Impact of pre-injury factors on outcome after severe traumatic brain injury: Does post-traumatic personality change represent an exacerbation of premorbid traits?
In their seminal paper, Kendall and Terry (1996) propose a model, modified from the theoretical framework of Lazarus and Folkman (1984), to account for individual differences in outcome and adjustment after traumatic brain injury (TBI). The model consists of three main components: antecedent variables, mediating factors, and outcomes. The focus of the present paper is on the first component, antecedent variables, particularly those that are precursors to the injury. Kendall and Terry identify a range of antecedent variables: cognitive impairments, neurological factors (pertaining to variables such as injury severity and lesion locus), personal resources (including self-esteem, locus of control), environmental resources (such as social support, family style, financial stressors), and situational factors. Heading the list, however, is pre-injury psychosocial functioning, which they describe as an “imperative” consideration in understanding post-trauma outcome and psychosocial adjustment after TBI. Kendall and Terry (1996) are not the first to draw attention to the potential significance of pre-injury factors. Thirty years ago, Lishman (1973) identified factors he described as “indirectly related to the injury”, such as environmental factors, emotional repercussions of the injury, and in particular, premorbid personality and mental constitution. These factors, he believed, contributed significantly to the postmorbid clinical picture. They are also important considerations in the neuropsychological assessment process to formulate and guide rehabilitation strategies (Alberts & Binder, 1991; Kay, 1992; Prigatano, 1999).