Negative Attribution Bias and Related Risk Factors After Brain Injury

Factors related to social inferencing performance in moderate-severe, chronic TBI

OBJECTIVE

Following traumatic brain injury (TBI), deficits in social cognition are common. Social inferencing is a crucial component of social cognition that enables an individual to understand the thoughts, feelings, and intentions of a communication partner when this information is not explicitly stated. Existing literature suggests a variety of factors contribute to social inferencing success (e.g. biological sex, executive functioning), yet findings are not conclusive, largely because these factors have been examined in isolation.

METHOD

In this cross-sectional study, stepwise regression with cross validation was used to examine the extent that several theoretically motivated factors were associated with social inferencing (measured by performance on The Awareness of Social Inference Test [TASIT]) in adult participants with TBI (n = 105). Demographic information, executive functioning, aggression, emotional functioning measures, and participation in society were all examined in relation to social inferencing performance.

RESULTS

The findings confirm the importance of higher-level cognitive skills (i.e. executive functioning) in social inferencing, and advance the literature by underlining the potential importance of productive participation in social inferencing performance.

CONCLUSION

This study innovatively highlights factors linked with social inferencing skills and, in doing so, how deficits in social inferencing might manifest in the lives of individuals with TBI.

Influence of medical humanization on patients' attribution in negative medical situations with communication as the mediator: a questionnaire study

Background

Patients' attribution in negative medical situations plays a vital role in reducing medical conflicts and developing high-quality healthcare. The purpose of this study was to investigate the triadic relations among patients' attribution, medical humanization and communication. Furthermore, the mediating effect of communication was tested.

Methods

A cross-sectional study on the relationship between patients' attribution in negative medical situations and medical staff's humanization and communication was conducted, with 3,000 participants totally from 103 hospitals of three different levels in different regions.

Results

There were significant positive correlations among medical staff's humanization, communication and patients' attributional styles (r = 0.112-0.236, p < 0.001 for all). Medical humanization had direct predictive effects on patients' attributional style in negative medical situations (β = 0.14, p < 0.01). Mediation analysis also indicated the indirect predictive effect of medical humanization on patients' attributions through communication (β = 0.02, p < 0.01).

Conclusion

Patients' attribution in negative medical situations is predicted by patients' perception of medical staff's humanization in healthcare and physicians' communication skills. Medical humanization not only affects patients' attributions in negative situations directly, but also influences patients' attributions via communication indirectly. The humanistic care should be included in medical education for healthcare professionals, and professional training on medical staff's humanization and communication skills is strongly needed to establish healthy and harmonious doctor-patient relationship.

Perceived care partner burden at 1-year post-injury and associations with emotional awareness, functioning, and empathy after TBI: A TBI model systems study

BACKGROUND

People with traumatic brain injury (TBI) can lack awareness of their own emotions and often have problems with emotion dysregulation, affective disorders, and empathy deficits. These impairments are known to impact psychosocial behaviors and may contribute to the burden experienced by care partners of individuals with TBI.

OBJECTIVE

To examine the associations of emotional awareness, emotional functioning, and empathy among participants with TBI with care partner burden.

METHOD

This multisite, cross-sectional, observational study used data from 90 dyads (participants with TBI and their care partner) 1-year post-injury. Participants with TBI completed the Difficulty with Emotional Regulation Scale (DERS; Awareness, Clarity, Goals, Impulse, Nonacceptance, and Strategies subscales); PTSD Checklist-Civilian Version; NIH Toolbox Anger-Affect, Hostility and Aggression Subdomains; PHQ-9; GAD-7; and the Interpersonal Reactivity Index (empathic concern and perspective taking subscales). Care partners completed the Zarit Burden Inventory (ZBI) and provided demographic information.

RESULTS

Care partners were predominately female (77%), and most were either a spouse/partner (55.2%) or parent (34.4%). In an unadjusted model that included assessments of emotional awareness, emotional functioning, and empathy of the participant with TBI, the DERS-Awareness and NIH-Hostility subscales accounted for a significant amount of variance associated with care partner burden. These findings persisted after adjusting for care partner age, relationship, education, and the functional status of the participant with TBI (β= 0.493 and β= 0.328, respectively).

CONCLUSION

These findings suggest that high levels of hostility and low emotional self-awareness can significantly affect the burden felt by TBI care partners.

An Examination of Social Inferencing Skills in Males and Females Following Traumatic Brain Injury

OBJECTIVE

This study examines sex differences in social inferencing deficits after traumatic brain injury (TBI), and examines the odds of males and females being impaired while controlling for potential confounders.

DESIGN

Cross-sectional survey.

SETTING

Outpatient.USA and a University in Canada.

PARTICIPANTS

One hundred five participants with TBI (60 males, 45 females) and 105 healthy controls (HC; 57 males, 48 females).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The Awareness of Social Inference Test (TASIT), which includes 1) Emotional Evaluation Test (EET), 2) Social Inference-Minimal (SI-M) test, and 3) Social Inference-Enriched (SI-E) test.

RESULTS

Within the HC sample, males and females performed similarly on all three TASIT subtests. Within the TBI group, males had significantly lower scores than females on EET (P = 0.03), SI-M (P=0.01) and SI-E (P=0.04). Using impairment cutoffs derived from the HC sample, significantly more males with TBI (30%) were impaired on the EET than females(16.7%); impairment was similar between males and females on SI-M and SI-E. When adjusting for executive functioning and education, the odds of being impaired on the EET did not significantly differ for males and females (OR = 0.47; 95% CI: 0.16 - 1.40; P = 0.18).

CONCLUSIONS

While more males with TBI have emotion perception deficits than females, the difference appears to be driven by education and executive functioning. Research is needed in larger samples with more definitive norms to better understand social inferencing impairments in males and females with TBI, and translation to interpersonal behaviors.