Military Mild Traumatic Brain Injury Predicts Greater Negative Metacognitive Bias

To determine if remote military mild traumatic brain injury (mTBI) is uniquely associated with deficits in global metacognition, independent of psychopathology.

Translational Research Center for TBI and Stress Disorders, VA Boston Healthcare System.

A total of 567 community-dwelling post-9/11 veterans (mean age = 34): 182 veterans with no mTBI, 134 with at least one nonmilitary mTBI, and 251 with at least one military mTBI. Exclusion criteria were severe neurologic, psychiatric, or cognitive impairment; moderate/severe TBI; or effort-measure failure.

Cross-sectional examining predictors of global metacognition of cognitive abilities.

Global metacognitive bias, calculated as self-reported cognition (WHODAS-II Understanding/Communicating) minus objective cognitive performance (attention, memory, executive composite). Secondary measures included self-reported and objective cognition and global metacognitive sensitivity (correlation between self-reported and objective cognition).

Self-reported cognition scores for veterans with remote military mTBI were significantly lower than their objective cognition scores, resulting in significantly more negative metacognitive bias (M = -0.27, SD = 1.05) than those with a nonmilitary mTBI (M = 0.24, SD = 0.84) or no mTBI (M = 0.33, SD = 0.99). Notably, this effect remained significant after accounting for post-traumatic stress disorder (PTSD), depression, and anxiety/stress. It was not explained by blast exposure, peritraumatic context, or time since last mTBI, although it was modestly related to lifetime mTBI count.

Military mTBI is associated with more negative metacognitive bias independent of psychiatric conditions. Such bias may impede recovery and treatment effectiveness, suggesting that metacognitive interventions could be a valuable component of mild TBI care.