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The Impact of Neurobehavioral Impairment on Family Functioning and the Psychological Well-Being of Male Versus Female Caregivers of Relatives With Severe Traumatic Brain Injury: Multigroup Analysis

Anderson, Malcolm I. PhD, RN, FRCNA; Simpson, Grahame K. PhD, FFACSW; Morey, Peter J. EdD

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

The Journal of Head Trauma Rehabilitation: November/December 2013 - Volume 28 - Issue 6 - p 453–463
doi: 10.1097/HTR.0b013e31825d6087
Original Articles

Objective: To examine the differential effect of neurobehavioral impairments (cognitive, behavioral, and social) on family functioning, family roles, and psychological distress in male versus female caregivers of relatives with severe traumatic brain injury (TBI).

Design: Structural equation modeling with multigroup analysis conducted in a cross-sectional sample to test an established theoretical model.

Participants: An aggregated sample of 122 caregivers (46 male, 76 female) of people with severe TBI. The sample comprised 64 spouses and 58 parents (29 parental couples) of 93 persons with TBI.

Measures: Neurobehavioral Problem Checklist; Family Assessment Device; and Brief Symptom Inventory.

Results: Structural equation modeling showed that the proposed model had acceptable fit indices for the combined sample. Multigroup analysis indicated that both male and female caregivers (i) responded similarly to the neurobehavioral impairments experienced by the injured relative and (ii) reported behavior having a direct effect on family functioning, which, in turn, increased psychological distress. However, the effect of disrupted family functioning was more influential on the level of distress in male caregivers than in female caregivers.

Conclusion: Evidence was found for gender-specific pathways underlying the psychological distress of male versus female caregivers. Such findings can assist in tailoring family support strategies so that they cater for caregivers of both genders.

Faculty of Nursing and Health, Avondale College of Higher Education, Sydney (Dr Anderson); Brain Injury Rehabilitation Unit, Liverpool Health Service, Sydney (Dr Simpson); Rehabilitation Studies Unit, University of Sydney, Sydney (Dr Simpson); and Faculty of Business, Avondale College of Higher Education, Cooranbong (Dr Morey), New South Wales, Australia.

Corresponding Author: Malcolm I. Anderson, PhD, RN, FRCNA, Faculty of Nursing and Health, Avondale College of Higher Education, Sydney, New South Wales, Australia (

This work was supported by the Avondale College of Higher Education Foundation and the Australasian Research Institute (grant 050301). The authors acknowledge the contributions made by the staff from the Brain Injury Rehabilitation Programmes in New South Wales in facilitating this project.

The authors declare no conflicts of interest.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins