Pre-injury status and adaptation following traumatic brain injury.

There are an estimated two million traumatic brain injuries (TBI) each year in the US. Behavioural and psychosocial sequelae are the most disabling consequences of TBI, but relatively little empirical data exist that identify factors underlying the variability in patient outcomes. There is an increasing appreciation that pre-injury coping liabilities are likely to contribute to persistent disability and that outcome reflects the combined effects of pre-morbid, injury-related, and post-injury factors. Despite this, most outcome studies focus on the effects of injury-related and post-injury variables. The present study evaluated outcome in 45 adults who suffered a moderate or severe TBI at least 2 years earlier. It was hypothesized that severity of pre-morbid psychiatric and substance abuse problems and less social support following brain injury would be associated with poorer post-injury adaptation as measured by employment status, independent living status, and neurobehavioural symptomatology. The authors found that pre-injury psychiatric and substance abuse histories predicted employment status and that pre-injury substance abuse predicted independent living status. Social support following TBI predicted significant other's assessment of the patients' neurobehavioural status. None of the independent variables were found to predict patient assessment of his or her own neurobehavioural functioning. These findings support the premise that pre-morbid coping liabilities are related to the degree of post-injury disability.