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Factors Influencing Self-Awareness Following Traumatic Brain Injury

Richardson, Cally BPsych (Hons); McKay, Adam PhD, MPsych (Clin Neuropsych); Ponsford, Jennie L. PhD, MA (Clin Neuropsych), BA (Hons)

Journal of Head Trauma Rehabilitation: March/April 2015 - Volume 30 - Issue 2 - p E43–E54
doi: 10.1097/HTR.0000000000000048
Original Articles

Objective: To examine self-awareness and injury-related, emotional and demographic factors across acute/subacute (3-12 months), medium-term (24–60 months), and long-term (120-240 months) time periods after traumatic brain injury (TBI), because unawareness of injury-related changes can affect engagement in rehabilitation and functional outcomes.

Participants: A total of 168 individuals with mild to severe TBI and 105 of their close others.

Main Outcomes Measures: Awareness Questionnaire (AQ) and Hospital Anxiety and Depression Scale.

Design: Cross-sectional study.

Results: There were no significant differences in awareness as a function of time postinjury, except for the AQ motor/sensory domain wherein individuals with TBI at longer time periods displayed increased awareness of deficits than those at earlier time periods. Greater patient-other AQ discrepancy scores (interpreted as lower patient awareness) were associated with longer posttraumatic amnesia duration in the individual with TBI and also with increased self-reported depressive symptoms in the close others. Conversely, smaller AQ discrepancy scores (interpreted as better awareness) were associated with increased self-reported depressive symptoms by the individuals with TBI.

Conclusion: This study highlights the limitations of using discrepancy scores to measure awareness, as ratings of injury-related changes are influenced by the mood of the individual with TBI and the close other, as well as by injury severity.

School of Psychology and Psychiatry, Monash University (Ms Richardson, Dr Ponsford, and Dr McKay); Monash-Epworth Rehabilitation Research Centre, Epworth Hospital (Ms Richardson and Dr Ponsford); and Epworth Rehabilitation (Dr McKay), Melbourne, Australia.

Corresponding Author: Cally Richardson, BPsych (Hons), School of Psychology and Psychiatry, Monash University, Wellington Road, Clayton, Melbourne 3800, Australia (

J.L.P. has received royalties from Psychology Press and Guilford Press for textbooks on traumatic brain injury.

The authors declare no conflicts of interest.

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