Kinship and family members' psychological distress after traumatic brain injury: A large sample study

Objective: To describe the level and type of psychological distress experienced by live-in relatives of people with traumatic brain injury (TBI) and to compare the distress of spouses with that of other relatives. Design: A 2 x 3 x 4 cross-sectional design was used, with two levels of kinship (parent/spouse); three categories of duration of coma (no coma, coma <1 week, coma >1 week); and three categories of time since injury (10-24 months; 25-48 months; >48 months), Multivariate analysis of variance ascertained differences in psychological distress among spouses and relatives. Regression analysis identified the psychiatric symptoms that accounted for ratings of perceived stress. Setting and Participants: Family members (N = 116) of a sample of outpatients with TBI, drawn from a database at a large urban medical center. Main Outcome Measures: The Brief Symptom inventory (BSI) and a perceived stress measure. Results: Over 40% of the relatives had clinically elevated scores on the BSI. The Obsessive Compulsive, Psychoticism, Paranoid Ideation and Hostility subscales were the most elevated. The BSI's Global Severity Index (GSI) correlated moderately with perceived stress. Spouses reported significantly more distress than other relatives (who were mostly parents) on all but three subscales. Male caregivers of female relatives with TBI displayed mote distress on the GSI than other gender combinations. Time since injury and patients' days In coma did not affect relatives' levels of distress. Conclusions: Standardized measures of psychological distress confirm the clinical impression that family caregivers of people with TBI feel alienated, isolated, overwhelmed, and mentally preoccupied. Spouses experience more distress, which suggests that earlier marital intervention may be useful. Further research should address the needs of male caregivers and ''cross-gender'' caregiving.