This study examined the relationship of patient variables to caregiver distress and family functioning after TBI in 62 families. An extension of Kreutzer et al. 1994 (in press), the present investigation used four categories of predictor variables: indices of injury severity, neuropsychological tests, neurobehavioural problem checklist scales, and kinship of caregiver (i.e. spouse vs. parent). Caregiver distress and family functioning were measured by the Brief Symptom Inventory (BSI) and Family Assessment Device (FAD), respectively. Regression analyses revealed that indices of injury severity did not predict BSI scores. Time post-injury predicted several FAD subscales. The number of the patient's neurobehavioural problems predicted BSI subscale scores most consistently, particularly the Global Severity Index, Somatic, Obsessive-Compulsive and Depression scales. Scores on the behaviour problem subscale predicted BSI scores better than other kinds of problems, and also had some relation to several FAD subscales. Of the 10 neuropsychological test scores, those which measured verbal abilities were more predictive of caregiver's BSI scores. Kinship (i.e. being a spouse) predicted Depression scores, even when other variables were partialled out. Research findings are integrated with European studies and clinical implications for understanding caregiver distress are discussed.
"However , results for caregiver depression are contradictory. One study found that caregivers' report of patient neurobehavioral problems does predict caregiver depression ; however, other studies found no relationship between caregivers' perception of patient functioning and caregiver depression    . "
[Show abstract][Hide abstract] ABSTRACT: Objective: To determine which factors are highly associated with burden and depression in a group of caregivers of persons with Traumatic Brain Injury (TBI) in Colombia, South America. Design: Prospective. Participants: Fifty-one pairs of individuals with TBI and their caregivers from two major cities in Colombia completed a comprehensive psychosocial evaluation that included information related to patient and caregiver sociodemographic factors, patient factors, and caregiver estimation of patient neurobehavioral functioning. Outcome measures: Caregiver burden (Zarit Burden Interview) and caregiver depression (PHQ-9). Results: Generalized linear models revealed that patient language problems and caregiver perception of patient functioning on six neurobehavioral domains were related to caregiver burden. Caregiver socioeconomic status and caregiver perception of patient functioning on six neurobehavioral domains were related to caregiver depression. These variables were then selected as candidates for the multiple regression models, which were fit separately for caregiver depression and burden, and revealed that caregivers' perception of patient depression was the only factor associated with both caregiver burden and depression. Conclusion: Caregivers' perception of patient depression was the single best predictor of both caregiver burden and depression. Implications for treatment based on these preliminary findings are discussed.
[Show abstract][Hide abstract] ABSTRACT: Advances in medical and assistive technology have increased the likelihood of survival following a traumatic brain injury (TBI). Consequently, families frequently must provide care to individuals with TBI. Because they are rarely prepared for the associated demanding medical needs and financial burden, family caregivers are at risk for physical and emotional problems, which can negatively influence their individual and family functioning. Whereas scholars have examined the influence of survivor functioning on caregiver burden, few have explicitly recognized that caregiver burden also influences survivor functioning. Results of a multivariate linear regression suggest that, in a sample of 51 pairs of TBI survivors and their caregivers living in Colombia, survivors receiving care from a family member who reported a higher level of burden had poorer objective neuropsychological functioning than those receiving care from a family member who reported a lower level of burden, after controlling for survivor education and history of occupational therapy. Therefore, a family-focused approach might maximize intervention effectiveness, especially for Latin American and Hispanic families, which tend to be characterized by a strong sense of familism. The emphasis on family can create problems in a healthcare system that views the individual as the primary unit.
"A variety of injury consequences has been shown to be related to both emotional distress in relatives and poor family functioning as measured on these scales. By far the most common predictive factors have been changes in behavioural control (Brooks, Campsie, Symington, Beattie, & Mckinlay, 1986; Kreutzer et al., 1994a; Marsh et al., 1998a, 1998b; Oddy, Humphrey, & Uttley, 1978; Ponsford et al., 2003), and cognitive difficulties (Ergh et al., 2002; Kreutzer et al., 1994a; Machamer, Temkin, & Dikmen, 2002; Ponsford et al., 2003; Testa et al., 2006). Other associated factors have included, the injured individual's emotional state (Ponsford et al., 2003; Testa et al., 2006), physical impairment (Chan, 2007; Marsh et al., 1998a), as well as the level of the injured person's community participation (Chan, 2007; Machamer et al., 2002; Winstanley, Simpson, Tate, & Myles, 2006) and social integration (Marsh et al., 1998a; Ponsford et al., 2003). "
[Show abstract][Hide abstract] ABSTRACT: The objectives of the study were to examine family functioning and relatives' emotional state after traumatic brain injury (TBI), and to test a model of the relationship between neurobehavioural status, family functioning and relatives' emotional status at two and five years post-injury. The relatives of 98 adult individuals who had sustained severe TBI were followed up 2 and 5 years post-injury and completed the Family Assessment Device, the Hospital Anxiety and Depression Scale, and rated the neurobehavioural status (cognitive, behavioural, emotional, social) of their injured relative, using the Structured Outcomes Questionnaire. A structural equation model, based on existing research, was developed and tested on 66 of the participants. The level of family functioning and the rates of clinically relevant levels of anxiety and depression did not change over time (p > .05). The starting path model was revised. The final model had an excellent fit, χ(2)(16) = 15.20, p = .51; CFI = 1.00, RMSEA < .001, p for test of close fit = .66. In this model, poor family functioning and symptoms of anxiety and depression in the relatives were predicted by behavioural and mood changes in the injured individual. The relationship between family functioning and relatives' mood was reciprocal. The findings suggest the need for timely investigation and institution of interventions. Support is needed both for individual family members in dealing with their emotional distress as well as for the family as a whole, with the aim of maximising quality of life for those with TBI and their relatives.
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