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Family burden and adaptation during the initial year after traumatic brain injury in children
S L Wade1, H G Taylor, D Drotar
1Rainbow Babies & Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Insights
Severe traumatic brain injury (TBI) in children significantly increases family burden and parental psychological distress compared to orthopedic injuries. Families with a child experiencing severe TBI require targeted support for adaptation.
Area of Science:
- Pediatric neurosurgery
- Child psychology
- Family medicine
Background:
- Traumatic brain injury (TBI) in children can cause lasting behavioral and cognitive issues.
- The impact of pediatric TBI on family burden and psychosocial health is not well understood.
Purpose of the Study:
- To investigate the hypothesis that moderate and severe TBI in children result in greater adverse consequences for families than orthopedic trauma.
- To quantify the differences in family burden, parental distress, and family functioning.
Main Methods:
- A cohort of 53 children with severe TBI, 56 with moderate TBI, and 80 with orthopedic injuries (ages 6-12) was studied.
- Caregivers completed assessments of injury burden, parental distress, and family functioning at baseline, 6, and 12 months post-injury.
- Multivariate repeated measures ANCOVA analyzed group differences in outcomes over time.
Main Results:
- Caregivers of children with severe TBI reported higher family burden, injury-related stress, and psychological symptoms than those with orthopedic injuries.
- Severe TBI caregivers were twice as likely to exceed clinical cutoffs for psychological symptoms and report family dysfunction.
- No significant differences were found in marital distress between groups.
Conclusions:
- Severe pediatric TBI imposes a substantial and persistent burden on caregivers, exceeding that of other traumatic injuries.
- Caregivers of children with severe TBI experience significant psychological distress and family dysfunction.
- Interventions are crucial to support family adaptation following pediatric TBI.
Objective:
Traumatic brain injury (TBI) often leads to long-term behavioral and cognitive deficits in children. However, little is known about the burden and psychosocial morbidity of pediatric TBI for families. The purpose of this study was to test the hypothesis that moderate and severe TBI in children has more adverse consequences than orthopedic trauma.
Design:
The sample was comprised of children between the ages of 6 and 12 recruited from hospital trauma and inpatient units including 53 with severe TBI, 56 with moderate TBI, and 80 with orthopedic injuries not involving central nervous system insult. Measures of injury-related burden, parental distress, and family functioning were administered to the child's primary caregiver at baseline assessment conducted soon after injury and at 6- and 12-month follow-ups. Multivariate repeated measures analysis of covariance was used to examine group differences in these outcomes over time.
Results:
Caregivers in the severe TBI group reported significantly higher levels of family burden, injury-related stress, and parental psychological symptoms than caregivers in the orthopedic injury group (ORTHO). The groups did not differ with respect to marital distress. Caregivers in the severe TBI group were significantly more likely than caregivers in the ORTHO group to exceed the clinical cutoff on the Brief Symptom Inventory and to report clinically significant levels of family dysfunction at follow-up.
Conclusions:
The findings suggest that severe TBI is a source of considerable caregiver morbidity, even when compared with other traumatic injuries. Caregivers in the severe TBI group had persistent stress associated with the child's injury, as well as the reactions of other family members, and a relative risk of clinically significant psychological symptoms nearly twice that of the ORTHO comparison group. These findings underscore the need for interventions that facilitate family adaptation after pediatric TBI.