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INTRODUCTION Emotional distress and sense of burden are experienced by many caregivers of persons with traumatic brain injury (TBI). 1-8 - PowerPoint PPT Presentation


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Physical Medicine and Rehabilitation. Model 1: Predictors of Caregiver Burden. INTRODUCTION Emotional distress and sense of burden are experienced by many caregivers of persons with traumatic brain injury (TBI). 1-8 Predicting which caregivers will experience

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INTRODUCTION Emotional distress and sense of burden are experienced by many caregivers of persons with traumatic brain injury (TBI). 1-8

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Physical Medicine and Rehabilitation

Model 1: Predictors of Caregiver Burden

  • INTRODUCTION

  • Emotional distress and sense of burden are

  • experienced by many caregivers of persons

  • with traumatic brain injury (TBI).1-8

  • Predicting which caregivers will experience

  • distress is critical for developing empirically-

  • based interventions.

  • Researchers have examined injury-related

  • variables and caregiver demographics to

  • predict caregivers’ adjustment following TBI.

  • Injury severity appears to be related to caregiver

  • distress at 3 to 6 months post-injury, but not at

  • longer follow-up intervals.4, 9-12

  • Changes in emotional and social functioning in

  • injured persons are strongly related to

  • caregivers’ perceived stress and emotional

  • functioning.4, 8-10, 13-17

  • Caregiver demographics: relationship to the

  • injured person has been studied most

  • frequently. Findings have been mixed.

  • Coping styles18-19 and social support17, 20, 21

  • appear to moderate the impact of injury on

  • caregiver perceived burden and distress.

  • Many caregivers have pre-existing difficulties

  • that may predispose them to greater distress

  • following injury, including emotional distress

  • and significant medical illnesses.4, 22 These

  • variables have the potential to help identify

  • caregivers at risk for developing greater

  • distress after injury.

  • PURPOSE

  • The contribution of pre-injury

  • medical and psychiatric histories to caregiver

  • outcome, above and beyond what can be

  • predicted by other variables, has remained

  • unexplored.

  • Our goal was to examine the relationship of pre-

  • injury caregiver medical and psychiatric

  • histories to perceived burden and emotional

  • distress among caregivers of persons with TBI.

  • METHOD

  • Participants

  • Sample consisted of 114 caregivers of persons

  • with medically documented complicated

  • mild/moderate (35%) or severe (65%) injury,

  • admitted to 1 of 3 participating centers.

  • Of 217 caregivers with baseline data, 114 had

  • follow-up data at 1 year post-injury.

  • Caregivers lost to follow-up did not differ from

  • those with follow-up data with regard to

  • demographics, medical or psychiatric history,

  • or severity of the person with injury.

  • Measures

  • Brief Symptom Inventory (BSI)24: 53 items

  • yield 3 global distress indices. Global

  • Severity Index scores were used as an

  • outcome measure of caregiver distress.

  • Modified Caregiver Appraisal Scale (MCAS)25,26:

  • used for caregivers of persons with TBI.

  • Perceived Burden Scale scores were used as

  • an outcome measure of perceived burden.

  • Ways of Coping Questionnaire (WOCQ)27: used

  • to identify frequently used coping strategies.

  • Escape-Avoidance and Positive Reappraisal

  • subscales were used as predictor variables.

  • Multidimensional Scale of Perceived Social

  • Support (MSPSS)28: assesses satisfaction with

  • perceived social support. The total score was

  • used as a predictor variable.

  • Disability Rating Scale (DRS)29: rates level of

  • functional ability in 8 areas. The total score

  • was used as a predictor variable.

  • Procedure

  • Caregivers’ demographics, medical history,

  • and psychiatric history were obtained

  • through structured interview.

  • Caregivers completed the BSI, MCAS, WOCQ,

  • and MSPSS at approximately 1 year post-

  • injury. A trained examiner rated the injured

  • person on the DRS at the same time interval.

  • Two multiple linear regression models were

  • constructed, one to predict caregiver

  • perceived burden and one to predict

  • caregiver distress. The models were identical

  • except for the outcome variables.

  • DISCUSSION

  • Perceived Burden

  • Poorer functional status of persons with injury was

  • associated with greater sense of burden among caregivers.

  • Increased perceived social support was related to

  • decreased sense of burden.

  • Increased use of Escape-Avoidance was associated with

  • elevated caregiver burden.

  • Global Distress

  • Caregivers with reported histories of significant illness(es)

  • reported higher levels of distress.

  • Similarly, caregivers with histories of treatment for

  • psychological problems reported higher levels of distress.

  • Increased use of Escape-Avoidance was associated with

  • elevated distress.

  • CONCLUSIONS

  • After accounting for the functioning of the person with

  • injury and caregiver demographics, pre-injury medical and

  • psychiatric history contributed significantly to overall level

  • of caregiver distress.

  • This suggests that caregiver distress after TBI is not only

  • associated with injury-related variables, but also appears

  • related to pre-existing characteristics of caregivers.

  • Since medical and psychiatric data are readily identifiable

  • at the time of injury, early intervention is possible for

  • caregivers at risk for elevated emotional distress.

  • This relationship was not obtained with respect to

  • caregiver burden. This is likely a function of the inherent

  • differences between the two outcome measures. The BSI

  • Global Severity Index is a general measure of distress that

  • may not necessarily be related to the role of caring for

  • the injured person. In contrast, the Perceived Burden Scale

  • of the MCAS assesses caregivers’ perceptions of stress

  • directly associated with the caregiving role.

  • The relationship between emotion-focused coping

  • (Escape-Avoidance) and caregiver distress and burden is

  • consistent with previous research.

  • Primary limitations: accuracy issues with respect to self-

  • reported medical and psychiatric history data; only single

  • measures of caregiver burden and overall emotional

  • distress were used.

Medical and Psychosocial Predictors of Caregiver Functioning After Traumatic Brain InjuryLynne C. Davis, Ph.D., Angelle M. Sander, Ph.D.,Margaret A. Struchen, Ph.D.,Mark Sherer,Ph.D., Risa Nakase-Richardson, Ph.D.,& James F. Malec, Ph.D.

RESULTS

Model 1: Predictors of Perceived Burden

Model 2: Predictors of Global Distress

*References available on handout


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