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Diagnosis Threat and Injury Beliefs after mid traumatic Brain Injury

Student thesis: Doctoral ThesisDoctor of Clinical Psychology

Background: Diagnosis threat is a form of stereotype threat, where individuals with a history of mild traumatic brain injury (mTBI) have shown performance decrements on cognitive tasks, owing to negative expectancies around cognitive ability elicited by cues in the environment. This study systematically reviews experimental studies to gauge the presence / absence of an effect of diagnosis threat on neuropsychological task performance in mTBI. It also investigates whether methodological variation and methodological quality contribute to variation in study findings.
Method: A systematic search of four online databases (Medline, PyscINFO, SportDISCUS, PsycEXTRA) was conducted to identify diagnosis threat studies that employed an experimental paradigm. Neuropsychological test outcomes were extracted, along with information on inclusion criteria, mTBI diagnostic criteria, participant characteristics and study design. Methodological quality was assessed using modified Scottish Intercollegiate Guidelines Network (SIGN) criteria.
Results: A total of nine studies were identified. Evidence for diagnosis threat was found, although there was considerable heterogeneity across study results. The most robust finding was the impact of diagnosis threat on the cognitive domain of attention / working memory. No clear associations between methodological variation, methodological quality and study outcome were noted.
Conclusions: The review found evidence for diagnosis threat, although the strength of this effect may be smaller than previously thought. Although there was heterogeneity across elements of study design, there was no obvious relationship between these factors and outcome. However, the substantial variation makes comparison difficult. These issues are similar to findings in other examinations of stereotype threat. Further research is needed to replicate findings and add clarity to the impact of diagnosis threat on both objective and subjective measures, and to further investigate the role of possible moderating variables. A more formal meta-analysis in the area may also be helpful to clarify findings in the research field. Future studies should aim to create established operational definitions and outcomes to improve consistency and comparability between studies.
Original languageEnglish
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Award date2015

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