The trajectory of awareness across the first year after traumatic brain injury: The role of biopsychosocial factors

Objective: To examine self-awareness over the first year following traumatic brain injury (TBI) and the association of demographic, biological, cognitive, psychological and social-environmental factors with change in awareness. Research design: Using a longitudinal design the progression of awareness and association of demographic and biopsychosocial factors with its trajectory were analysed using random effects regression. Methods and procedures: Sixty individuals with mainly moderate-to-severe TBI completed assessments at 3, 6 and/or 12 months post-injury. Measures of awareness (Self-Awareness of Deficits Interview; SADI), demographic (age at time of injury and gender), injury severity (post-traumatic amnesia duration), cognitive (Trails Making Test-Part B), psychological (Hospital Anxiety and Depression Scale) and social-environmental (return to pre-injury activities) factors were administered. Main outcomes and results: Awareness improved over the first year post-injury. Analysis of SADI sub-scales revealed that females had greater awareness in terms of setting more realistic goals early in recovery compared to males. Models including demographic, biological, cognitive, psychological and social-environmental factors did not contribute significantly to prediction of awareness on the SADI above the influence of time. Conclusions: Time post-injury had the strongest influence on the development of awareness. This understanding may be important in determining the optimal timing of rehabilitative intervention.