The Impact of Traumatic Brain Injury on Self-Identity: A Systematic Review of the Evidence for Self-Concept Changes

Objectives: This review systematically appraised the evidence for changes to self-identity after traumatic brain injury (TBI) in adults and investigated associations between self-concept changes and neurocognitive and psychosocial functioning. Methods: Systematic searches of 4 databases (PsycINFO, PubMed, CINAHL, and Cochrane Systematic Review Database) were undertaken from January 1983 to July 2014. Empirical studies were included if they used a quantitative measure of pre-/postinjury changes in self-concept after TBI or compared levels of self-concept between TBI and control participants. Results: Fifteen studies met the review criteria and, despite methodological differences, provided mostly evidence of negative changes to self-concept. However, stability in self-concept and positive changes to sense of self were also reported in some studies. Furthermore, levels of self-esteem and personality characteristics did not significantly differ between participants with TBI and orthopedic/trauma controls. Negative self-concept changes were associated with emotional distress in 3 studies. Conclusions: People with TBI most commonly experience negative changes in self-identity; however, such changes are also reported after other traumatic events or injuries. Greater consistency in measurement of self-identity change and use of longitudinal designs is recommended to improve understanding of factors contributing to self-concept changes after TBI and to guide clinical interventions.