Impaired self-awareness after traumatic brain injury: inter-rater reliability and factor structure of the Dysexecutive Questionnaire (DEX) in patients, significant others and clinicians.

AIMS: This study sought to address two questions: (1) what is the inter-rater reliability of the Dysexecutive Questionnaire (DEX) when completed by patients, their significant others, and clinicians; and (2) does the factor structure of the DEX vary for these three groups? METHODS: We obtained DEX ratings for 113 patients with an acquired brain injury from two brain injury services in the UK and two services in Ireland. We gathered data from two groups of raters-"significant others" (DEX-SO) such as partners and close family members and "clinicians" (DEX-C), who were psychologists or rehabilitation physicians working closely with the patient and who were able to provide an opinion about the patient's level of everyday executive functioning. Intra-class correlation coefficients and their 95% confidence intervals were calculated between each of the three groups (self, significant other, clinician). Principal axis factor (PAF) analyses were also conducted for each of the three groups. RESULTS: The factor analysis revealed a consistent one-factor model for each of the three groups of raters. However, the inter-rater reliability analyses showed a low level of agreement between the self-ratings and the ratings of the two groups of independent raters. We also found low agreement between the significant others and the clinicians. CONCLUSION: Although there was a consistent finding of a single factor solution for each of the three groups, the low level of agreement between significant others and clinicians raises a question about the reliability of the DEX.

Emotional distress and awareness following acquired brain injury: an exploratory analysis.

BACKGROUND: Symptoms of depression and anxiety are commonly reported following brain injury, providing ongoing challenges to patients, clinicians and carers. There is increasing interest in the influence of impaired awareness on emotional distress, supported by psychological investigations. OBJECTIVE: To explore the relationship between awareness and time since injury on reported emotional distress. METHOD: Awareness was assessed by comparing the reports of persons with brain injury to the reports of their treating clinicians and significant others. Fifty-four participants with acquired brain injury (ABI) completed the Awareness Questionnaire, the Dysexecutive Questionnaire and the Hospital Anxiety and Depression Scales. Clinicians and significant others completed the Awareness Questionnaire and the Dysexecutive Questionnaire in relation to each participant. RESULTS: Analyses of variance identified a main effect of awareness, such that participants with better awareness of their difficulties had higher emotional distress, regardless of time since injury. CONCLUSION: Findings support psychological theories suggesting that emotional distress is a response to the stressor of a brain injury and denial of difficulty, manifesting as impaired awareness, may play a protective role. They highlight the importance of understanding a patient's level of awareness so as to provide support aimed at minimizing the impact of distress on the rehabilitation outcome.