title: Self-awareness and neurobehavioral outcomes, 5 years or more after moderate to severe brain injury.
abstract: OBJECTIVE
  To examine self-awareness 5 years or more after traumatic brain injury (TBI) and its relation to outcomes.
  
  
  METHODS
  Sixty-two adults with moderate to severe TBI and significant other (SO) informants (family or close friend).
  
  
  METHODS
  Regional veterans medical center.
  
  
  METHODS
  TBI Follow-up Interview, Community Integration Questionnaire, Satisfaction with Life Scale, and Caregiver Burden Inventory.
  
  
  METHODS
  Five to 16 years after acute inpatient rehabilitation, separate staff contacted and interviewed subjects and SOs. Subject awareness was defined as inverse subject-SO discrepancy scores.
  
  
  RESULTS
  Subjects significantly underreported neurologic symptoms and overreported their work and home functioning; their self-ratings of emotional distress and social functioning did not differ from SO ratings. Employment was associated with greater self-awareness of cognitive deficits, even after controlling for injury severity. Subjects' life-satisfaction was associated with better self-reported neurologic functioning, which frequently did not agree with SO ratings. Caregiver burden was worse as SOs perceived subjects as having worse symptoms and poorer work and social integration.
  
  
  CONCLUSIONS
  Impaired self-awareness remains evident more than 5 years after TBI. People with TBI are more likely to gain employment when they are aware of their cognitive deficits and abilities. However, subjective quality of life, for subjects and SOs, was related to their own perception of the TBI outcomes.
authors.affiliation: Defense and Veterans Brain Injury Center (Mss Kelley and Long, and Drs Sullivan, Loughlin, Hutson, Dahdah, and Poole) and Psychology Service (Drs Sullivan, Hutson, and Poole, and Ms Long), Veterans Affairs Health Care System, Palo Alto, California; Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, California (Mss Kelley and Long, and Drs Sullivan, Loughlin, Hutson, and Dahdah); and Defense and Veterans Brain Injury Center, Silver Spring, Maryland (Dr Schwab).
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kelley
authors.forename: Campbell
authors.initials: C
authors.lastname: Sullivan
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Loughlin
authors.forename: Lee
authors.initials: L
authors.lastname: Hutson
authors.forename: Marie N
authors.initials: MN
authors.lastname: Dahdah
authors.forename: Margaret K
authors.initials: MK
authors.lastname: Long
authors.forename: Karen A
authors.initials: KA
authors.lastname: Schwab
authors.forename: John H
authors.initials: JH
authors.lastname: Poole
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001364:Awareness; D001930:Brain Injuries / Q000175:diagnosis / Q000523:psychology* / Q000534:rehabilitation*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006787:Hospitals, Veterans; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011788:Quality of Life; D015203:Reproducibility of Results; D018570:Risk Assessment; D012647:Self-Assessment; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome