A 45-year-old male construction worker presents with right ankle pain after falling from a two-story building and landing on his right leg. He noticed immediate pain and inability to bear weight on the affected limb. Physical examination reveals diffuse soft tissue swelling around the ankle joint without any open injuries. The patient reveals he never completed a high school degree, smokes 1/2 a pack of cigarettes per day, and occasionally uses marijuana recreationally. Injury radiographs are shown in figures A and B. The patient undergoes an ankle-spanning external fixator placement for soft tissue stabilization and then undergoes definitive fixation shown in figures C and D. Which factor suggests a poor clinical outcome and failure to return to work?