Deficits In Social Functioning Research Articles

EPA-0506 - Social cognition and it's correlates to functional outcomes in schizophrenia

Background Deficits in social functioning, including communication, work, social skills, and community functioning, are a defining feature of schizophrenia. Functional outcomes of schizophrenia are affected by several factors such as social cognition, neurocognition, psychopathology, and clinical outcomes. The multifaceted association among these factors and functional outcome continues to be unclear. Given the significant role of functional outcomes in schizophrenia, there has been increasing importance in factors that may underlie these outcomes. If the characteristics of these factors can be defined, interventions may be developed to improve them, which, in turn, will have a parallel impact on long term functioning and outcome. The current study examines whether social cognition, neurocognition and clinical symptoms have a relationship on functional outcomes in patients with schizophrenia. Methods 37 patients with DSM-IV schizophrenia were assessed for: Neurocognition; MCCB-MATRICS, Clinical Symptoms: PANSS, Social Cognition: MSCEIT, Emotion Recognition-40 (ER-40), Dynamic Social Cognition Battery (DSCB: Emotion Identification - Facial, Verbal and Non Verbal), Functional Outcomes: University of San Diego Performance Based Assessment (USCD-UPSA), Social Skills: Personal and Social Performance Scale (PSP). Structural Equation Modeling (SEM) employed with maximum likelihood estimation for test effects. Results The overall model fit was χ 2 =39.6, P C min / df =1.25, NFI=0.96, Tucker-Lewis index (Bentler and Bonnet nonformed fit index)=0.97, RMSEA=0.044. Regression weights of the latent variable 'Marder Negative Factor' were significant and high ( β =0.91) and a substantial amount of variance could be explained by negative symptoms, indicating that the negative factor is a reliable measure of the latent variable. In addition, the regression weights of the latent variable social cognition to the 3 indicators were moderate and significant (Emotion Recognition DSCB: β =0.77, ER-40: β =0.46, and Nonverbal Emotion Identification, β =0.44). Like social cognition, the latent variable functional assessment explained a substantial amount of variance in the latent variables of working memory (45%). Impact of social cognition on negative symptoms ( β =0.91) was greater than the direct impact of social functioning ( β =0.78) and functional assessments ( β =0.63). Conclusions This study suggests that 49% of negative symptoms could be explained by impaired social cognition and that 49% of social functioning skills could be explained by social cognition. Our findings suggest that social cognition may be an essential target to improve functional outcomes. These findings provide evidence that may help develop novel interventions.

EPA-0121 – How to measure social cognition in schizophrenia? a comparison of measurements

Objectives Developing empirically sound measures for social cognition is a key step in improving the factors that contribute to deficits in social functioning in schizophrenia. Investigating the psychometric properties and acceptability of social cognitive instruments may contribute to identification of a reliable and valid instrument for schizophrenia patients. Aims To investigate the psychometric properties and acceptability of a dynamic social cognition scale (DSCB) compared to three common social cognition instruments in schizophrenia. Methods 41 patients with schizophrenia were evaluated to assess acceptability, internal consistency and validity of five social cognition measures: DSCB, Emotion Recognition-40 (ER-40), Facial Emotion Identification Task (FEIT), Tone Matching Task and MSCEIT. Multiple linear regressions were conducted to identify variables which perform well as social cognition determinants. Results The DSCB and FEIT showed good acceptability, evidenced by shorter administration time, completion and patient preference for the DSCB. Good levels of internal consistency were found for the DSCB (α = 0.851), ER-40 (α = 0.803), and FEIT (α = 0.782). Confirmatory Factor Analysis indicated sufficient to good model fit. The DSCB and the ER-40 demonstrated a good model fit. The correlations for the DSCB were significant for the ER-40 ( r = 0.512) and FEIT ( r = 0.500). Conclusions Findings suggest that DSCB is the preferred instrument to evaluate social cognition, due to its dynamic nature and short administration time. Further research is needed to develop and improve these measurements. Additionally, the DSCB, FEIT and ER-40 show adequate to good reliability and validity.

