Self-assessment of impairment, impaired self-awareness, and depression after traumatic brain injury

James F. Malec, Julie A. Testa, Beth K. Rush, Allen W. Brown, Anne M. Moessner

Research output: Contribution to journalArticlepeer-review

80 Scopus citations


OBJECTIVE: To identify patient features associated with early and late depression after traumatic brain injury (TBI). PARTICIPANTS: 3 clinical trauma groups (mild TBI, moderate-severe TBI, orthopedic injury) and their significant others. MEASURES: Preinjury: age, education, substance abuse, and psychiatric history; Injury severity: classification using Glasgow Coma Scale and cranial CT scan, posttraumatic amnesia; Early impairment: Neurobehavioral Functioning Inventory (NFI), Impaired Self-Awareness (ISA); Social and family support: Multidimensional Scale of Perceived Social Support, Family Assessment Device; Depression: NFI Depression Scale. METHOD: Regression analyses of predictor variables on early and late measures of depression. RESULTS: Depression rates did not differ among the 3 trauma groups. Preinjury level of education, previous psychiatric history, and perceived level of social support explained a small portion of the variance in depressive symptoms. Patients' self-assessment of their impairment at discharge was most strongly correlated with both early and late depression. ISA was associated with reduced self-report of depressive symptoms. However, when those with ISA were excluded from the analysis, self-assessment of impairment remained strongly associated with depression. CONCLUSIONS: Patients' self-assessment of impairment is strongly associated with early and late depression. Presence and severity of TBI does not appear to play a direct role in depression but does appear related to ISA, which serves as a barrier to the development of depression. Focusing on impairment appears to be a cardinal feature of depression in both patients with TBI and an orthopedic trauma group.

Original languageEnglish (US)
Pages (from-to)156-166
Number of pages11
JournalJournal of Head Trauma Rehabilitation
Issue number3
StatePublished - May 2007


  • Brain injury
  • Depression
  • Impaired self-awareness
  • Rehabilitation

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation
  • Clinical Neurology


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