Purpose This sub-study examines factors influencing the ability to return to work following major trauma, expanding on prior research into post-traumatic stress (PTSD), anxiety, and depression. Methodology Participants were selected from Christchurch Hospital patients included in the New Zealand Major Trauma Registry (NZ-MTR; Injury Severity Score [ISS] ≥12). Eligible participants received a questionnaire assessing DSM-V symptoms of PTSD, depression, and anxiety using self-reported rating scales. A follow-up questionnaire collected data on employment status pre and post trauma. Statistical analyses included Pearson Chi-square tests for discrete variables and Mann-Whitney U tests for continuous variables, both two-tailed. Results 203 respondents (24.3% response rate). 130 were employed full-time pre-trauma, with 73 (57%) returning to full-time work post-trauma. Mean follow-up period was 2 years and 9 months. Factors associated with reduced chance of returning to work included older age (p = 0.008), longer hospital stays (p = 0.001), intensive care admission (p = 0.03), and meeting DSM thresholds for anxiety (p = 0.02) and depression (p < 0.01). Interestingly, neither Injury severity score (p = 0.24) nor PTSD (p = 0.37) significantly impacted return-to-work outcomes. Conclusion This study identifies factors influencing occupational recovery after major trauma. Older age, prolonged hospitalization, ICU admission, and mental health symptoms (anxiety and depression) reduce the likelihood of returning to work. These findings underscore the importance of addressing mental health alongside physical recovery. Future research should evaluate the long-term employment impacts of trauma and effectiveness of targeted rehabilitation.