Traumatic Brain Injury Caregivers Research Articles

Health-related quality of life and mental health outcomes in Mexican TBI caregivers.

Research has documented the deleterious effects on caregivers of providing care for an individual with traumatic brain injury (TBI). TBI caregivers in Mexico specifically have reduced health-related quality of life (HRQOL) across both physical and mental health domains. The purpose of the current study was to uncover the system of connections between Mexican TBI caregivers' HRQOL and their mental health. A cross-sectional survey was conducted at a public medical facility in Guadalajara, México. Ninety family caregivers of individuals with TBI completed measures of HRQOL, satisfaction with life, depression, and burden. A canonical correlation analysis revealed that the better the caregivers' HRQOL, the better their mental health was, with the effect reaching a large-sized effect. A distinct pattern emerged linking caregivers' higher energy levels and better social functioning to lower depression and greater satisfaction with life. A series of multiple regressions similarly uncovered that the most robust independent HRQOL predictors of caregiver mental health were vitality and social functioning. Especially for TBI caregivers with poor health, behavioral health interventions in Latin America that target the HRQOL domains of social functioning and vitality may significantly improve caregiver mental health, and as a result, informal care for TBI.

Family needs and TBI caregiver mental health in Guadalajara, Mexico

Traumatic brain injury (TBI) is a leading cause of death in Mexico, and Mexican TBI caregivers have been shown to experience significant mental health problems and high levels of family needs. This study investigated the associations between family needs and Mexican TBI caregiver mental health. Ninety TBI caregivers from Guadalajara, Mexico completed measures assessing their own mental health (depression, anxiety, burden, satisfaction with life, and self-esteem) and family needs (physical health, informational, financial, social support, and household). Family health needs were uniquely associated with all indices of caregiver mental health, and household needs were uniquely associated with caregiver depression, burden, and anxiety. Additionally, social support needs were related to caregiver satisfaction with life, informational needs to burden, and financial needs to self-esteem. Interventions for TBI caregivers in Mexico-and likely in other global regions with high levels of familism-should include an emphasis on overall family health, the delineation of family roles regarding household responsibilities, the improvement of social support networks and the social presence of family members, and the provision of complete and relevant information regarding TBI. When these needs are more comprehensively met, caregiver mental health will likely improve.

Influence of TBI Impairments and Related Caregiver Stress on Family Needs in Guadalajara, Mexico

This study recruited 90 traumatic brain injury (TBI) caregivers from Guadalajara, Mexico to examine influences of five domains of TBI impairment and related caregiver stress on five types of family needs. Canonical correlations suggested that greater social impairment in individuals with TBI and related caregiver stress were associated with higher informational, household and health needs in families. Meanwhile greater physical impairments in individuals with TBI and related caregiver stress were associated with higher household needs. Additionally, greater emotional impairments in individuals with TBI and related caregiver stress were associated with higher informational needs. Caregiver interventions targeting specific TBI impairments and related caregiver stress may meet family needs and thereby improve the quality of informal care for their family members with TBI.

Using multiple views of family dynamics to predict the mental health of individuals with TBI and their caregivers in Mexico

To examine differences in ratings of family dynamics between individuals with traumatic brain injury (TBI) and their family caregivers in Mexico, as well as differences in the prediction of caregiver and patient mental health outcomes from those ratings. Forty-two patient-caregiver dyads (n = 84) from the National Institute of Rehabilitation in México City participated in a comprehensive evaluation of their family dynamics and mental health. Patients' and caregivers' ratings of family dynamics were significantly correlated and did not differ across five of six types of family dynamics, but caregivers rated their family's level of empathy higher than patients, p < 0.001. Additionally, all patient and caregiver ratings of family dynamics were significantly correlated. Patients', caregivers', and combined (using structural equation modeling latent constructs) ratings of family dynamics robustly predicted four times as many caregiver mental health outcomes as patient mental health outcomes. Family dynamics influence both TBI patient and caregiver mental health but much more so in caregivers. Research on families of individuals with TBI in Mexico should incorporate both patient and caregiver perspectives to more comprehensively depict the environment in which TBI rehabilitation occurs.

Connecting family needs and TBI caregiver mental health in Mexico City, Mexico

Purpose: This study examined relationships between caregiver mental health and the extent to which needs were met in families of individuals with traumatic brain injury (TBI) in Mexico City, Mexico.Method: Sixty-eight TBI caregivers completed Spanish versions of instruments assessing their own mental health and whether specific family needs were met.Results: Twenty-seven per cent of caregivers reported clinically significant depression levels, 40% reported below-average life satisfaction and 49% reported mild-to-severe burden. Several of the most frequently met family needs were in the emotional support domain, whereas the majority of unmet needs were in the health information domain. Family needs and caregiver mental health were significantly and highly related. When family needs were met, caregiver mental health was better. The strongest pattern of connections in multivariate analyses was between family instrumental support (assistance in the completion of daily life tasks) and caregiver burden, such that caregivers with less instrumental support had greater burden. Additional results suggested that instrumental support uniquely predicted caregiver satisfaction with life, burden and depression.Conclusions: Interventions for TBI caregivers, especially in Latin America, should help family members determine how best to meet their health information and instrumental needs, with the former being likely to improve caregiver mental health.

