Objective Versus Subjective Cognitive Status Following Mild Traumatic Brain Injury: The Role of Psychological Factors.

Objective: To determine whether there is a relationship between objective cognitive performance and self-reported cognitive status after mild traumatic brain injury (mTBI) and whether mental health symptoms influence this relationship.

Participants and design: Secondary analysis of the Federal Interagency Traumatic Brain Injury Research Informatics System database included an initial sample of 2657 participants. Cases with missing data, questionable validity, age over 65, or mild-complicated, moderate, or severe TBI were excluded resulting in a final sample of 614 individuals (n = 138 controls and n = 476 mTBI).

Main measures: Z-scores were derived using the Brief Test of Cognition by Telephone (BTACT) cognitive screener and the composite of the cognitive complaint items (CC) on the Rivermead Postconcussion Symptoms Questionnaire to represent objective and subjective cognitive status, respectively. The cognitive discrepancy was calculated by regressing BTACT on CC scores and retaining standardized residuals which produced a different score. A linear regression model was fitted using continuous cognitive discrepancy scores as the outcome and age, gender, time since injury, education, and mental health status (obtained via several self-report questionnaires) as predictors.

Results: Individuals with mTBI had higher affective symptoms and cognitive complaints but did not differ from controls based on objective cognitive abilities. Affective symptoms were significantly higher in individuals with mTBI who reported higher subjective complaints than expected based on cognitive scores. Older age, female gender, and increased emotional distress were associated with greater cognitive discrepancy in the whole sample.

Conclusions: Consistent with prior research, elevated psychological symptoms burden was associated with higher subjective cognitive complaints in relation to objective cognitive abilities. These results highlight the continued need for psychological intervention in post-mTBI recovery.