A contemporary model of stress for understanding family functioning and the psychological distress in relatives of people with severe traumatic brain injury (TBI)

Objective: Conservation of Resources, a theory of stress and coping, was combined with the McMaster Model of Family Functioning to form a unique framework to test the relationship between neurobehavioural impairments, family functioning and psychological distress in relatives of people with severe TBI. The model proposed that chronic stressors (i.e. neurobehavioural impairments) would have both a direct effect on relative distress, as well as indirect effects as mediated by disrupted family functioning. Method: This multi-site study used an ex post facto design with a sample of 104 relatives (40 parents and 64 spouses) from NSW. Measures included the Neurobehavioural problem Checklist, Brief Symptom Inventory, and Family Assessment Device. Structural equation modelling was used to test the model. In parallel, in-depth interviews based on the McMaster model (i.e. Structured Interview of Family Functioning) were conducted with a sub-group of the relatives (n=10) to more fully explore the family dynamics. Results: Direct effects were found between all 3 components of the model: 1. Severe neurobehavioural impairments had a direct effect on relative distress; 2. Relatives reporting high levels of neurobehavioural impairments also identified significant disruption in family functioning; 3. Disrupted family functioning was associated with high levels of distress. Significantly, relative distress was intensified by the indirect effects of neurobehavioural impairments mediated by the disruption to family functioning. The interview data supported the model, but also found that neurobehavioural impairments disrupted affective relationships among family members, an issue not detected by the standardised scales. Conclusions: There are at least twp pathways by which neurobehavioural impairments impact upon relative distress, suggesting that treatment of such distress should also target the broader disruption to family functioning. A mixed method approach may strengthen the validity of research into the complex nature of family adaptation to TBI. Copyright © 2006 Nova Science Publishers.