Psychosocial adjustment following closed head injury: A model for understanding individual differences and predicting outcome

In addition to permanent physical and cognitive deficits, many individuals with closed head injury (CHI) experience poor psychosocial outcomes, such as interpersonal and family conflict, emotional distress, and behavioural disturbances. Although very little is known about the characteristics that predispose these individuals to psychosocial disruption following CHI, many researchers have suggested that neurological factors, such as the locus of the lesion, the severity of the injury or the level of cognitive impairment, offer the most parsimonious explanation. However, a number of studies have indicated that neurological factors are unable to account adequately for individual variation in psychosocial outcome, and that there might be a significant role for non-neurological factors. Despite this evidence, there has been a lack of research that has systematically investigated the non-neurological determinants of psychosocial adjustment among individuals with CHI. The present paper describes a model derived from the Lazarus and Folkman (1984) cognitive-phenomenological theory of stress and adjustment, which is proposed to be a heuristically useful framework for the examination of the non-neurological variables that might influence psychosocial well-being following CHI. It is proposed that, with adequate research, this model will have utility for the identification of ''at risk'' individuals and will provide a focus for rehabilitative efforts.