Awareness typologies, long-term emotional adjustment and psychosocial outcomes following acquired brain injury

Abstract

Previous research suggests considerable heterogeneity within groups of individuals identified as having low self-awareness or good self-awareness following acquired brain injury (ABI). The present study aimed to identify typologies of individuals according to neuropsychological and psychological factors related to awareness deficits and compare emotional adjustment and psychosocial outcomes at the initial assessment and 12-month follow-up. Eighty-four participants with ABI (mean time since injury = 3.9 years) were assessed on the Self-Awareness of Deficits Interview, Awareness Questionnaire, Symptom Expectancy Checklist, Marlowe-Crowne Social Desirability Scale, Hospital Anxiety Depression Scale, Sydney Psychosocial Reintegration Scale, and an error self-regulation index. A 12-month follow-up assessment of emotional adjustment and psychosocial outcomes was conducted. A hierarchical cluster analysis distinguished four awareness typologies, namely, “poor self-awareness” (n = 12), “high defensiveness” (n = 13), “high symptom reporting” (n = 15), and “good self-awareness” (n = 44). An overall comparison of outcomes indicated that the poor self-awareness and high symptom reporting typologies experienced poorer outcomes than the high defensiveness and good self-awareness typologies. The findings confirm that there are different awareness typologies and highlight the need to tailor interventions according to the nature of awareness deficits.

The Prince Charles Hospital Foundation and a National Health and Medical Research Council Public Health Post-Doctoral Fellowship jointly funded this study. We would like to thank the staff from the Prince Charles Hospital, Princess Alexandra Hospital (BIRU), Commonwealth Rehabilitation Service and Brain Injury Association of Queensland. Additionally, we would like to thank Kasey Wise, Julie-Anne Brennan, Melanie Oettinger, Sascha Hardwick, Jenny Bedford, Jenny Desbois and Eliza Grant. Our gratitude is also extended to the participants and their families.