DIFFERING PROBLEM PERCEPTIONS OF STAFF, SURVIVORS, AND SIGNIFICANT OTHERS AFTER BRAIN INJURY

Objective: To examine the relationships of the perceptions of staff, s urvivors of brain injury (BT), and significant others (SOs) as represe nted on their respective versions of the Mayo-Portland Adaptability In ventory (MPAI) to each other, to psychometric markers of memory and ex ecutive cognitive function, and to depression. Design: Nonparametric a nalyses 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 survivo r on the appropriate form of the MPAI. Main Outcome Measures: Ratings on staff, survivor, and SO forms of the MPAI; MPAI indicator of depres sion; Trailmaking Test; Rivermead Behavioral Memory Test. Results: Sta ff 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 a nd nondepressed survivors. SO MPAI summary scores were more strongly r elated to those of staff than to those of survivors for nondepressed s urvivors. 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 execut ive cognitive function than did other survivors. Depressed survivors d id not consistently over- or underestimate their level of disability r elative to staff Conclusions: A degree of dysphoria may represent an a ppropriate reaction to BI and set an appropriate emotional tone for ac curate 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 expl oratory analyses suggest six major sources of bias affecting problem a ssessment by survivors, SO, and staff: depression, ISA, lay versus pro fessional terminology, values, observational opportunities, and impact /burden.