Experiences that challenge self-identity following traumatic brain injury: a meta-synthesis of qualitative research

Abstract
Purpose: To systematically review and synthesise the qualitative literature on experiences that challenge self-identity following traumatic brain injury (TBI).

Method: Four electronic databases were searched systematically for qualitative research published between 1965 and August 2017, investigating subjective experiences of identity change following TBI. Papers which met the inclusion criteria were evaluated using the Critical Skills Appraisal Programme (CASP) tool and synthesised using guidelines by Thomas and Harden (2008).

Results: Of the 1965 papers retrieved, 36 met inclusion and quality criteria. Synthesis resulted in six themes: (1) awareness of change in physical, cognitive, emotional and social functioning; (2) autobiographical memory loss; (3) responses of other people that highlight change; (4) loss of autonomy; (5) comparing old me and new me–loss of valued roles and activities; (6) social rejection and stigma.

Conclusions: An in-depth understanding of the experiences that challenge self-identity after TBI can inform rehabilitation to support individuals to negotiate these processes with less distress and more successfully.

Implications for Rehabilitation
After a traumatic brain injury some people perceive catastrophic changes in their self-identity, and this can have a substantial negative impact on their psychological well-being.

Circumstances and events that can trigger such appraisals include developing awareness of loss of ability and function; gaps in autobiographical memory; when others highlight loss and change; the loss of valued roles and activities; and social stigma and rejection.

Clinicians should be aware of these triggers and their potential impact so that they can support people to negotiate them more effectively, with less damage to self-identity and psychological well-being.