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Self-Awareness and Health-Related Quality of Life After Traumatic Brain Injury

Sasse, Nadine Psych; Gibbons, Henning PhD; Wilson, Lindsay PhD; Martinez-Olivera, Ramon MD; Schmidt, Holger MD; Hasselhorn, Marcus PhD; von Wild, Klaus MD; von Steinbüchel, Nicole PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

The Journal of Head Trauma Rehabilitation: November/December 2013 - Volume 28 - Issue 6 - p 464–472
doi: 10.1097/HTR.0b013e318263977d
Original Articles

Objective: To investigate the relations among self-awareness (SA), impaired SA, and health-related quality of life (HRQOL) after traumatic brain injury (TBI).

Participants: One hundred forty-one adults hospitalized with TBI and their significant others from a cross-sectional multicenter study. Using Glasgow Coma Scale classification, 32 participants had severe injuries, 29 moderate, 44 mild, and 25 complicated mild TBI.

Measures: Patient Competency Rating Scale for Neurorehabilitation; Short Form-36 Health Survey; Cognitive Quality of Life; Quality Of Life after Brain Injury; Hospital Anxiety and Depression Scale; Profile of Mood States; Glasgow Outcome Scale Extended.

Method: Patient Competency Rating Scale for Neurorehabilitation ratings made by participants and their significant others were used to assess SA and discrepancies between the 2 ratings were used to define impaired SA.

Results: Significant associations were identified between SA and HRQOL, anxiety, depression, and severity of injury. Participants with and without impaired SA differed in cognitive HRQOL and leisure activities. Using multiple regression, no direct predictors of SA were identified, although interaction effects were observed.

Conclusion: After TBI, lower SA is associated with higher estimates of HRQOL, particularly in the cognitive domain. Although the associations are modest, the assessment of SA should play a role in the interpretation of reported HRQOL after TBI.

Department of Medical Psychology and Medical Sociology (Ms Sasse, Drs Gibbons, and von Steinbüchel), Neurosurgery (Dr Martinez-Olivera), and Neurology (Dr Schmidt), University Medical Center, Göttingen, Germany; Department of Psychology, University of Stirling, Stirling, United Kingdom (Dr Wilson); German Institute for International Educational Research DIPF, Frankfurt am Main, Germany (Dr Hasselhorn); and KvW Neuroscience Consulting, Münster, Germany (Dr von Wild).

Corresponding Author: Nadine Sasse, Dipl.-Psych., Department of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37, 37073 Göttingen, Germany (

This study was funded by the ZNS–Hannelore Kohl Foundation, Germany (project number 2008014). Participant recruitment was assisted by Professor K. M. Stürmer and Dr S. Sehmisch, Trauma Surgery, Plastic and Reconstructive Surgery, University Medical Center Göttingen (UMG); Professor V. Rohde, Neurosurgery, UMG; Professor R. Behr, Neurosurgery, Clinical Center Fulda; Professor W. Deinsberger, Neurosurgery, Clinical Center Kassel and Dr W. Puschendorf, Westend Neurological Clinic, Bad Wildungen. The authors thank all these collaborators and individuals after TBI and their significant others who participated in this study.

The authors declare no conflicts of interest.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins