Cognitive, emotional and interpersonal determinants of loneliness in brain injury survivors

Loneliness is a frequent yet understudied consequence of acquired brain injury (ABI), associated with poorer psychological adjustment and social participation. This study examined the relative contributions of executive dysfunction, emotional reactivity, and concealment to loneliness in individuals with chronic ABI.

Cross-sectional observational study of 103 adults with ABI (61.2% men; mean age ≈ 51 years; mean time since injury ≈ 80 months). Measures included the UCLA Loneliness Scale, Frontal Systems Behaviour Scale, Perth Emotional Reactivity Scale, and Anticipated Stigma/Concealment Questionnaire. Analyses comprised correlations and hierarchical regressions.

Loneliness was significantly associated with greater negative emotional reactivity (ρ = .74, p < .001) and concealment (ρ = .56, p = .001). Executive dysfunction showed a small positive association with loneliness (ρ = .20, p = .04). The final regression model explained 58% of variance in loneliness (R² = .58, F(3,99) = 46.27, p < .001). Negative emotional reactivity and concealment remained significant independent predictors, whereas executive dysfunction did not.

Post-ABI loneliness is primarily associated with negative emotional reactivity and concealment. Findings support screening for loneliness, emotional reactivity, and concealment, and interventions targeting emotional hyperreactivity and tendencies to conceal information routinely in clinical rehabilitation settings following acquired brain injury.