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A Conceptual Model of Irritability Following Traumatic Brain Injury: A Qualitative, Participatory Research Study

Hammond, Flora M. MD; Davis, Christine PhD; Cook, James R. PhD; Philbrick, Peggy; Hirsch, Mark A. PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP; Brenner, Lisa PhD, ABPP

Journal of Head Trauma Rehabilitation: March/April 2016 - Volume 31 - Issue 2 - p E1–E11
doi: 10.1097/HTR.0000000000000136
Focus on Clinical Research and Practice, Part 1

Background: Individuals with a history of traumatic brain injury (TBI) may have chronic problems with irritability, which can negatively affect their lives.

Objectives: (1) To describe the experience (thoughts and feelings) of irritability from the perspectives of multiple people living with or affected by the problem, and (2) to develop a conceptual model of irritability.

Design: Qualitative, participatory research.

Participants: Forty-four stakeholders (individuals with a history of TBI, family members, community professionals, healthcare providers, and researchers) divided into 5 focus groups.

Procedures: Each group met 10 times to discuss the experience of irritability following TBI. Data were coded using grounded theory to develop themes, metacodes, and theories.

Measures: Not applicable.

Results: A conceptual model emerged in which irritability has 5 dimensions: affective (related to moods and feelings); behavioral (especially in areas of self-regulation, impulse control, and time management); cognitive-perceptual (self-talk and ways of seeing the world); relational issues (interpersonal and family dynamics); and environmental (including environmental stimuli, change, disruptions in routine, and cultural expectations).

Conclusions: This multidimensional model provides a framework for assessment, treatment, and future research aimed at better understanding irritability, as well as the development of assessment tools and treatment interventions.

Indiana University School of Medicine and Rehabilitation Hospital of Indiana, Indianapolis (Dr Hammond); Departments of Communication Studies (Drs Davis and Mr Hirsch) and Psychology (Dr Cook), University of North Carolina at Charlotte; and Carolinas Rehabilitation, Carolinas Healthcare System, Charlotte, North Carolina (Ms Philbrick and Dr Hirsch).

Corresponding Author: Flora M. Hammond, MD, and Rehabilitation Hospital of Indiana, 4141 Shore Dr, Indianapolis, IN 46254 (flora.hammond@rhin.com).

The authors declare no conflicts of interest.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.