The role of pre-morbid personality in predicting rehabilitative outcome in people with acquired brain injury: A systematic review

Pre-morbid personality is often reported to be a significant factor in accounting for patients' outcome following Acquired Brain Injury (ABI). The purpose of the present systematic literature review was to examine the impact of pre-morbid personality on outcomes in people who have sustained an ABI. The Cochrane Register, Web of Science, MEDLINE, PUBMED, PsycINFO, Science Direct and EMBASE were systematically searched using specified keywords. Additionally, key journals were searched and reference lists of included studies were examined to identify further studies that might meet inclusion criteria. Moreover, a number of eminent international scholars who have published work in this area were contacted to help identify the possible existence of 'difficult to source' studies or papers in press. The systematic review identified 1098 peer-reviewed published papers (1990-2010). The sequential application of specified exclusion criteria subsequently reduced this number to four. All four studies were American and reported on Traumatic Brain Injury specifically. Personality was construed under the Five Factor Model, and the NEO-PI or NEO-PI-R was the method of personality assessment undertaken in all of the short-listed studies. There were a variety of outcomes assessed across studies, namely Social Role Engagement, Behavioural Adjustment, Independence and Neurobehavioural Functioning. The proportion of the variance accounted for by personality ranged from 57% in relation to behavioural adjustment and 7% in relation to participation and independence ratings. While the breadth and number of quality studies were low, the results of this systematic review may suggest that assessment of personality dimensions may be helpful for behavioural adjustment outcomes but would appear to possess more limited explanatory power for broader outcomes such as independence and community or social role engagement. Moreover, applied psychologists may be better served including assessments of distress rather than personality as this may be a proximal issue inhibiting the attainment of positive rehabilitative outcomes following injury to the brain.