Melbourne School of Psychological Sciences - Theses
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ItemLongitudinal prospective study of self-esteem and psycho-social function after childhood traumatic brain injury: delineating the contribution of injury, environmental, and individual factors( 2023-07)Background: Traumatic brain injury (TBI) is a significant public health burden that is a key contributor to lifelong disability. Such injuries can disrupt brain networks undergoing maturation during childhood and derail their ongoing development, contributing to profound changes in functioning. Sustaining a childhood TBI may also influence how individuals perceive themselves i.e., their self-esteem; however, current evidence base is weakened by retrospective, cross-sectional designs, and recruitment of heterogeneous samples. The overall aim of this prospective, longitudinal investigation was to examine the impact of paediatric TBI on self-esteem across childhood/adolescence and into young adulthood, and identify factors that contribute to individual variation in self-esteem. Method: The original study comprised 112 children and adolescents with mild-severe TBI (Anderson et al., 2013). For comparison, 43 typically developing controls matched on age, sex, and socioeconomic status were included. Participating families, both children and their parents, completed assessments at an outpatient clinic or at home at 6- and 12-months post-injury. At the 13-year follow-up time point, 29 young adults with childhood TBI and 10 typically developing controls were recruited from the existing cohort. Consenting participants completed questionnaires online. Results: As documented in three published and one submitted manuscript (chapters 6-9), findings revealed that some aspects of self-esteem may be especially vulnerable to deterioration following TBI. Specifically, perceived competence in both academic and behavioural domains was found to be significantly lower amongst children and adolescents with TBI, relative to typically developing controls. Individual variance in longitudinal self-esteem outcomes was documented in relation to injury factors (TBI severity, injury age, presence of frontal lobe pathology), environmental variables (parent mental health, family function, peer relations), and individual characteristics (social isolation, emotional wellbeing). For young adult survivors of childhood TBI, low self-esteem was endorsed by a sizeable proportion (approximately 20% or 1 in 5 TBI participants). Conclusions: Evidence for links between self-esteem and a multitude of injury, environmental, and individual factors accord with both developmental and brain-injury specific theoretical frameworks, and caution against exclusive reliance on injury-related variables when determining consequences of childhood TBI, especially in the context of self-esteem. While injury severity had some influence, environmental, and individual factors consistently made the largest and most significant contribution to global and domain-specific self-esteem. Collectively, results from the present investigation underscore the importance of routine and ongoing screening of non-injury, potentially modifiable risk factors, which likely represent useful targets for clinical interventions and rehabilitation programs seeking to optimise self-esteem in the short- and long-term following childhood TBI.