Mental Trauma Experienced by Caregivers of patients with Diffuse Axonal Injury or Severe Traumatic Brain Injury

ContextAs with care giving and rehabilitation in chronic illnesses, the concern with traumatic brain injury (TBI), particularly with diffuse axonal injury (DAI), is that the caregivers are so overwhelmingly involved in caring and rehabilitation of the victim that in the process they become traumatized themselves. This review intends to shed light on the hidden and silent trauma sustained by the caregivers of severe brain injury survivors. Motor vehicle accident (MVA) is the highest contributor of TBI or DAI. The essence of trauma is the infliction of pain and suffering and having to bear the pain (i.e. by the TBI survivor) and the burden of having to take care and manage and rehabilitate the TBI survivor (i.e. by the TBI caregiver). Moreover many caregivers are not trained for their care giving task, thus compounding the stress of care giving and rehabilitating patients. Most research on TBI including DAI, focus on the survivors and not on the caregivers. TBI injury and its effects and impacts remain the core question of most studies, which are largely based on the quantitative approach.Evidence AcquisitionQualitative research can better assess human sufferings such as in the case of DAI trauma. While quantitative research can measure many psychometric parameters to assess some aspects of trauma conditions, qualitative research is able to fully reveal the meaning, ramification and experience of TBI trauma. Both care giving and rehabilitation are overwhelmingly demanding; hence , they may complicate the caregivers’ stress. However, some positive outcomes also exist.ResultsCaregivers involved in caring and rehabilitation of TBI victims may become mentally traumatized. Posttraumatic recovery of the TBI survivor can enhance the entire family’s closeness and bonding as well as improve the mental status of the caregiver.ConclusionsA long-term longitudinal study encompassing integrated research is needed to fully understand the traumatic experiences of caregivers. Unless research on TBI or DAI trauma is given its proper attention, the burden of trauma and injury on societies will continue to exacerbate globally.

Exploring the Connections Between Traumatic Brain Injury Caregiver Mental Health and Family Dynamics in Mexico City, Mexico

To examine the patterns of family dynamics that are most associated with the mental health of traumatic brain injury (TBI) caregivers from Mexico. It was hypothesized that healthier family dynamics would be associated with better caregiver mental health. A cross-sectional study of self-reported data collected from TBI caregivers through the Mexican National Institute of Rehabilitation in Mexico City, Mexico, the premier public medical facility in Mexico that provides rehabilitation services to patients with various disabilities. One public outpatient medical and rehabilitation facility. Sixty-eight caregivers of individuals with moderate-to-severe TBI from Mexico City, Mexico, were related to an individual with TBI who was≥3 months after injury, a primary caregiver for≥3 months, familiar with the patient's history, and without neurologic or psychiatric conditions. The average (standard deviation) age of caregivers was 50.94 ± 12.85 years), and 82% were women. The caregivers completed Spanish versions of instruments that assessed their own mental health and family dynamics. Outcomes assessed included family dynamics (Family Adaptability and Cohesion Evaluation Scale-Fourth Edition; Family Communication Scale; Family Satisfaction Scale; Family Assessment Device-General Functioning; and Relationship-Focused Coping Scale), and caregiver mental health (Patient Health Questionnaire-9, Zarit Burden Interview, and Satisfaction with Life Scale). Results of canonical correlation analyses suggested that caregiver mental health and family dynamics were positively related, with a large effect size. Caregivers with high family satisfaction and cohesion tended to have a low burden and high satisfaction with life. In addition, caregiver depression and burden were positively related to each other and were both inversely related to caregiver satisfaction with life. TBI caregiver interventions in Latino populations would likely benefit from including programming or techniques to improve family dynamics, especially family cohesion, given the strong potentially reciprocal influence of these dynamics on caregiver mental health.

Just how bad is it? Comparison of the mental health of Mexican traumatic brain injury caregivers to age-matched healthy controls

To compare the mental health of family caregivers of individuals with Traumatic brain injury (TBI) to an age-matched healthy control from Guadalajara, Mexico. Hospital Civil Fray Antonio Alcade, a public medical facility in Guadalajara, Mexico. Ninety family caregivers of individuals with TBI and 89 healthy controls (n = 179) did not differ with respect to age, sex, marital status, education, or household income. Outcome measures assessed satisfaction with life (Satisfaction with Life Scale), depression (Patient Health Questionnaire-9), social support (Interpersonal Support Evaluation List), self-esteem (Rosenberg Self-Esteem Scale), and anxiety (State-Trait Anxiety Inventory). A multivariate analysis of variance found that in comparison to controls, TBI caregivers reported substantially lower mental health scores across all indices, as well as lower social support in two out of three comparisons. The effect sizes of the social support differences were small; two out of five mental health differences reached medium-sized effects; and the other three reached large-sized effects. Because TBI caregivers' mental health influences the quality of informal care they can provide, mental health interventions for family caregivers are an extremely important part of TBI rehabilitation in Latin America, especially considering familism as a core value in Latino culture.

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.

