A Cross-Sectional Examination of the Relationship between Subjective Self-Regulatory Difficulties and Functional...

To test if subjective self-regulatory difficulties correlate with functional outcomes, and to test for group differences in self-regulatory abilities and functional outcomes between Veterans with and without a history of traumatic brain injury (TBI).

All Personality Assessment Inventory (PAI) protocols administered in the VA electronic system (N = 36,830) were pulled. Invalid PAI protocols were excluded, resulting in a sample size of N = 30,171. Of these, 1,933 had either a visit diagnosis of or service connected disability related to TBI. We conducted non-parametric tests of correlations and group differences while statistically adjusting for demographics.

Nearly all statistical tests were significant, even after accounting for multiple comparisons. Therefore, we focused on findings with large effect sizes. Strong correlations were observed among self-reported self-regulatory difficulties as well as between self-regulatory difficulties and functional outcomes. Notably, self-reported difficulties with emotion regulation (Affective Instability, BOR-A), inattention/disinhibition (Inattention Index), and general cognitive complaints (Thought Disorder, SCZ-T) were all associated with an indicator of future suicide attempt risk (Suicide Potential Index; ρs = .66-.78). Across all variables, effect sizes for TBI vs non-TBI comparisons were very small (${\eta}_p^2$s ≤ .003) and thus not practically significant.

Subjective self-regulatory difficulties, including emotion regulation difficulties, were associated with worse functional outcomes, and no meaningful differences were found between Veterans with vs without TBI. Therefore, results support the utility of addressing subjective self-regulatory complaints, regardless of the presence of objective cognitive deficits and/or TBI history, in treatment and rehabilitation efforts (e.g., cognitive rehabilitation).