Factors Influencing Self-Awareness Following Traumatic Brain Injury

Objective: To examine self-awareness and injury-related, emotional and demographic factors across acute/subacute (3-12 months), medium-term (24-60 months), and long-term (120-240 months) time periods after traumatic brain injury (TBI), because unawareness of injury-related changes can affect engagement in rehabilitation and functional outcomes. Participants: A total of 168 individuals with mild to severe TBI and 105 of their close others. Main Outcomes Measures: Awareness Questionnaire (AQ) and Hospital Anxiety and Depression Scale. Design: Cross-sectional study. Results: There were no significant differences in awareness as a function of time postinjury, except for the AQ motor/sensory domain wherein individuals with TBI at longer time periods displayed increased awareness of deficits than those at earlier time periods. Greater patient-other AQ discrepancy scores (interpreted as lower patient awareness) were associated with longer posttraumatic amnesia duration in the individual with TBI and also with increased self-reported depressive symptoms in the close others. Conversely, smaller AQ discrepancy scores (interpreted as better awareness) were associated with increased self-reported depressive symptoms by the individuals with TBI. Conclusion: This study highlights the limitations of using discrepancy scores to measure awareness, as ratings of injury-related changes are influenced by the mood of the individual with TBI and the close other, as well as by injury severity.