Theory of mind impairment after severe traumatic brain injury and its relationship with caregivers' quality of life.

Purpose: Theory of mind (ToM) deficits are common consequences of severe Traumatic Brain Injury (sTBI), but little is known about their impact on patients' and their caregivers' quality of life. This study aimed (i) to examine the presence of ToM difficulties in individuals with sTBI and adequate levels of self-awareness (SA); (ii) to investigate their relationship with perceived Health Related Quality of Life (HRQoL) in patients and their caregivers. Methods: Twenty individuals with sTBI and adequate levels of SA, and 20 healthy controls (HCs) were recruited. ToM was examined by the Faux-pas Recognition paradigm. The QOLIBRI questionnaire was administered to patients and their caregivers to assess their HRQoL. Cognitive functioning and psychopathology were evaluated. Results: Individuals with sTBI were less accurate than HCs on the Faux-pas Recognition paradigm. Patients' satisfaction of HRQoL was related to their performance on the Wisconsin Card Sorting Test. Caregivers' satisfaction was significantly predicted by patients' score on the Faux-pas paradigm. Conclusions: ToM is impaired in individuals with sTBI and adequate levels of SA. Moreover, their ToM performance predicted HRQoL in the caregivers. From a clinical perspective, these results provide understanding of the potential impact of ToM impairment in subjects with sTBI and their social system.