An investigation of self concept after traumatic brain injury

Abstract

Although there has been abundant previous research into the cognitive, emotional and behavioural sequalae of brain injury, there has been little research into the multidimensional aspects, predictors and improvement over time of an individual’s self concept following brain injury. There is evidence to suggest that self concept is often rated more poorly post injury relative to pre-injury. It has been shown that, in the general population, self concept can be influenced by a range of factors, including age, gender, education and familial relationship; however, little is known regarding factors that may influence self concept after brain injury. While some studies have suggested that self-concept may be altered by a variety of interventions and through interactions with close others, no known previous studies have made comparisons with demographically matched controls. The aims in the present thesis were (a) to compare the global and multidimensional self concept and self esteem post injury in a brain- injured sample with a matched trauma free sample, (b) to investigate the interrelationships between self concept, and injury related factors, demographic characteristics, psychological distress and family functioning post injury in individuals with brain injury and, (c) to examine the impact of a family focused intervention on self concept post injury in a brain injured sample. Forty-one ABI participants and 41 demographically matched controls completed the Tennessee Self concept scale (TSCS: 2), Hospital Anxiety and Depression Scales (HADS), the Family Assessment Device (FAD) and the Rosenberg Self Esteem scale (RSE). Of the ABI participants, majority were male (n = 29, 70.7%) and had been involved in a motor vehicle accident (n=22, 53.7%) with a mean age of 39.36 years at the time of participation in the study (SD=14.53, range = 18-73 years). Other causes of injury included assaults (7.3%), work related incidents (2.4%), and falls (19.5%), and other causes such as encephalitis (9.8%) and Cerebrovascular Accident (CVA; 7.3%). These latter participants were included on the basis that the injury had occurred at a young age and in the absence of progressive illness. The experience of sudden disruption to personal and family life and disruption of the family developmental cycle was similar to the TBI participants. Time since injury ranged from 1 to 20 years, with most participants approximately five years post injury (mean= 39.36, SD = 14.53). All participants had had moderate to severe brain injury and majority had completed 12 years of education (mean = 12.58, SD=12.4). TBI survivors rated themselves more poorly both globally and on a range of self concept dimensions, as measured by the TSCS: 2, including Social, Family, Academic, Work and Personal self concept compared to trauma free controls. They also reported higher mean levels of depression and anxiety on the HADS. Demographic and injury related factors had no significant influence on self concept post injury. However levels of anxiety and depression and family function, particularly family communication and affective responsiveness significantly predicted self concept post injury. Depression was the strongest predictor, followed by anxiety and family communication. Despite participating in a family focused intervention aimed at improving the functioning and recovery of individuals and families through information sharing, problem solving and social networking, the TBI participants demonstrated no significant changes in mood, self concept and family functioning relative to controls on the measures employed. Overall the thesis findings suggest that self concept and self esteem are negatively altered post injury compared to trauma free controls. Mood had a significant influence on self-concept after TBI, representing a possible focus of intervention to facilitate the emotional adjustment of the injury survivor and improve self concept. The observed relationships between family functioning, particularly familial responsiveness and communication, and self concept suggest the importance of including families in the rehabilitation process, both in acute and long term stages after injury. However, the failure of the family focused intervention to significantly alter self concept ratings suggests that this particular intervention may not be the most appropriate means of improving self concept in individuals with TBI. Given the sample size of this study, future research may benefit from examining larger samples.