Executive functions, social information processing, and social adjustment in young children born with very low birth weight

Children born with very low birth weight (VLBW) are at risk for neurocognitive and behavioral sequelae. Although VLBW infants are at higher risk for deficits in executive functions (EFs) and social functioning during school-age years, few studies have investigated those sequelae or their association in young children born VLBW. We examined the associations between EFs and social functioning in preterm, VLBW children age 4–6 years (n = 20) and matched, term-born, normal birth weight controls admitted to the neonatal intensive care unit (NICU) after birth (n = 18). The groups did not differ significantly on measures of EFs, social information processing, or parent-reported social adjustment. The VLBW group had lower IQs than controls, though both group means were in the average range. Within the VLBW group, medical predictors of better EFs included older gestational age at birth and no history of bronchopulmonary dysplasia. Across groups, EFs and social information processing were positively correlated. Deficits in EFs and social functioning may emerge after the preschool years in VLBW children, or improved care of children born VLBW may be reducing the cognitive and psychosocial sequelae observed in earlier cohorts. Among children born VLBW, early EFs may be directly related to social information processing.

Social Functioning Across the Course of Schizophrenia

Deficits in social functioning are prevalent in individuals with schizophrenia and can often be as debilitating as the illness itself. Recent research has suggested that problems in social functioning can be seen long before the onset of schizophrenia and are generally present throughout the course of the disease. Recent literature on social functioning is critically reviewed for high-risk groups, first-episode psychosis, and later schizophrenia. Deficits in social functioning begin as early as childhood and often continue throughout the course of schizophrenia. However, social functioning can stabilize or even improve later in the course of the illness. Implications and directions for future research are discussed. Keywords: Illness course, long-term, schizophrenia, social functioning.

Developing a Predictive Gene Classifier for Autism Spectrum Disorders Based upon Differential Gene Expression Profiles of Phenotypic Subgroups.

Autism spectrum disorders (ASD) are neurodevelopmental disorders which are currently diagnosed solely on the basis of abnormal stereotyped behavior as well as observable deficits in communication and social functioning. Although a variety of candidate genes have been identified on the basis of genetic analyses and up to 20% of ASD cases can be collectively associated with a genetic abnormality, no single gene or genetic variant is applicable to more than 1-2 percent of the general ASD population. In this report, we apply class prediction algorithms to gene expression profiles of lymphoblastoid cell lines (LCL) from several phenotypic subgroups of idiopathic autism defined by cluster analyses of behavioral severity scores on the Autism Diagnostic Interview-Revised diagnostic instrument for ASD. We further demonstrate that individuals from these ASD subgroups can be distinguished from nonautistic controls on the basis of limited sets of differentially expressed genes with a predicted classification accuracy of up to 94% and sensitivities and specificities of ~90% or better, based on support vector machine analyses with leave-one-out validation. Validation of a subset of the "classifier" genes by high-throughput quantitative nuclease protection assays with a new set of LCL samples derived from individuals in one of the phenotypic subgroups and from a new set of controls resulted in an overall class prediction accuracy of ~82%, with ~90% sensitivity and 75% specificity. Although additional validation with a larger cohort is needed, and effective clinical translation must include confirmation of the differentially expressed genes in primary cells from cases earlier in development, we suggest that such panels of genes, based on expression analyses of phenotypically more homogeneous subgroups of individuals with ASD, may be useful biomarkers for diagnosis of subtypes of idiopathic autism.

Social deficits in children with chronic tic disorders: Phenomenology, clinical correlates and quality of life

Youth with chronic tic disorders (CTD) experience social problems that have been associated with functional impairment and a diminished quality of life. Previous examinations have attributed social difficulties to either tic severity or the symptom severity of coexisting conditions, but have not directly explored performance deficits in social functioning. This report examined the presence and characteristics of social deficits in youth with CTD and explored the relationship between social deficits, social problems, and quality of life. Ninety-nine youth (8–17years) and their parents completed a battery of assessments to determine diagnoses, tic severity, severity of coexisting conditions, social responsiveness, and quality of life. Parents reported that youth with CTD had increased social deficits, with 19% reported to have severe social deficits. The magnitude of social deficits was more strongly associated with inattention, hyperactivity, and oppositionality than with tic severity. Social deficits predicted internalizing and social problems, and quality of life above and beyond tic severity. Social deficits partially mediated the relationship between tic severity and social problems, as well as tic severity and quality of life. Findings suggest that youth with CTD have social deficits, which are greater in the presence of attention-deficit hyperactivity disorder and obsessive compulsive disorder. These social deficits play an influential role in social problems and quality of life. Future research is needed to develop interventions to address social performance deficits among youth with CTD.

