Predicting emotional well-being following traumatic brain injury: a test of mediated and moderated models

This study examined two models for predicting emotional well-being following traumatic brain injury (TBI), namely the Lazarus and Folkman (1984) mediated model of stress and coping and the stress-buffer hypothesis (Cohen & Edwards, 1988). The mediated model suggests that antecedent variables (i.e., personal and environmental resources) will predict emotional well-being, but their effect will be mediated through cognitive variables, such as appraisal and coping. In contrast, the moderated (buffer) hypothesis suggests that resources will protect individuals from the effects of stress, so will have different relationships with outcome at different levels of perceived stress. Ninety individuals with TBI were recruited from a major hospital in Brisbane, Australia. They and their relatives completed questionnaires at three time intervals: discharge, one month and nine months post-discharge, discharge being in 1998. Hierarchical regression was used to examine the relationships among the proposed predictors, mediators and outcomes. Support was found for some aspects of both models in the short-term. In the long-term, stress-buffer effects were no longer apparent. However, with the exception of family support, the predictors all influenced long-term adjustment through their impact on short-term adjustment. The role of family support as a direct predictor of emotional well-being in the long-term is highlighted. The findings have the potential to enable the identification of "at risk" individuals prior to discharge and can highlight important foci for rehabilitation. Specifically, the study has identified the importance of early psychological intervention to address appraisal and the need to engage families in rehabilitation.