Psychosocial adjustment 17 years after severe brain injury.

OBJECTIVES To examine very long term psychosocial outcome following severe brain injury in a large cohort, with the aim of evaluating Thomsen's observation that even after very serious head trauma the long term outcome in some patients is reasonably good. METHODS The cohort consisted of 80 patients who had suffered severe brain injury evaluated at a mean time of 17 years post injury (range 10-32 years). Information regarding employment status and relationship status was obtained during clinical interview. Psychosocial outcome measures included the Supervision Rating Scale, Satisfaction with Life Scale, Hospital Anxiety and Depression Scale (HADS), Patient Competency Rating Scale, and Community Integration Questionnaire. RESULTS Of the cohort, 72.0% lived independently, 28.7% were in full time employment, and 60.0% were married or cohabiting. The mean rating of life satisfaction was "slightly dissatisfied", but no serious emotional problems were evident from self report ratings on the HADS. Mean functional competency ratings and community integration levels were just below those reported for non-disabled patients. CONCLUSIONS Results indicate that although long term psychosocial functioning in patients with severe head injury remains compromised, long term adjustment may be better than expected from data reported by studies assessing psychosocial outcome at earlier stages of recovery.