The longitudinal association between social functioning and theory of mind in first-episode psychosis

IntroductionThere is some cross-sectional evidence that theory of mind ability is associated with social functioning in those with psychosis but the direction of this relationship is unknown. This study investigates the longitudinal association between both theory of mind and psychotic symptoms and social functioning outcome in first-episode psychosis.MethodsFifty-four people with first-episode psychosis were followed up at 6 and 12 months. Random effects regression models were used to estimate the stability of theory of mind over time and the association between baseline theory of mind and psychotic symptoms and social functioning outcome.ResultsNeither baseline theory of mind ability (regression coefficients: Hinting test 1.07 95% CI −0.74, 2.88; Visual Cartoon test −2.91 95% CI −7.32, 1.51) nor baseline symptoms (regression coefficients: positive symptoms −0.04 95% CI −1.24, 1.16; selected negative symptoms −0.15 95% CI −2.63, 2.32) were associated with social functioning outcome. There was evidence that theory of mind ability was stable over time, (regression coefficients: Hinting test 5.92 95% CI −6.66, 8.92; Visual Cartoon test score 0.13 95% CI −0.17, 0.44).ConclusionsNeither baseline theory of mind ability nor psychotic symptoms are associated with social functioning outcome. Further longitudinal work is needed to understand the origin of social functioning deficits in psychosis.

Prospective evaluation of health-related quality of life in patients with glioblastoma multiforme treated on a phase II trial of hypofractionated IMRT with temozolomide

To report health-related quality of life (HRQOL) in glioblastoma (GBM) patients treated on a phase II trial of hypofractionated intensity-modulated radiotherapy (hypo-IMRT) with temozolomide (TMZ). GBM patients received postoperative hypo-IMRT to 60 Gy in 10 fractions with TMZ. HRQOL was assessed using the EORTC quality of life questionnaire core-30 and the EORTC brain cancer module, performed at baseline, RT completion, 1 mo post-RT, and every 3 mos thereafter. Changes from baseline were calculated for each specific HRQOL scale. A ≥ 10 point change in any HRQOL scale from the mean baseline score was significant. 24 patients were treated. Compliance with HRQOL assessments at baseline, RT completion, and 1, 3, 6, 9, and 12 mos post-RT was 100, 96, 92, 79, 70, 68 and 53 %, respectively. Up to 12 mos post-RT, no significant changes were seen in global health status, physical functioning, role functioning, emotional functioning, fatigue, nausea, vision, headache or seizure. Significant improvement was seen in insomnia, future uncertainty, motor dysfunction and drowsiness. Significant worsening was observed in cognitive functioning, social functioning, appetite loss and communication deficit. 60 Gy hypo-IMRT in 6-Gy fractions with TMZ does not appear to negatively impact overall HRQOL.

Dissociation of Frontotemporal Dementia–Related Deficits and Neuroinflammation in Progranulin Haploinsufficient Mice

Frontotemporal dementia (FTD) is a neurodegenerative disease with hallmark deficits in social and emotional function. Heterozygous loss-of-function mutations in GRN, the progranulin gene, are a common genetic cause of the disorder, but the mechanisms by which progranulin haploinsufficiency causes neuronal dysfunction in FTD are unclear. Homozygous progranulin knock-out (Grn(-/-)) mice have been studied as a model of this disorder and show behavioral deficits and a neuroinflammatory phenotype with robust microglial activation. However, homozygous GRN mutations causing complete progranulin deficiency were recently shown to cause a different neurological disorder, neuronal ceroid lipofuscinosis, suggesting that the total absence of progranulin may have effects distinct from those of haploinsufficiency. Here, we studied progranulin heterozygous (Grn(+/-)) mice, which model progranulin haploinsufficiency. We found that Grn(+/-) mice developed age-dependent social and emotional deficits potentially relevant to FTD. However, unlike Grn(-/-) mice, behavioral deficits in Grn(+/-) mice occurred in the absence of gliosis or increased expression of tumor necrosis factor-α. Instead, we found neuronal abnormalities in the amygdala, an area of selective vulnerability in FTD, in Grn(+/-) mice. Our findings indicate that FTD-related deficits resulting from progranulin haploinsufficiency can develop in the absence of detectable gliosis and neuroinflammation, thereby dissociating microglial activation from functional deficits and suggesting an important effect of progranulin deficiency on neurons.

