety. CONCLUSIONS:Occupational gaps are commonly experienced after severe traumatic brain injury. Lack of engagement in desired occupations is associated with greater anxiety and poorer psychosocial functioning. Anxiety regarding these gaps may contribute to negative comparisons between one's pre-injury and post-injury self. Identification of occupational gaps and their psychological impact may guide the focus of client-centred rehabilitation approaches. Implications for Rehabilitation Gaps between current activity engagement (i.e., post injury) and desired activity engagement are commonly experienced after severe traumatic brain injury. Greater desired re-engagement gaps (i.e., when individuals report they are not completing activities that they would like to do) are associated with greater anxiety and poorer psychosocial functioning. Individuals who are unable to re-engage in desired activities are more likely to experience anxiety, which in turn may contribute to negative self-discrepancy. It may be beneficial to explore the personal meaning of changes in occupation after traumatic brain injury.