Psychosocial adjustment after traumatic brain injury: what are the important variables?
BACKGROUND
The common legacy of severe degrees of traumatic brain injury is varying degrees and types of impairments, which impact significantly upon the individual's resumption of pre-morbid psychosocial roles. Yet there are few data to indicate the relative contribution of these and other non-injury related variables.


METHODS
Seventy individuals with varying levels of disability after severe traumatic brain injury were examined neurologically and neuropsychologically, on average at 6 years post-trauma. A range of biographical, injury, impairment and psychological variables were examined with multiple regression analyses to identify those that contributed to successful psychosocial reintegration.


RESULTS
Severity of injury and impairments, along with chronicity and level of self-esteem were significant predictors of psychosocial adjustment. Further analyses revealed that within the neuropsychological domain, the variable measuring behavioural regulation of abilities was the most significant. Examination of specific domains of psychosocial functioning (occupational activities, interpersonal relationships and independent living skills) revealed different patterns of significant predictor variables, in addition to indices of the severity of initial injury: neurophysical impairments and memory functioning predicted successful occupational activities; chronicity, cognitive speed and behavioural regulation predicted success in interpersonal relationships; and neurophysical impairments, behavioural regulation and memory functioning predicted independent living skills.


CONCLUSIONS
These results reinforce the overriding importance of injury severity and neurological factors (both neurophysical as well as neuropsychological) in predicting psychosocial adjustment after traumatic brain injury. Support for the contribution of non-neurological factors was also found.
Department of Medicine, University of Sydney, Royal Rehabilitation Centre, NSW, Australia.
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D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis / Q000523:psychology*; D003710:Demography; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012720:Severity of Illness Index; D012917:Social Adjustment