Perceiving Goals and Actions in Individuals with Autism Spectrum Disorders

In the present study, we investigated the ability to parse familiar sequences of action into meaningful events in young individuals with autism spectrum disorders (ASDs), as compared to young individuals with typical development (TD) and young individuals with moderate mental retardation or learning disabilities (MLDs). While viewing two videotaped movies, participants were requested to detect the boundary transitions between component events at both fine and coarse levels of the action hierarchical structure. Overall, reduced accuracy for event detection was found in participants with ASDs, relative to participants with TD, at both levels of action segmentation. The performance was, however, equally diminished in participants with ASDs and MLDs under the course-grained segmentation suggesting that difficulties to detect fine-grained events in ASDs cannot be explained by a general intellectual dysfunction. Reduced accuracy for event detection was related to diminished event recall, memory for event sequence and Theory of Mind abilities. We hypothesized that difficulties with event detection result from a deficit disrupting the on-line processing of kinematic features and physical changes of dynamic human actions. An impairment at the earlier stages of the event encoding process might contribute to deficits in episodic memory and social functioning in individuals with ASDs.

MEG premotor abnormalities in children with Asperger's syndrome: Determinants of social behavior?

Children with Asperger's syndrome show deficits in social functioning while their intellectual and language development is intact suggesting a specific dysfunction in mechanisms mediating social cognition. An action observation/execution matching system might be one such mechanism. Recent studies indeed showed that electrophysiological modulation of the “Mu-rhythm” in the 10–12 Hz range is weaker when individuals with Asperger's syndrome observe actions performed by others compared to controls. However, electrophysiological studies typically fall short in revealing the neural generators of this activity. To fill this gap we assessed magnetoencephalographic Mu-modulations in Asperger's and typically developed children, while observing grasping movements. Mu-power increased at frontal and central sensors during movement observation. This modulation was stronger in typical than in Asperger children. Source localization revealed stronger sources in premotor cortex, the intraparietal lobule (IPL) and the mid-occipito-temporal gyrus (MOTG) and weaker sources in prefrontal cortex in typical participants compared to Asperger. Activity in premotor regions, IPL and MOTG correlated positively with social competence, whereas prefrontal Mu-sources correlated negatively with social competence. No correlation with intellectual ability was found at any of these sites. These findings localize abnormal Mu-activity in the brain of Asperger children providing evidence which associates motor-system abnormalities with social-function deficits.

Understanding the Interaction of Temperament and Social Skills in the Development of Social Anxiety in Children with Autism Spectrum Disorders

Children with Autism Spectrum Disorders (ASD) often have comorbid psychopathology in addition to socialcommunication difficulties. Social anxiety is of particular interest because it has been linked to downstream deficits in social functioning. Bellini found a link between social skills, temperament, and the development of social anxiety. The current paper examines whether negative affectivity moderates the relationship between social skills and social anxiety. Twenty-five high-functioning children diagnosed with ASD were administered self and parent report questionnaires measuring pragmatics ability, socialization behaviors, negative affectivity, and social anxiety. High negative affectivity was related to social anxiety, and moderated the relationship between socialization behaviors and social anxiety. Pragmatics ability was not related to social anxiety. Together, these results indicate that negative affectivity is an important factor in the relationship between social skills and social anxiety, and that not all social skills deficits contribute to social anxiety.

824 – Social functioning in schizophrenia offspring

Between the risk factors for developing a first episode psychosis, social functioning is considered to be one of the most important factors. The aim of the study is to compare social functioning in schizophrenia offspring and controls, and to determine possible associations between social functioning and prodromal symptoms. The study examined social functioning (by using the Social Functioning Scale) in 25 Schizophrenia offspring seeking psychiatric help for different problems, and 25 healthy controls. Clinical status was assessed with the Brief Psychiatric Rating Scale, HAM-D and HAM-A. Schizophrenia offspring had significantly more social functioning deficits than controls. Social functioning was most strongly associated with depression and anxiety symptoms and less with minor psychotic symptoms. Social functioning deficits precede the onset of first episode psychosis, especially in persons at risk and, therefore, it could represent an early detection sign. Association with depression and anxiety symptoms should be an early intervention point.

