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The Relative Importance of Metacognitive Skills, Emotional Status, and Executive Function in Psychosocial Adjustment Following Acquired Brain Injury

Ownsworth, Tamara PhD; Fleming, Jennifer PhD

Journal of Head Trauma Rehabilitation: July-August 2005 - Volume 20 - Issue 4 - p 315–332

Objectives To examine the interrelationships between metacognitive skills and measures of emotional status and executive function following acquired brain injury (ABI), and examine their relative importance to psychosocial outcomes.

Design A cross-sectional multicentre study employing correlational and multiple regression analyses.

Participants Sixty-seven adults with ABI living in the community, on average 4.4 years (SD = 4.7) postinjury.

Measures Sydney Psychosocial Reintegration Scale, Self-Awareness of Deficits Interview, Self-Regulation Skills Interview, Hospital Anxiety Depression Scale, Beck Hopelessness Scale, and standardized measures of executive function.

Results Metacognitive skills correlated with level of hopelessness and executive measures of idea generation and error self-regulation. The best predictor of psychosocial outcome was depressive symptoms, with specific outcomes additionally related to error self-regulation and intellectual awareness.

Conclusions The findings highlight the need to evaluate interventions targeting depression and metacognitive skills to improve psychosocial outcomes.

Division of Occupational Therapy, The University of Queensland (Dr Ownsworth), and the Occupational Therapy Department, Princess Alexandra Hospital (Dr Fleming), Brisbane, Australia.

Corresponding author: Tamara Ownsworth, PhD, Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, 4072 Australia (e-mail:

The authors acknowledge the assistance of Professor Jenny Strong, Sascha Hardwick, Kasey Wise, and staff from CRS Australia, Princess Alexandra Hospital, Prince Charles Hospital, and the Brain Injury Association of Queensland. A National Health Medical Research Council Public Health (Australia) Fellowship supported this research.

© 2005 Lippincott Williams & Wilkins, Inc.