Differing problem perceptions of staff, survivors, and significant others after brain injury

Objective: To examine the relationships of the perceptions of staff, survivors of brain injury (BI), and significant others (SOs) as represented on their respective versions of the Mayo-Portland Adaptability inventory (MPAI) to each other, to psychometric markers of memory and executive cognitive function, and to depression. Design: Nonparametric analyses of data obtained from consecutive clinical cases; exploratory individual item comparisons of MPAI forms. Setting: Outpatient clinic in a hospital-based comprehensive rehabilitation center. Participants: 45 to 51 pairs of staff, survivors, and SOs who had rated the survivor on the appropriate form of the MPAI. Main Outcome Measures: Ratings on staff, survivor, and SO forms of the MPAI; MPAI indicator of depression; Trailmaking Test; Rivermead Behavioral Memory Test. Results: Staff and survivor MPAIs correlated moderately well with each other only for subjects identified as depressed by staff. SO MPAI summary scores correlated moderately well with Staff MPAI scores for both depressed and nondepressed survivors. SO MPAI summary scores were more strongly related to those of staff than to those of survivors for nondepressed survivors. Survivors with impaired self-awareness (ISA) (ie, those who tended to greatly underestimate their problems relative to staff) were infrequently depressed and had more difficulty on a measure of executive cognitive function than did other survivors. Depressed survivors did not consistently over- or underestimate their level of disability relative to staff. Conclusions: A degree of dysphoria may represent an appropriate reaction to BI and set an appropriate emotional tone for accurate self-assessment after BI. Conversely, more extensive disability, impaired executive cognitive function, and ISA subsequent to BI are likely to interfere with normal emotional adaptation. Primary and exploratory analyses suggest six major sources of bias affecting problem assessment by survivors, SO, and staff: depression, ISA, lay versus professional terminology, values, observational opportunities, and impact/burden.