The Impact Of Brain Injury On Family Members

After a traumatic brain injury medical professionals tend to focus on the patient but research shows a great impact on family members as well. Studies in the 1970s began to recognize these issues, while other work in the 1980s documented emotional distress that persisted for up to seven years and many studies in the 1990s identified tremendous levels of stress on caregivers and family members. The special April issue of the journal NeuroRehabilitation sheds light on the substantial advances in the science of family member and caregiver research with six special articles by experts in the field, exploring ways in which interventions can be targeted for optimum effectiveness.

In spite of growing evidence of family/caregiver distress after injury, developing appropriate intervention strategies to help families and caregivers has lagged behind.Guest editor Angelle M. Sander, Ph.D., of the Department of Physical Medicine & Rehabilitation at the Baylor College of Medicine/Harris County Hospital District, Houston, Texas, writes, “The research of the past three decades provides sufficient evidence of the need to develop well-designed intervention studies. The articles in this issue present important information that can guide researchers and clinicians in developing interventions. It is hoped that the next special issue devoted to families/caregivers might focus entirely on advances in intervention research, which can ultimately improve the quality of life for persons with brain injury and their family members.”Rivera and colleagues found that caregivers whose approach to problem-solving was negative, avoidant or impulsive were more likely to be depressed. Hanks and colleagues showed that if the coping style of caregivers was emotion-focused, these caregivers felt more burdened. On the other hand, the amount of behavioral control within the family unit and the amount of social support given tended to reduce the burden felt by caregivers. These studies suggest that interventions should target coping, problem-solving and social support.Two articles focus on important demographic characteristics that have been largely overlooked to date. Sander and colleagues investigated racial/ethnic differences in caregivers’ coping, distress and perceived burden. While Black and Hispanic caregivers experienced distress levels similar to those of White caregivers, Black and Hispanic caregivers tended to make greater use of distancing as a coping strategy and tended to have more traditional caregiver ideology, such as the belief that caring for a loved one with injury is an obligation. The results suggest that interventions should consider racial/ethnic differences in coping styles and perceptions of the caregiving role. The article by Kreutzer and colleagues is one of the few to date to investigate longitudinal changes in the marital relationship after injury. Finding that less than one quarter of marriages dissolved after TBI, they showed that the marriages that were stable over time involved persons who had been married longer, were older, and had sustained non-violent and less severe injuries. These results suggest that younger couples, those who were married for a short time, and those who were victims of violent injury should be targeted for marital/family therapy after injury.The review by Boschen and colleagues showed that only four controlled studies regarding effective interventions for caregivers have been done and these were considered to be of low to moderate quality. A surprising finding was that the research about caregivers of patients with dementia and chronic illnesses was also lacking. There seems to be some benefit of cognitive behavioral interventions, which often address problem-solving and coping styles. Another avenue to address these is described in the article by Charles and colleagues, where the results of a pre-post-test study investigating a multigroup family intervention are discussed. This intervention is unique in its inclusion of the entire family, including children. Their results showed that, while family members’ distress and family dysfunction continued after the intervention, the intensity had decreased, and participants reported high levels of satisfaction. The treatment appears to hold promise, but calls for future research using a wait list control group to determine effectiveness.(Source: NeuroRehabilitation : Baylor College : April 2007.)