Impaired self-awareness and denial of disability in a community sample of people with traumatic brain injury

Figures & data

Table 1. Sample characteristics (n = 78).

	Frequency (%)
Female	21 (26.9)
Male	57 (73.1)
Level of education
Low	35 (44.9)
High	43 (55.1)
Cause of TBI
Motor vehicle accident	39 (50.0)
Fall	34 (43.6)
Violence	3 (3.7)
Industrial accident	1 (1.3)
Unknown	1 (1.3)
	Mean (±SD)	Range
Age	46.6 (17.8)	19–79
Years post injury	3.1 (1.5)	0.6–6.0
Severity of TBI
GCS (n = 53)	6.5 (3.5)	3–15
PTA (days) (n = 39)	19.8 (27.9)	0.02–106.5
LOC (days) (n = 31)	14.6 (22.1)	0–120
ISA sum score	2.2 (2.2)	0–8
ISA severity score	13.2 (16.2)	0–67
DD sum score	1.67 (1.7)	0–6
DD severity score	9.4 (10.7)	0–43
PCRS discrepancy score	3.0 (12.5)	−25.4 to 28.2
PCRS total score patient	114.7 (17.2)	80–150
PCRS total score relative	111.7 (18.9)	60–148
LDST 60 s writing (z-score)	−0.94 (1.2)	−3.9 to 3.0
LDST 60 s verbal (z-score)	−1.3 (1.0)	−5.0 to 0.7
VVLT total score (z-score)	0.05 (1.3)	−3.0 to 2.8
VVLT delayed recall (z-score)	−0.26 (1.2)	−2.8 to 1.7
HFTT left hand (t-score)	39.1 (12.0)	0–64
HFTT right hand (t-score)	40.4 (11.8)	6–73
Fluency (t-score)	45.6 (11.7)	22–84
Zoo map test	10.3 (5.0)	−8 to 16
COPE inventory avoidance	21.7 (5.1)	12–35
DMM total	10.3 (5.8)	1–38
Denial total score	3.5 (2.1)	0–13
Projection total score	3.6 (3.8)	0–22
Identification total score	3.2 (2.4)	0–13
HADS-Anxiety	6.0 (3.6)	0–14

Note. High education included senior secondary education, university preparatory education, higher professional education, and university. Low education included primary education or less.

TBI: traumatic brain injury; MVA: motor vehicle accident; GCS: Glasgow Coma Scale; PTA: post-traumatic amnesia; LOC: loss of consciousness; ISA: Impaired Self-Awareness; DD: Denial of Disability; PCRS: Patient Competency Rating Scale; DMM: Defense Mechanism Manual; LDST: Letter Digit Substitution Test; VVLT: Visual Verbal Learning Test; HFTT: Halstead Finger Tapping Test; HADS: Hospital Anxiety and Depression Scale.

Figure 1. Distribution of the severity scores on the Impaired Self-Awareness (ISA) scale and the Denial of Disability (DD) scale.

Table 2. Relationships between the ISA and DD scales and other measures.

	ISA severity	DD severity
GCS	−0.32*	−0.04
PTA	0.37*	0.08
LOC	0.42*	−0.13
PCRS discrepancy score	−0.03	−0.01
Neuropsychological assessment
LDST 60 s writing (z-score)	−0.30**	0.01
LDST 60 s verbal (z-score)	−0.22	0.07
VVLT total score (z-score)	−0.47**	0.05
VVLT delayed recall (z-score)	−0.45**	0.07
HFFT left hand (t-score)	−0.17	0.07
HFFT right hand (t-score)	−0.08	0.03
Fluency (t-score)	−0.21	0.04
Zoo map test raw score	−0.39**	0.17
COPE Inventory Avoidance	0.11	−0.14
Total defense mechanism score TAT	−0.15	0.05
Denial relative score	0.24*	−0.18
Projection relative score	−0.24*	0.04
Identification relative score	−0.04	0.20
HADS anxiety	−0.05	−0.22*

*p ≤ 0.05; **p ≤ 0.001.

ISA: Impaired Self-Awareness; DD: Denial of Disability; GCS: Glasgow Coma Scale; PTA: post-traumatic amnesia; LOC: loss of consciousness; PCRS: Patient Competency Rating Scale; LDST: Letter Digit Substitution Test; VVLT: Visual Verbal Learning Test; HFTT: Halstead Finger Tapping Test; DMM: Defense Mechanism Manual; HADS: Hospital Anxiety and Depression Scale.