B-116: Subjective-Objective Cognitive Discrepancies in Veterans With mTBI: Impacts of Psychiatric Conditions and Comorbidity on Global Metacognitive Bias

Abstract

Objective: Global metacognitive bias (discrepancy in objective and self-reported cognition) is associated with negative outcomes in Veterans with mild traumatic brain injury (TBI/mTBI). This study examined the impact of psychiatric comorbidity on this relationship, specifically depression and posttraumatic stress disorder (PTSD), in U.S. Veterans and service members with mTBI. Method/Data Selection: Participants (N = 2,857) were grouped by diagnosis: depression (n = 269), PTSD (n = 286), comorbid depression and PTSD (n = 693), and no diagnosis (n = 1,609). The sample was predominantly male (87.7%), White (70.4%), non-Hispanic (81.5%), and ~42.3 years old (SD = 10.6). Objective cognition was assessed via a neuropsychological battery spanning attention, memory, processing speed, executive function, and verbal fluency; self-reported cognition was measured using the cognitive domain of the Neurobehavioral Symptom Inventory (NSI). A global metacognitive bias composite was computed by subtracting mean objective performance from NSI scores, with lower scores reflecting worse self-reported than objective cognition. Results/Data Synthesis: Compared to no diagnosis, PTSD only (B = -0.57, 95% CI [-0.69, -0.46]), depression only (B = -0.74, 95% CI [-0.85, -0.62]), and comorbid depression and PTSD (B = -1.2, 95% CI [-1.3, -1.1]) were each significantly associated with more negative metacognitive bias (ps < .001). Single-diagnosis groups did not differ, while the comorbid group demonstrated significantly greater negative bias than either single-diagnosis group. Conclusions: Findings suggest that Veterans with depression and PTSD were the most likely to endorse discrepancies in self-reported and objective cognitive functioning following mTBI, pointing to the need for heightened screening and targeted intervention in this group.