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Family functioning and emotional state two and five years after traumatic brain injury

Published online by Cambridge University Press:  04 February 2010

JENNIE PONSFORD  and
MICHAEL SCHÖNBERGER
JENNIE PONSFORD*
Affiliation:
School of Psychology and Psychiatry, Monash University, Melbourne Australia Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia National Trauma Research Institute, Melbourne, Australia
MICHAEL SCHÖNBERGER
Affiliation:
School of Psychology and Psychiatry, Monash University, Melbourne Australia Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
*
*Correspondence and reprint requests to: Jennie Ponsford, Ph.D., School of Psychology, Psychiatry, and Psychological Medicine, Monash University, Clayton Campus, Wellington Road, Building 17, VIC 3800, Australia. E-mail: Jennie.Ponsford@med.monash.edu.au
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Abstract

Previous studies have documented poor family functioning, anxiety, and depression in relatives of individuals with traumatic brain injury (TBI). However, few studies have examined family functioning over extended periods after injury. The present study aimed to investigate family functioning and relatives’ emotional state 2 and 5 years following TBI, predictive factors, and their interrelationships. Participants were individuals with TBI and their relatives, with 301 seen at 2 years and 266 at 5 years post-injury. Measures included a Structured Outcome Questionnaire, Family Assessment Device (FAD), Hospital Anxiety and Depression Scale, and the Craig Handicap Assessment and Reporting Technique. Results showed that while the group did not differ greatly in family functioning from a normative group, a significant proportion showed unhealthy functioning across most FAD subscales. Both TBI participants and their relatives showed elevated rates of anxiety and depression. There was little difference between family functioning or relatives’ anxiety or depression levels at 2 and 5 years post-injury. Path analysis indicated that neurobehavioral changes in the injured individual have an impact on family functioning and distress in relatives even at 5 years post-injury. These findings indicate the need for long-term support of families with a brain-injured member. (JINS, 2010, 16, 306–317.)

Keywords

Traumatic brain injuryFamily functioningRelativesAnxietyDepressionStructural Equation Modelling
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 16 , Issue 2 , March 2010 , pp. 306 - 317
Copyright
Copyright © The International Neuropsychological Society 2010