Depression and anxiety in parent versus spouse caregivers of adult patients with traumatic brain injury: A systematic review

A systematic review of studies which evaluated depression and anxiety in parent versus spouse caregivers of adults with traumatic brain injury (TBI) was conducted. Demographic variables of the TBI patients and caregivers, study design, measurement tools used, and outcomes reported were collected. Twenty-four studies met the inclusion criteria and were evaluated for methodological quality. While the majority of studies revealed no significant differences between caregiver types on measures of depression and/or anxiety, there was a great deal of variation in methodology and quality between the studies. Overall, high levels of caregiver distress were exposed, regardless of caregiver type (parent versus spouse). There is a need for qualitative and quantitative research designs in order to elucidate the factors that put caregivers at risk for depression and anxiety.

Pharmacologic Venous Thromboembolism Prophylaxis after Traumatic Brain Injury: A Critical Literature Review

Despite the frequency and morbidity of venous thromboembolism (VTE) development after traumatic brain injury (TBI), no national standard of care exists to guide TBI caregivers for the use of prophylactic anticoagulation. Fears of iatrogenic propagation of intracranial hemorrhage patterns have led to a dearth of research in this field, and it is only relatively recently that studies dedicated to this question have been performed. These have generally been limited to retrospective and/or observational studies in which patients are classified in a binary fashion as having the presence or absence of intracranial blood. This methodology does not account for the fact that smaller injury patterns stabilize more rapidly, and thus may be able to safely tolerate earlier initiation of prophylactic anticoagulation than larger injury patterns. This review seeks to critically assess the literature on this question by examining the existing evidence on the safety and efficacy of pharmacologic VTE prophylaxis in the setting of elective craniotomy (as this is the closest model available from which to extrapolate) and after TBI. In doing so, we critique studies that approach TBI as a homogenous or a heterogenous study population. Finally, we propose our own theoretical protocol which stratifies patients into low, moderate, and high risk for the likelihood of natural progression of their hemorrhage pattern, and which allows one to tailor a unique VTE prophylaxis regimen to each individual arm.

Health-related quality of life in caregivers of individuals with traumatic brain injury from Guadalajara, Mexico

The goal of the present study was to assess the health-related quality of life of a group of family caregivers of individuals with traumatic brain injury from Guadalajara, Mexico. Ninety family caregivers of individuals with traumatic brain injury and 83 healthy controls completed the Short-Form 36, a self-report health-related quality of life measure composed of 8 component areas: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, mental health, and role-emotional. The samples were statistically similar with respect to age, gender, marital status, and education. However, caregivers had significantly lower household income than controls. After controlling for income, results showed significantly lower scores for traumatic brain injury caregivers compared with healthy controls on 6 Short-Form 36 subscales: role-emotional, vitality, mental health, social functioning, bodily pain, and general health. Caregivers of individuals with traumatic brain injury living in Guadalajara, Mexico report having poorer health-related quality of life across various domains including mental and general health. Future studies should be conducted to determine which specific factors (e.g. lack of services, physical strain of providing care) are responsible for reduced health-related quality of life in these areas. It is likely that resources, such as respite services, adult day-care, aides, outpatient rehabilitation, psycho-educational programs, and support groups would increase health-related quality of life for these individuals.

Racial Differences in Caregiving Patterns, Caregiver Emotional Function, and Sources of Emotional Support Following Traumatic Brain Injury

Compare white and African American caregivers of people with moderate to severe traumatic brain injury (TBI) regarding caregiving patterns, emotional function and life satisfaction, and preferred supports. Prospective, observational study; 1, 2, or 5 years post-TBI. Six TBI model systems. Two hundred fifty-six caregivers (195 white and 61 African American). Brief Symptom Inventory-18, Satisfaction With Life Scale. Races differed as to kinship patterns, with more white caregivers including spouses and more African Americans including "other relatives." African Americans spent significantly more time in direct caregiving, and reported more depression. African American TBI survivors were significantly more disabled than whites, which appeared to account for emotional function differences. Whites were more likely to use professional services for emotional support. Across races, TBI caregiver emotional health is affected by the functional level of the survivor. African American caregivers may be at risk for worse emotional consequences due to worse survivor outcomes, yet may underutilize professional services.

Traumatic Brain Injury Caregiver Distress and Use of Support Services

Traumatic Brain Injury Caregiver Distress and Use of Support Services

Predictors of Traumatic Brain Injury Caregiver Adjustment and the Role of Irrational Beliefs: Towards a Cognitive Model

The provision of care to a relative with a traumatic brain injury (TBI) has been shown to be distressing for the primary caregiver (usually the spouse or parent). Much research has examined factors which affect caregiver adjustment to brain injury. However, the impact of caregiver cognitions, in particular irrational beliefs, as a potential factor in poor adjustment, has received little if any attention in the TBI caregiving literature. This article provides a review of predictors of TBI caregiver adjustment and a discussion of the cognitive model and the impact of irrational beliefs on adjustment. As caregivers are central to the rehabilitation process, there is a need for research into irrational beliefs and TBI caregivers as well as the development of interventions which focus specifically on the caregiver's beliefs and perceptions of events.