Secondary Logo

Institutional members access full text with Ovid®

Early Indicators and Contributors to Psychological Distress in Relatives During Rehabilitation Following Severe Traumatic Brain Injury: Findings From the Brain Injury Outcomes Study

Winstanley, Julie PhD; Simpson, Grahame PhD; Tate, Robyn PhD; Myles, Bridget BA

Section Editor(s): Caplan, Bruce PhD, ABPP

Journal of Head Trauma Rehabilitation: November-December 2006 - Volume 21 - Issue 6 - p 453–466

Objectives To develop a multivariate model of the dynamic interactions among key variables associated with relative distress and disrupted family functioning after traumatic brain injury (TBI).

Participants A relative sample (parents, spouses, close others; n = 134) derived from a statewide cohort of people with TBI recruited to the multicenter Brain Injury Outcomes Study.

Setting A consecutive series of referrals over a 2-year period to the 11 adult units of the Brain Injury Rehabilitation Program in New South Wales, Australia.

Main Outcome Measures Relative measures included General Health Questionnaire–28 (psychological distress), Family Assessment Device (family functioning), and BIOS Family Needs Questionnaire (perceived adequacy of support). The degree of impairment and level of participation of the person with TBI were assessed by the Mayo-Portland Adaptability Inventory and Sydney Psychosocial Reintegration Scale, respectively.

Analysis Path analysis examined the varying contribution of impairment, participation, and support variables to both relative distress and disturbances in family functioning.

Results The overall model accounted for substantial proportions of the variance in psychological distress and family functioning. Importantly, the distress experienced by relatives was not due to the direct impact of the neurobehavioral impairments, but the effect of these impairments was mediated by the degree of community participation achieved by the person with TBI.

Conclusions The model highlights the impact on families when the person with TBI experiences restrictions in participation. Clinically, a greater focus on the provision of respite or case management services may assist in reducing relative distress.

Faculty of Medicine, Rehabilitation Studies Unit, University of Sydney (Drs Winstanley and Tate and Ms Myles), and the Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney (Dr Simpson), New South Wales, Australia; and the Faculty of Science, Health and Education, University of the Sunshine Coast, Queensland, Australia (Dr Winstanley).

Corresponding author: Julie Winstanley, PhD, Faculty of Science, Health and Education, University of the Sunshine Coast, Maroochydore DC, Queensland 4558, Australia (e-mail:

This study was funded by the New South Wales Motor Accidents Authority, the NSW Department of Health, and the Commonwealth Department of Health and Aged Care, Australia.

We thank the clients and their families for participating in the study, and the assistance of clinicians of the Units of the New South Wales Brain Injury Rehabilitation Program is gratefully acknowledged.

© 2006 Lippincott Williams & Wilkins, Inc.