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References

REFERENCES

Allen, K., Linn, R.T., Gutierrez, H., & Willer, B.S. (1994). Family burden following traumatic brain injury. Rehabilitation Psychology, 39, 29–48.Google Scholar
Anderson, M.I., Parmenter, T.R., & Mok, M. (2002). The relationship between neurobehavioural problems of severe traumatic brain injury (TBI), family functioning and the psychological wellbeing of the spouse/caregiver: Path model analysis. Brain Injury, 16, 743–757.Google Scholar
Bjelland, I., Dahl, A.A., Haug, T.T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of Psychosomatic Research, 52, 69–77.CrossRefGoogle ScholarPubMed
Boake, C., & High, W.M. (1996). Functional outcome from traumatic brain injury – Unidimensional or multidimensional? American Journal of Physical Medicine & Rehabilitation, 75, 105–113.Google Scholar
Bragg, R.M., Klockars, A.J., & Berninger, V.W. (1992). Comparison of families with and without adolescents with traumatic brain injury. Journal of Head Trauma Rehabilitation, 7, 94–108.Google Scholar
Brooks, D.N. (1991). The head-injured family. Journal of Clinical and Experimental Neuropsychology, 13, 155–188.Google Scholar
Brooks, D.N., Campsie, L., Symington, C., Beattie, A., & McKinlay, W. (1987). The effects of severe head injury on patient and relative within seven years of injury. Journal of Head Trauma Rehabilitation, 2, 1–13.Google Scholar
Carnevale, G.J., Anselmi, V., Busichio, K., & Millis, S.R. (2002). Changes in ratings of caregiver burden following a community-based behavior management program for persons with traumatic brain injury. Journal of Head Trauma Rehabilitation, 17, 83–95.CrossRefGoogle ScholarPubMed
Chan, J. (2007). Carers’ perspective on respite for persons with acquired brain injury. International Journal of Rehabilitation Research, 30, 137–146.CrossRefGoogle ScholarPubMed
Douglas, J.M., & Spellacy, F.J. (1996). Indicators of long-term family functioning following severe traumatic brain injury in adults. Brain Injury, 10, 819–839.Google Scholar
Douglas, J.M., & Spellacy, F.J. (2000). Correlates of depression in adults with severe traumatic brain injury and their carers. Brain Injury, 14, 71–88.Google Scholar
Draper, K., Ponsford, J., & Schönberger, M. (2007). Psychosocial and emotional outcomes 10 years following traumatic brain injury. Journal of Head Trauma Rehabilitation, 22, 278–287.CrossRefGoogle ScholarPubMed
Epstein, N.B., Baldwin, L.M., & Bishop, D.S. (1983). The McMaster Family Assessment Device. Journal of Marital and Family Therapy, 9, 171–180.Google Scholar
Ergh, T.C., Hanks, R.A., Rapport, L.J., & Coleman, R.D. (2003). Social support moderates caregiver life satisfaction following traumatic brain injury. Journal of Clinical and Experimental Neuropsychology, 25, 1090–1101.CrossRefGoogle ScholarPubMed
Ergh, T.C., Rapport, L.J., Coleman, R.D., & Hanks, R.A. (2002). Predictors of caregiver and family functioning following traumatic brain injury: Social support moderates caregiver distress. Journal of Head Trauma Rehabilitation, 17, 155–174.CrossRefGoogle ScholarPubMed
Flora, D.B., & Curran, P.J. (2004). An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychological Methods, 9, 466–491.Google Scholar
Gan, C., Campbell, K.A., Gemeinhardt, M., & McFadden, G.T. (2006). Predictors of family system functioning after brain injury. Brain Injury, 20, 587–600.CrossRefGoogle ScholarPubMed
Gan, C., & Schuller, R. (2002). Family system outcome following acquired brain injury: Clinical and research perspectives. Brain Injury, 16, 311–322.Google Scholar
Gervasio, A.H., & Kreutzer, J.S. (1997). Kinship and family members’ psychological distress after traumatic brain injury: A large sample study. Journal of Head Trauma Rehabilitation, 12, 14–26.Google Scholar
Hall, K.M., Karzmark, P., Stevens, M., Englander, J., O’Hare, P., & Wright, J. (1994). Family stressors in traumatic brain injury: A two-year follow-up. Archives of Physical Medicine & Rehabilitation, 75, 876–884.Google Scholar
Hanks, R.A., Rapport, L.J., & Vangel, S. (2007). Caregiving appraisal after traumatic brain injury: The effects of functional status, coping style, social support and family functioning. Neurorehabilitation, 22, 43–52.CrossRefGoogle ScholarPubMed
Herrmann, C. (1997). International experiences with the Hospital Anxiety and Depression Scale: A review of validation data and clinical results. Journal of Psychosomatic Research, 42, 17–41.Google Scholar
Hoofien, D., Gilboa, A., Vakil, E., & Donovick, P.J. (2001). Traumatic brain injury (TBI) 10–20 years later: A comprehensive outcome study of psychiatric symptomatology, cognitive abilities and psychosocial functioning. Brain Injury, 15, 189–209.Google Scholar
Jacobs, H.E. (1988). The Los Angeles Head Injury Survey: Procedures and initial findings. Archives of Physical Medicine & Rehabilitation, 69, 425–431.Google ScholarPubMed
Kabacoff, R.I., Miller, I. W., Bishop, D.S., Epstein, N.B., & Keitner, G.I. (1990). A psychometric study of the McMaster Family Assessment Device in psychiatric, medical and nonclinical samples. Journal of Family Psychology, 3(4), 431–439.Google Scholar
Kreutzer, J.S., Gervasio, A.H., & Camplair, P.S. (1994a). Patient correlates of caregivers’ distress and family functioning after traumatic brain injury. Brain Injury, 8, 211–230.CrossRefGoogle ScholarPubMed
Kreutzer, J.S., Gervasio, A.H., & Camplair, P.S. (1994b). Primary caregivers’ psychological status and family functioning after traumatic brain injury. Brain Injury, 8, 197–210.CrossRefGoogle ScholarPubMed
Livingston, M.G., Brooks, D.N., & Bond, M.R. (1985). Three months after severe head injury: Psychiatric and social impact on relatives. Journal of Neurology, Neurosurgery & Psychiatry, 48, 870–875.Google Scholar
Machamer, J., Temkin, N., & Dikmen, S. (2002). Significant other burden and factors related to it in traumatic brain injury. Journal of Clinical and Experimental Neuropsychology, 24, 420–433.Google Scholar
Marsh, N.V., Kersel, D.A., Havill, J.H., & Sleigh, J.W. (1998a). Caregiver burden at 1 year following severe traumatic brain injury. Brain Injury, 12, 1045–1059.Google Scholar
Marsh, N.V., Kersel, D.A., Havill, J.H., & Sleigh, J.W. (1998b). Caregiver burden at 6 months following severe traumatic brain injury. Brain Injury, 12, 225–238.CrossRefGoogle ScholarPubMed
Marsh, N.V., Kersel, D.A., Havill, J.H., & Sleigh, J.W. (2002). Caregiver burden during the year following severe traumatic brain injury. Journal of Clinical and Experimental Neuropsychology, 24, 434–447.Google Scholar
Medd, J., & Tate, R.L. (2000). Evaluation of an anger management therapy programme following acquired brain injury: A preliminary study. Neuropsychological Rehabilitation, 10, 185–201.Google Scholar
Miller, I.W., Bishop, D.S., Epstein, N.B., & Keitner, G.I. (1985). The McMaster Family Assessment Device: Reliability and validity. Journal of Marital and Family Therapy, 11, 345–356.Google Scholar
Moore, A., Stambrook, M., & Peters, L. (1993). Centripetal and centrifugal family life cycle factors in long-term outcome following traumatic brain injury. Brain Injury, 7, 247–255.Google Scholar
Oddy, M., Humphrey, M., & Uttley, D. (1978). Stresses upon the relatives of head-injured patients. British Journal of Psychiatry, 133, 507–513.Google Scholar
Perlesz, A., Furlong, M., & McLachland, D. (1989). Family-centred rehabilitation: Family therapy for the head injured and their relatives. In Harris, R.D.Burns, R. & Rees, R. (Eds.), Recovery from brain injury: Expectations, needs and processes (pp. 180–191). Adelaide, South Australia: Institute for the Study of Learning Difficulties.Google Scholar
Perlesz, A., Kinsella, G., & Crowe, S. (1999). Impact of traumatic brain injury on the family: A critical review. Rehabilitation Psychology, 44, 6–35.CrossRefGoogle Scholar
Perlesz, A., Kinsella, G., & Crowe, S. (2000). Psychological distress and family satisfaction following traumatic brain injury: Injured individuals and their primary, secondary, and tertiary carers. Journal of Head Trauma Rehabilitation, 15, 909–929.Google Scholar
Ponsford, J., Olver, J., Nelms, R., Curran, C., & Ponsford, M. (1999). Outcome measurement in an inpatient and outpatient traumatic brain injury rehabilitation programme. Neuropsychological Rehabilitation, 9, 517–534.CrossRefGoogle Scholar
Ponsford, J., Olver, J., Ponsford, M., & Nelms, R. (2003). Long-term adjustment of families following traumatic brain injury where comprehensive rehabilitation has been provided. Brain Injury, 17, 453–468.CrossRefGoogle ScholarPubMed
Powell, J., Heslin, J., & Greenwood, R. (2002). Community based rehabilitation after severe traumatic brain injury: A randomised controlled trial. Journal of Neurolog, y Neurosurgery and Psychiatry, 72, 193–202.Google Scholar
Rivera, P.A., Elliott, T.R., Berry, J.W., & Grant, J.S. (2008). Problem-solving training for family caregivers of persons with traumatic brain injuries: A randomized controlled trial. Archives of Physical Medicine & Rehabilitation, 89, 931–941.Google Scholar
Rodgers, M.L., Strode, A.D., Norell, D.M., Short, R.A., Dyck, D.G., & Becker, B. (2007). Adapting multiple-family group treatment for brain and spinal cord injury intervention development and preliminary outcomes. American Journal of Physical Medicine & Rehabilitation, 86, 482–492.Google Scholar
Rosenbaum, M., & Najenson, T. (1976). Changes in life patterns and symptoms of low mood as reported by wives of severely brain-injured soldiers. Journal of Consulting and Clinical Psychology, 44, 881–888.CrossRefGoogle Scholar
Rosenthal, M., & Young, T. (1988). Effective family intervention after traumatic brain injury: Theory and practice. Journal of Head Trauma Rehabilitation, 3, 42–50.Google Scholar
Sander, A.M., Sherer, M., Malec, J.F., High, W.M., Thompson, R.N., Moessner, A.M., et al. . (2003). Preinjury emotional and family functioning in caregivers of persons with traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 84, 197–203.CrossRefGoogle ScholarPubMed
Schönberger, M., & Ponsford, J. (in press). The factor structure of the Hospital Anxiety and Depression Scale in individuals with traumatic train injury. Psychiatry Research.Google Scholar
Singer, G.H.S., Glang, A., Nixon, C., Cooley, E., Kerns, K.A., Williams, D., et al. . (1994). A comparison of two psychosocial interventions for parents of children with acquired brain injury: An exploratory study. The Journal of Head Trauma Rehabilitation, 9, 38–49.Google Scholar
Snaith, R.P., & Zigmond, A.S. (1983). The Hospital Anxiety and Depression Scale with the Irritability-Depression-Anxiety Scale and the Leeds Situational Anxiety Scale: Manual. Berkshire, UK: NFER-Nelson.Google Scholar
Testa, J.A., Malec, J.F., Moessner, A.M., & Browt, A.W. (2006). Predicting family functioning after TBI: Impact of neurobehavioral factors. Journal of Head Trauma Rehabilitation, 21, 236–247.Google Scholar
Thomsen, I.V. (1984). Late outcome of very severe blunt head trauma: A 10–15 year 2nd follow-up. Journal of Neurology, Neurosurgery and Psychiatry, 47, 260–268.CrossRefGoogle Scholar
Whelan-Goodinson, R., Ponsford, J., & Schönberger, M. (2009). Validity of the Hospital Anxiety and Depression Scale to assess depression and anxiety following traumatic brain injury as compared with the Structured Clinical Interview for DSM-IV. Journal of Affective Disorders, 114, 94–102.Google Scholar
Whiteneck, G.G., Charlifue, S.W., Gerhart, K.A., Overholser, J.D., & Richardson, G.N. (1992). Quantifying handicap: A new measure of long-term rehabilitation outcomes. Archives of Physical Medicine and Rehabilitation, 73, 519–526.Google Scholar
Winstanley, J., Simpson, G., Tate, R., & Myles, B. (2006). Early indicators and contributors to psychological distress in relatives during rehabilitation following severe traumatic brain injury: Findings from the brain injury outcomes study. Journal of Head Trauma Rehabilitation, 21, 453–466.Google Scholar