1300 – Depressive symptoms in schizophrenia

Introduction Depressive symptoms in schizophrenia are important not only because they contribute significantly to the suffering caused by the illness but also because they exacerbate deficits in psycho social functioning and commonly precede attempted and completed suicide. Objectives It is important to define and clinically assess such symptoms accurately as there is now increasing evidence that they can be treated successfully. Aims The authors assessed the presence and severity of depressive symptoms, as well as their associations with other clinical and socio-demographic measures, in a group of patients with schizophrenia, who were not in a major depressive episode or diagnosed with schizoaffective disorder. And also possible differences in frequency of depressive symptoms in inpatient and outpatient group. Methods Thirty adult inpatients with schizophrenia and 30 comparison subject with schizophrenia in outpatient treatment were studied. Depressive symptoms were rated primarily with the Hamilton Depression Rating Scale. M.I.N.I. Screen and M.I.N.I were used to screen out other disorders and confirm the diagnosis of schizophrenia. Socio-demographic questionnaire that was used was designed specifically for this study. Results Our results indicate significant presence of depressive symptoms in all study subjects. Mean value of total HAM-D score for the whole sample was 15,63±7,724, corresponding to mild depression. Average total score was significantly higher in the subgroup of inpatients (18.97±6,636) compared with (12,3±7,373) in outpatients. Conclusions The results indicate significant presence of depressive symptoms in patients diagnosed with schizophrenia. This should probably be reflected in guidelines for evaluation and treatment of these patients.

Proteomics and Cholesterol in Autism

Autism Spectrum Disorder (ASD) diagnosis is increasing worldwide. ASDs are characterized by impaired social function, stereotyped behaviors/interests and communication deficits. ASD causes are poorly understood and treatments are largely limited to behavioral interventions once problems have developed and been detected. Here we discuss the potential use of mass spectrometry and proteomics in early diagnosis of ASD. The potential link between at least some subtypes of ASD, the cholesterol system and proteins that interact with cholesterol is also discussed.

A Randomized, Placebo-Controlled Study of the Impact of the 7-Day Buprenorphine Transdermal System on Health-Related Quality of Life in Opioid-Naïve Patients With Moderate-to-Severe Chronic Low Back Pain

This study evaluated the impact of treatment with Buprenorphine Transdermal System (BTDS) on the health-related quality of life for patients with moderate-to-severe chronic low back pain (CLBP), and the correspondence between quality of life and pain. A multicenter, enriched, double-blind (DB), placebo-controlled, randomized trial evaluated BTDS 10 and 20 μg/hour for treatment of opioid-naïve patients with moderate-to-severe CLBP. The SF-36v2 survey, which measures 8 domains of quality of life, was administered at screening and following an open-label run-in period with BTDS and at weeks 4, 8, and 12 of the DB phase. Post hoc analyses compared SF-36v2 scores between BTDS and placebo groups during the DB phase. Condition burden was examined through comparisons with a U.S. general population sample. Correlations examined the correspondence between quality of life and pain measures. BTDS produced larger improvements than placebo at 12 weeks in all quality-of-life domains (Ps < .05). Treatment group differences in both physical and mental quality of life emerged by 4 weeks. Patients' pretreatment quality of life was worse than that in the general population (Ps < .05); only BTDS treatment eliminated deficits in pain, social functioning, and role limitations due to emotional health. Improvements in quality of life were moderately associated with pain reduction. These data suggest that moderate-to-severe CLBP patients receiving BTDS exhibited better quality of life than patients receiving placebo. PerspectiveThis post hoc analysis suggests that patients with moderate-to-severe CLBP treated with BTDS exhibit better health-related quality of life than those using placebo within 4 weeks of treatment, and were more likely to exhibit clinically meaningful improvements in quality of life following 12 weeks of treatment.

Psychosocial Functioning and Cognitive Deficits are Not Associated With Membrane-Bound Catechol-O-Methyltransferase Deoxyribonucleic Acid Methylation in Siblings of Patients With Schizophrenia

