A Mixed Methods Investigation of the Impact of Neurocognition, Gender Role Conflict and Self-Identity on Psychosocial Adjustment to Traumatic Brain Injury

Many persons with traumatic brain injury (TBI) experience substantial emotional distress and psychosocial adjustment difficulties. The contribution of alterations in gender roles and self-identity to psychosocial adjustment has been hypothesized, but not empirically investigated. To address this gap in the research, the current study: (1) assessed experiences of gender role conflict and changes in sense of self after TBI, (2) assessed gender and racial/ethnic differences on gender role conflict and changes in sense of self (3) investigated the mediation effects of cognitive functioning and avoidant coping, and (4) tested a moderated-mediation model of psychosocial adjustment by gender and race/ethnicity. Using an equal-status, concurrent mixed-method approach, 60 persons with TBI, who were at least 3 months post injury, participated in a semi-structured interview regarding the gender role conflict and self-identity after TBI, brief neuropsychological assessments of cognitive functioning, and self-report measures on gender roles, gender role conflict, sense of self, coping, acceptance of disability, anxiety, and depression. Using quota sampling of men and women, forty-eight of the sixty participants completed qualitative interviews based on their racial make-up and stage of recovery. An overall model using structural regression modeling was utilized to test meditational and moderated mediation effects of factors influencing psychosocial adjustment to TBI. Persons with TBI reported gender role conflict and changes in sense of self, which impacted their adjustment to TBI. Avoidant coping fully mediated the relationship between self-identity and psychosocial adjustment. A theory of Reconstructing Identity after TBI emerged from the data, which has implications for clinical practice, service delivery and identifying key factors associated with psychosocial adjustment of a diverse sample of persons with TBI.