Research Reports - The occurrence of early impaired self-awareness after traumatic brain injury and its relationship with emotional distress and psychosocial functioning

Brain Inj. 2017 Oct 23:1-8. doi: 10.1080/02699052.2017.1346297. [Epub ahead of
print]

Geytenbeek M(1)(2), Fleming J(1)(2), Doig E(1), Ownsworth T(3).

OBJECTIVE: To describe the occurrence of impaired self-awareness (ISA) after
traumatic brain injury (TBI) and its association with emotional distress and
psychosocial functioning following discharge.
DESIGN: Prospective cohort design with data collection at discharge and 1-, 3-
and 6-month follow-up.
PARTICIPANTS: 81 adults with TBI.
MEASURES: Self-awareness was measured using a discrepancy score generated from
the Mayo-Portland Adaptability Index (MPAI-4) Ability subscale, and significant
other's ratings of Item 20 on the MPAI-4. Other measures were the Depression
Anxiety Stress Scale-21 and Sydney Psychosocial and Reintegration Scale.
RESULTS: The discrepancy score method identified more cases of ISA than the
single-item rating by significant others. Using discrepancy scores, the
occurrence of ISA was 69.1% at discharge, and for those remaining in the study 6
months later, it was 54.3%. Better self-awareness was associated with greater
anxiety at discharge, and stress at discharge, 3 and 6 months later, and better
psychosocial functioning at all time points. Participants with ISA had
significantly poorer relationships at 6 months post-discharge after controlling
for injury severity.
CONCLUSION: Whilst self-awareness is associated with greater stress in patients
with TBI, it is also associated with better outcomes, indicating the importance
of targeting ISA in rehabilitation. 

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