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Predictors of family functioning one year following traumatic brain injury in children
J B Rivara1, G C Fay, K M Jaffe
1Department of Rehabilitation Medicine, School of Social Work, University of Washington, Seattle.
Insights
Preinjury family functioning significantly predicts outcomes one year after pediatric traumatic brain injury (TBI), especially for severe injuries. Early identification of at-risk families is crucial for providing necessary support.
Area of Science:
- Neuroscience
- Pediatric Psychology
- Family Studies
Background:
- Traumatic brain injury (TBI) significantly impacts child development and family dynamics.
- Understanding long-term family functioning post-TBI is essential for effective intervention.
- Pre-injury family status is a critical factor often overlooked in TBI recovery research.
Purpose of the Study:
- To examine changes in family functioning during the year after pediatric TBI.
- To identify predictors of family outcome following TBI.
- To assess the influence of injury severity versus pre-injury status on family functioning.
Main Methods:
- Longitudinal study of 94 children (ages 6-15) with varying TBI severity (mild, moderate, severe).
- Data collection included family interviews and standardized measures at 3 weeks, 3 months, and 12 months post-injury.
- Analysis focused on changes in family functioning and predictive relationships between pre-injury factors and later outcomes.
Main Results:
- Severe TBI group showed greater family functioning deterioration over 12 months compared to mild/moderate groups.
- Pre-injury family global functioning was a stronger predictor of 12-month functioning (R2 = .38–.68) than injury severity (R2 = .05–.09).
- Pre-injury status in specific areas was the strongest predictor for four out of five outcomes; pre-injury coping best predicted stress.
Conclusions:
- Pre-injury family functioning is a more significant determinant of long-term outcomes than injury severity.
- Families experiencing TBI, particularly severe cases, face significant and persistent challenges.
- Early identification of at-risk families and provision of ongoing support are vital for optimizing family well-being after pediatric TBI.
Abstract:
This study examined changes in family functioning and predictors of family outcome during the year following traumatic brain injury (TBI). The families of 94 children with TBI (mild = 50, moderate = 25, severe = 19), ages six to 15, were consecutively enrolled from two regional medical centers. Family interview ratings and standard measures of family and child functioning were completed three weeks after injury (measuring preinjury status), as well as three and 12 months. Two-thirds of families had moderate to good preinjury global functioning and coping resources, but more than half exhibited high levels of stress and at-risk family relationships. No significant preinjury differences by injury severity were seen on any measure. Whereas few changes in family functioning were observed over the year in the mild or moderate groups, greater deterioration occurred in the severe group. From one third to one half noted moderate to severe strain in 13 problem areas often seen in individuals with TBI. Preinjury family global functioning, however, was more strongly predictive of 12-month family functioning (R2 = .38 to .68) than was injury severity (R2 = .05 to .09). In four out of five outcome areas assessed at 12 months, preinjury status in each area was the strongest single predictor. Preinjury coping was the best predictor of stress. Families at risk can be identified and need ongoing support for optimal functioning.