In this study, we investigated whether the siblings of patients with schizophrenia have deficits in cognition and psychosocial functioning and whether the psychosocial functioning and cognitive deficits correlate with the methylation status of the membrane-bound catechol-O-methyltransferase (MB-COMT) gene in peripheral leukocytes. Cognitive abilities were evaluated using the attention/vigilance Continuous Performance Test, delayed/immediate recall scores, the Wisconsin Card Sorting Test, and the Semantic Verbal Fluency Test. Psychosocial functioning was evaluated using the Scale for the Assessment of Negative Symptoms, the Global Assessment of Functioning scale, and the Social Adjustment Scale. A bisulfate-based sequencing was adopted to analyze the methylation status of the MB-COMT promoter in peripheral leukocytes. Significant impairments in attention/vigilance and verbal memory and significant decreases in immediate and delayed recall scores were observed in the siblings of patients with schizophrenia compared with the healthy subjects. In addition, significant deficits in global social functioning and in social interaction were found in the siblings. The tested region of the MB-COMT promoter was generally unmethylated in peripheral leukocytes, without significant correlation with behavioral deficits in the siblings.Our study demonstrated that the siblings have significant deficits in cognition and psychosocial functioning, which may not be associated with MB-COMT methylation in peripheral leukocytes.

Everyday Social Behavior During a Major Depressive Episode

Although social functioning deficits are believed to characterize major depressive disorder (MDD), few studies have examined the social behavior of individuals with MDD in everyday life. The current study’s aim is to assess the everyday social behavior of individuals in a current major depressive episode. Participants with current MDD (n = 29) and healthy controls (n = 28) wore the electronically activated recorder (EAR), an ambulatory assessment device, for 3–4 days. The EAR recorded 90-second sound clips from participants’ immediate environments. Participants’ conversations were transcribed and locations and activities coded. Indicators of social isolation and negative emotional expression were examined. Individuals with and without MDD spent similar amounts of time talking, laughing, and with another person. However, depressed people spent less time in groups and used more negative emotion words, particularly in reference to the self, and particularly around romantic partners. Findings suggest depressed people’s social interactions suffer in quality but not quantity.

Schizotypy, social cognition, and interpersonal sensitivity.

Social cognition in relation to schizophrenia liability remains largely uncharted terrain. Successful social interactions involve sensitivity to the feelings and behavior of others, and the ability to convey and communicate cues to elicit desired responses from others. Disruption in any part of this process will affect social interactions and functioning, including occupational functioning. Individuals who do better on tasks measuring interpersonal sensitivity are more interpersonally skilled and better adjusted (Hall, Andrzejewski, & Yopchick, 2009), and those who perform poorly on tasks of interpersonal sensitivity, such as patients with schizophrenia, have known interpersonal and social functioning deficits (e.g., Toomey, Schuldberg, Corrigan, & Green, 2002). Schizotypic subjects were compared to depression vulnerable and normal control subjects on a well-established dynamic test of interpersonal sensitivity, the Profile of Nonverbal Sensitivity (PONS; Rosenthal, Hall, DiMatteo, Rogers, & Archer, 1979, 2011). Results revealed a deficit for schizotypes relative to both the depression-risk and normal control groups on the PONS. Our examination of the interpersonal sensitivity in schizotypes may shed light on the social functioning problems seen in patients with schizophrenia in a translational research framework.

Moderated Mediation Path Analysis of Mexican Traumatic Brain Injury Patient Social Functioning, Family Functioning, and Caregiver Mental Health

ObjectiveTo examine the system of connections among traumatic brain injury (TBI) patient social functioning, family functioning, and caregiver depression and burden in Mexico. DesignCross-sectional survey. SettingA public medical facility. ParticipantsMexican TBI patient-caregiver dyads (N=84) participated in this study. Most of the patients with TBI were men (81%), with an average age ± SD of 38.83±13.44 years. The majority of caregivers (86%) were women, with an average age ± SD of 51.74±11.29. InterventionNot applicable. Main Outcome MeasuresOutcomes assessed included family functioning (Family Satisfaction Scale), patient social functioning (Medical Outcomes Study 36-Item Short-Form Health Survey), and caregiver mental health (Patient Health Questionnaire-9 and Zarit Burden Interview). ResultsA moderated mediation path model found that patient social functioning and family functioning predicted caregiver burden, and caregiver burden mediated the effect of family functioning on caregiver depression. Caregivers with strong family functioning tended to have low burden, no matter the level of patient social functioning. This path model provided an excellent fit and explained 47% of the variance in caregiver burden and 36% of the variance in caregiver depression. ConclusionsIn Mexico, strong family functioning is an important buffer in the relationship between TBI patient social functioning deficits and caregiver mental health, especially because familism is a core value in Latino culture. Rehabilitation interventions designed to strengthen family functioning may improve caregiver mental health, thereby influencing the quality of informal care that caregivers are able to provide.