"It Is not only the Kind of Injury that Matters, but the Kind of Head": The Contribution of Premorbid Psychosocial Factors to Rehabilitation Outcomes after Severe Traumatic Brain Injury

Abstract

Two studies are reported examining the influence of premorbid psychosocial variables in determining rehabilitation outcomes after traumatic brain injury (TBI). The focus of Study 1 was indices of premorbid social maladjustment (PSM). A consecutive series of 85 subjects with TBI admitted to a rehabilitation unit was assessed 6 years post-trauma. Eleven subjects (13%) had evidence of PSM. These subjects were matched on age, gender, and severity of injury with 11 subjects in the series without evidence of PSM. There were no differences between the groups regarding overall outcome on the Glasgow Outcome Scale, level of psychosocial reintegration, or severity of neuropsychological impairments. The aim of Study 2 was to examine premorbid personality characteristics in subjects with TBI. An independent sample of 30 subjects was followed prospectively. As soon afterthe injury as feasible, a detailed psychosocial history was obtained from a close relative, who also rated the premorbid personality of the TBI person using the Eysenck Personality Questionnaire—Revised (EPQ-R). Nine subjects had evidence of poor premorbid histories and 17 subjects had unremarkable histories. Significant group differences were demonstrated for three of the six EPQ-R scales (Psychoticism, Addiction, and Criminality). Comparison of the two groups regarding the severity of neuropsychological impairments and level of psychosocial reintegration achieved by 6 months post-trauma, however, revealed no significantdifferences, replicating the results of the first study. Correlational analyses indicated that only severity of injury, and notpremorbid personality variables, was related to psychosocial functioning.