Perceived poor sleep quality is the most commonly reported issue among veterans with a history of mild traumatic brain injury (mTBI). Poor sleep can impact aspects of objective and subjective executive functioning abilities (e.g., planning, organization, decision-making) and lead to decreased societal participation. However, less is known about how perceived executive dysfunction impacts the relationship between perceived poor sleep and societal participation in veterans with a prior history of mTBI. We hypothesized that executive dysfunction mediates the relationship between subjective sleep quality and societal participation.

Participants included sixty-two U.S. veterans [Age: M=41.73 (SD=13.19); Education: M=15.16 (SD=2.20); 14.5% female]. The participants completed the Mayo-Portland Adaptability Inventory - 4 (MPAI-4; total scores), the Behavior Rating Inventory of Executive Function - Adult (BRIEF-A; subscale planning/organizing), and the Pittsburg Sleep Quality Index (PSQI; total scores). 21 participants met diagnostic criteria for Post-traumatic stress disorder (PTSD) [as determined by a cutoff score of 45 on the PTSD Checklist for DSM-5 (PCL-5)]. A mediation analysis was utilized to examine the impact of executive functions on the relationship between perceived sleep quality and societal participation. Mediation analyses were conducted via linear regression modeling using SPSS Version 27. Post hoc analyses were conducted to control for PTSD, which is common in veteran populations.

The total PSQI scores significantly predicted MPAI-4 total scores F(1, 53) = 16.740, p < .001 (R2= .55) when controlling for PTSD diagnoses. A mediation analysis showed that BRIEF-A Planning/Organizing T-scores partially mediate the relationship between PSQI scores and MPAI-4 scores when controlling for PTSD diagnoses F(2, 54) = 12.055, p < .001 (R2 = .61).

Results suggest that per000eived sleep quality impacts societal participation. However, how patients perceive their executive functioning abilities partially mediates the relationship between perceived sleep quality and societal participation, such that perceived poor sleep quality leads to reduced societal participation when there is subjective executive dysfunction. Therefore, clinical interventions should focus on the cognitive rehabilitation of executive functioning among veterans with a history of mTBI to improve their subjective experience. Ultimately, these efforts may improve veterans’ participation and utilization of healthcare services.