Associations between illness perceptions, distress, self-reported cognitive difficulties and cognitive performance after mild traumatic brain injury

Deborah L. Snell; Josh W. Faulkner; Jonathan A. Williman; Noah D. Silverberg; Alice Theadom; Lois J. Surgenor; Richard J. Siegert

doi:10.1071/IB24074

RESEARCH ARTICLE (Open Access)

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Associations between illness perceptions, distress, self-reported cognitive difficulties and cognitive performance after mild traumatic brain injury

Deborah L. Snell

^A ^* , Josh W. Faulkner

^B , Jonathan A. Williman ^C , Noah D. Silverberg ^D ^E ^F , Alice Theadom ^G , Lois J. Surgenor ^H and Richard J. Siegert ^G

+ Author Affiliations

- Author Affiliations

^A Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand.

^B School of Psychology, Te Herenga Waka-Victoria University of Wellington, Wellington, New Zealand.

^C Biostatistics and Computation Biology Unit, University of Otago Christchurch, Christchurch, New Zealand.

^D Department of Psychology, University of British Columbia, Vancouver, Canada.

^E Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, Canada.

^F Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada.

^G TBI Network, Department of Psychology and Neuroscience, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.

^H Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand.

^* Correspondence to: debbie.snell@otago.ac.nz

Handling Editor: Cynthia Honan

Brain Impairment 26, IB24074 https://doi.org/10.1071/IB24074

Submitted: 18 July 2024 Accepted: 3 July 2025 Published: 1 August 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the Australasian Society for the Study of Brain Impairment. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Objectives

To examine associations between subjective and objective cognitive problems, and factors potentially modifying these relationships, after mild traumatic brain injury (mTBI).

Methods

Treatment-seeking adults (n = 95) were assessed 6 weeks (Time 1) and then 6 months later (Time 2) after mTBI. Validated questionnaires assessed cognitive, emotional and somatic mTBI symptoms, distress, catastrophising, and beliefs about symptoms and recovery. Cognitive performance was measured using the National Institutes of Health Toolbox Cognition Battery. Using correlations and linear regression, we explored associations between psychological factors, objectively measured cognitive performance and self-reported cognitive symptoms.

Results

There were only modest correlations between subjective cognitive symptoms and objective cognitive performance at assessment timepoints. In contrast, there were medium to large correlations between subjective cognitive symptoms, post-concussion symptom burden and psychological factors. Post-concussion symptom burden and beliefs about symptoms and recovery at Time 1 predicted persisting self-reported cognitive symptoms at Time 2.

Conclusions

High post-concussion symptom burden and non-recovery expectations may increase risk for persistent subjectively experienced cognitive symptoms. Our findings may guide targeted treatment efforts focusing on factors with potential to influence cognitive symptom reporting after mTBI.

Keywords: adults, cognitive outcomes, cognitive performance, expectations, mild traumatic brain injury (mTBI), National Institutes of Health Toolbox Cognition Battery, post-concussion symptoms, self reported cognitive symptoms.

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