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Published on: January 30, 2018
Predicting family functioning after TBI: impact of neurobehavioral factors
Julie A Testa1, James F Malec, Anne M Moessner
1Department of Psychiatry, Mayo Clinic, Rochester, MN 55905, USA. testa.julie@mayo.edu
Insights
Family dysfunction and ongoing neurobehavioral issues after traumatic brain injury (TBI) increase patient distress. Identifying high-risk families is crucial for timely intervention and support following TBI or orthopedic injuries (OI).
Area of Science:
- Neuroscience
- Psychology
- Rehabilitation Medicine
Background:
- Traumatic brain injury (TBI) and orthopedic injuries (OI) can lead to long-term neurobehavioral problems and impact family functioning.
- Understanding the interplay between injury severity, neurobehavioral deficits, and family dynamics is essential for effective patient recovery.
- Previous research has highlighted the challenges faced by individuals and their families post-injury, but specific risk factors require further elucidation.
Purpose of the Study:
- To identify risk factors associated with poor family functioning and neurobehavioral problems following moderate/severe TBI, mild TBI, and OI.
- To examine the longitudinal relationship between family functioning and neurobehavioral outcomes at hospital discharge and one-year follow-up.
- To inform the development of targeted interventions for high-risk individuals and families.
Main Methods:
- Longitudinal analysis of an inception cohort including patients with moderate/severe TBI, mild TBI, and OI.
- Data collected at hospital discharge and one-year follow-up.
- Assessment of family functioning using the Family Assessment Device and neurobehavioral status via the Neurobehavioral Functioning Index.
Main Results:
- Patients with moderate/severe TBI exhibited more depression, memory/attention deficits, motor impairments, and communication difficulties compared to OI patients at discharge.
- These neurobehavioral deficits persisted at one-year follow-up in the moderate/severe TBI group.
- Approximately one-third of all patient groups reported unhealthy family functioning at both assessment points, with family dysfunction strongly correlating with neurobehavioral symptoms.
Conclusions:
- Family dysfunction at discharge and persistent neurobehavioral problems are significant predictors of distress one year after TBI.
- Early identification of families at high risk for dysfunction is critical for implementing necessary referrals and treatment.
- Interventions should address both neurobehavioral deficits and family system dynamics to improve long-term outcomes post-TBI.
Objective:
To identify risk factors for poor family functioning and neurobehavioral problems after traumatic brain injury (TBI) or orthopedic injuries (OI).
Design:
Longitudinal analyses of data from an inception cohort.
Participants:
Seventy-five patients with moderate/severe TBI, 47 patients with mild TBI, and 44 patients with OI at discharge; and 49 patients with moderate/severe TBI, 24 patients with mild TBI, and 33 patients with OI at 1-year follow-up.
Outcome Measures:
Measures of family functioning (Family Assessment Device) and Neurobehavioral Functioning Index at hospital discharge and 1-year follow-up.
Results:
At discharge, patients with moderate/severe TBI had more symptoms of depression, memory/attention problems, and motor impairments than patients with OI and greater communication difficulties than patients with OI or mild TBI. At follow-up, patients with moderate/severe TBI continued to have more problems in memory/attention, depression, and communication. Approximately one third of each group had unhealthy family functioning at each assessment period. Few patients reported both impaired family functioning and clinical depression. Distressed family functioning correlated strongly with increased rates of neurobehavioral symptoms. Family dysfunction at follow-up was best predicted by family dysfunction at discharge and depression or memory/attention deficits at follow-up.
Conclusions:
After TBI, patients at the greatest risk for distress at follow-up were those with family dysfunction at discharge and continued neurobehavioral problems. High-risk families need to be identified so that necessary referrals and/or treatment can be offered.
