Associations between executive functioning, coping, and psychosocial functioning after acquired brain injury

Objectives: To examine the relationships between executive functioning, coping, depressive symptoms, and quality of life in individuals with neuropsychiatric symptoms after acquired brain injury (ABI).

Design: Cross-sectional study.

Methods: Individuals (n = 93) in the post-acute and chronic phase (>3 months) after ABI and their significant others (N = 58) were recruited from outpatient clinics of four mental health centres in the Netherlands. Outcome measures were the Trail Making Test, Stroop Colour Word Test, Frontal Systems Behavioural Scale, Utrecht Coping List, Patient Health Questionnaire, and Life Satisfaction Questionnaire. Data were analysed with multiple regression analyses.

Results: Self-reported executive dysfunction was associated with greater use of passive coping styles (β = .37, p < .01), and passive coping, in turn, was associated with lower quality of life (β = -.57, p < .001) and more depressive symptoms (β = .65, p < .001). Problem-focused coping was associated with higher quality of life among individuals who reported better executive functioning (β = -.94, p < .05). Performances on executive functioning tests were not associated with coping, depressive symptoms, or quality of life.

Conclusions: For clinicians, these data indicate that individuals who report greater difficulties with executive functioning after ABI are inclined to use maladaptive passive coping styles, which should be targeted in treatment. In comparison, individuals who report greater difficulties with executive functioning should not be prompted to use problem-focused coping styles. These individuals may benefit from other coping styles, such as the use of seeking social support or acceptance of problems.

Practitioner points: Coping influences the association between executive functioning and quality of life. Individuals who report difficulties with executive functioning after ABI may be inclined to use passive coping styles, which are maladaptive. Problem-focused coping strategies may be more useful for individuals who have strong executive abilities. This study was a cross-sectional study; thus, a cause-and-effect relationship could not be established between executive functioning, coping, and psychosocial functioning. As this research was part of standard clinical care, non-traditional tests for executive functioning were not administered.