Demographic and cognitive predictors of long-term psychosocial outcome following traumatic brain injury

Abstract

Demographic factors and cognitive impairment have been found previously to have associations with outcome after brain injury. Kendall and Terry (1996) suggest that preinjury psychosocial functioning, neurological factors, and cognitive impairment have a direct relationship with multidimensional psychosocial adjustment, but that cognitive impairment also has an indirect relationship by means of the mediation of appraisal and coping variables. The aim of this study was to explore these theoretical relationships at very late stages of recovery after brain injury. A total of 131 participants who were more than 10 years after injury (mean 5 15.31 yr) completed a neuropsychological assessment, plus outcome measures that included employment status, community integration, life satisfaction, quality of life (QoL), and emotion. Results indicated that injury severity was predictive of life satisfaction; gender and relationship status predicted community integration; and age at injury predicted employment status. Impairment in working memory directly predicted all outcomes except QoL and anxiety. An indirect relationship was also evident between working memory, life satisfaction, and depression. Results partially support Kendall and Terry's model but the variables that significantly influence outcome seem to be determined by the outcome dimensions selected. (JINS, 2006, 12, 350-358.)

Functional outcome 10 years after traumatic brain injury: Its relationship with demographic, injury severity, and cognitive and emotional status

“…On the other hand, Hoofien et al (2002) reported that injury severity, as measured by length of coma, was only predictive of psychiatric symptoms, accounting for 16% of the variance in this area. Wood and Rutterford (2006a) found that PTA duration was not significantly associated with most outcome measures, except for satisfaction with life, accounting for just 7.8% of variance. They suggested that the predictive power of injury severity may decline over time.…”

“…Regarding the influence of demographic variables, studies by Dawson and Chipman (1995), Hoofien et al (2002), Johnson (1998), Tate et al (2005), and Wood and Rutterford (2006a) have found no significant association between either age or gender and outcome. However, higher preinjury education has been associated with better long-term outcome in employment, social functioning, and community integration, both alone and in combination with injury severity, age, gender, and0or relationship status (Dawson & Chipman, 1995;Hoofien et al, 2002;Wood & Rutterford, 2006a).…”

“…Hoofien et al (2002) did assess long-term cognitive functioning, in terms of IQ, and psychiatric state, but did not examine their association with functional outcome measures. Wood and Rutterford (2006a) found in their mild-moderately injured TBI group that working memory was the only concurrently measured cognitive function associated with outcome, measured by self-reported community integration, life satisfaction, and depression. They did not investigate the relationship between psychiatric state and functional outcome measures.…”

“…However, higher preinjury education has been associated with better long-term outcome in employment, social functioning, and community integration, both alone and in combination with injury severity, age, gender, and0or relationship status (Dawson & Chipman, 1995;Hoofien et al, 2002;Wood & Rutterford, 2006a). Tate et al (2005) found that more skilled preinjury employment was associated with better outcome in living skills, relationships, and employment.…”

“…Given the youth of those injured, developing an understanding of factors predicting longer-term outcomes is important as a basis for planning for their future needs. Only a few studies have investigated factors predicting outcome more than 10 years after injury (Dawson & Chipman, 1995;Himanen et al, 2006;Hoofien et al, 2002;Johnson, 1998;Tate et al, 2005;Wood & Rutterford, 2006a). Findings from these long-term studies have been mixed, partly due to use of variable outcome measures.…”