Health-related quality of life after traumatic brain injury in context of self-awareness and coping modes

In reports and judgments on individual life circumstances, a person´s subjective perspective is not only of general psychological interest, but also of special relevance in clinical psychological assessment and medical applications. Thus, health-related quality of life (HRQOL) is an established outcome criterion in medical care, complementing objective diagnostic indicators by the patients´ subjectively experienced and rated satisfaction with their own health and life. Until recently, assessment of HRQOL after traumatic brain injury (TBI) was impeded since no TBI-specific instrument was available. This diagnostic gap has been resolved with the development and validation of the QOLIBRI questionnaire, which is innovatively used in the present research. Application of this new tool opens up the possibility to examine associations with other facets of the proposed HRQOL model by investigating the relation between reported HRQOL and other clinically relevant aspects such as self-awareness of physical and cognitive impairment and individual coping strategies after experiencing TBI. Within this context, the present report aimed to elucidate determinants and correlates of HRQOL after TBI, focusing on quality and extent of self-awareness of the resulting deficits, as well as preferred strategies patients employ to cope with their injury and its consequences. The obtained findings confirm the expected associations by demonstrating significant correlations between TBI-specific HRQOL, self-awareness, and coping strategies. A lack of self-awareness or anosognosia (i.e., unrealistically positive appraisement of their post-injury abilities and competencies), frequently observed after TBI, was seen to go along with more optimistic HRQOL self-reports. Presence of impaired self-awareness may well also lead to overly positive HRQOL ratings in this particular subgroup, thus demanding caution when interpreting their subjective assertions. Moreover, different individual utilization of specific coping strategies was also found to be differentially related to the reported HRQOL profile. As demonstrated here, self-awareness and impaired self-awareness as well as preferentially employed coping strategies represent important factors within a TBI-specific model of HRQOL. In addition to underlining the clinical and practical relevance of including the subjective perspective in rehabilitation and supportive healthcare efforts after TBI, the associations documented in this particular clinical sample also contribute to uncovering systematic relations among general aspects of human experience and behavior