Patient outcome in the year following severe head injury and relatives' psychiatric and social functioning.

Abstract

SUMMARY Fifty-seven consecutive severe male head injury patients together with a defined female relative were assessed at home 3, 6 and 12 months after injury in order to measure the psychiatric and social impact of the injury on the relative. Relatives were found to have significant and persistent psychiatric and social dysfunction and they considered themselves to have a high burden in caring for the relative throughout the year. No particular relationship was found to be the more vulnerable. The most frequent predictor of the relatives' psychiatric and social status was the level of symptomatic complaints voiced by the patients. The findings suggest the need for comprehensive rehabilitation of head injury patients and their relatives.After a severe head injury, there is often a critical period when survival is the main issue.' Those who subsequently return home frequently present a multitude of deficits and handicaps.25 Often the main burden in dealng with these problems falls on the shoulders of a close relative, usually female.Rosenbaum and Najenson6 assessed a group of Israeli war wounded soldiers and their wives 1 year after injury. They used two control groups of relatives. Higher levels of depression were recorded in the head injury wives, associated with behavioural and role shifts in their husbands.A mixed sex group of relatives of 54 head injured patients was studied prospectively at 1 month, 6 months and 12 months after injury by Odddy et al.7 They too found high levels of depression (Wakefield Depression Inventory) in the relatives, particularly at 1 month after injury when 39% scored above the threshold level on the scale. This reduced to approximately 20% at the later follow-ups, although the incidence of emotional or psychosomatic" disorders remained high throughout the year. This latter figure is however consistent with the incidence of minor emotional disorder in a normal population.8 The high levels of depression were found to be associated with the duration of post traumatic amnesia (PTA),9 the time spent in hospital and with Address for reprint requests: Dr MG Livingston, Dept of Psychological Medicine, University of Glasgow, 6 Whittingehame Gardens, Great Western Rd, Glasgow G12 OAA, UK. return to work. They were, in addition, associated with personality change and subjective complaints in the patients.McKinlay et al'°studied a close relative of 55 severely head injured adults (PTA greater than or equal to 2 days). Relatives were asked at 3, 6 and 12 months after injury to rate stress experienced on a seven point scale. Over 70% scored either medium or high stress on each occasion, associated with mental and behavioural changes in the patient. Workers from the same group'" examined the relationship between strain in relatives (a measure of subjective burden) and personality change in the patient in more detail. As the year after the injury progressed, an increased association developed between personality change in patients and subjective burden in the relatives.The studies quoted provide ...

Patterns of change and stability in caregiver burden and life satisfaction from 1 to 2 years after severe traumatic brain injury: A Norwegian longitudinal study

“…The French PariS-TBI study reported a decrease in caregiver burden from 1 to 4 years post-injury (Bayen et al, 2014;Bayen et al, 2013). Among 57 caregivers of patients with severe TBI, the perceived level of burden was high at the 3-, 6-and 12-months follow-up times, with a slight increase between 6 and 12 months (M. G. Livingston et al, 1985).…”

Parental stress and burden following traumatic brain injury amongst children and adolescents

“…Those caring for and living with an adult who has experienced TBI report significant levels of burden and distress [4,5]. Clinically significant levels of anxiety, depression, and impaired social adjustment have been observed at six months post-injury for over one third of those caring for people with severe TBI [6].…”

Severe Traumatic Brain Injury: Some Effects on Family Caregivers

“…According to Zeigler, the reasons for staying include feelings of guilt and fear of social condemnation, a sense of responsibility, or gratitude and fond memories. While research such as that by Livingston, et al (1985) often indicated heightened stress in family members having to cope with a brain-injured person, this is not always the case (Thomsen, 1974). Maitz (1990) suggested that adjustment is related to family characteristics such as cohesion, adaptability, marital adjustment, and affectional relations among family members.…”

“…Caring for the injured person places a considerable burden on the family and can result in ongoing psychological dysfunction (Livingston, Brooks, & Bond, 1985).…”