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Primary Objective: To examine the predictive associations of family satisfaction, functional impairment, pain, and depression on health-related quality-of-life (HRQoL) among persons with traumatic brain injury (TBI) through structural equation modelling (SEM)., Research Design: Participants were part of a larger longitudinal study of adjustment following TBI. Direct and indirect effects of predictor variables on HRQoL were analyzed through SEM., Methods and Procedures: The sample included 131 participants with TBI (89 men, 42 women) who had been discharged from an acute care hospital. The Sickness Impact Profile was administered to measure HRQoL at or beyond 24 months post-discharge. Predictor variable measures included the Functional Independence Measure, Family Satisfaction Scale and single items assessing the presence of pain and depression., Main Outcomes and Results: SEM revealed direct effects of functional impairment (p < 0.001), family satisfaction (p < 0.01), depression (p < 0.05) and pain (p < 0.01) on HRQoL. Indirect effects from functional impairment (p < 0.05) and pain (p < 0.05) to HRQoL through depression were also present., Conclusions: The presence of pain and depression, greater functional impairment and lower family satisfaction were predictively associated with lower HRQoL. Depression further mediated the effects of pain and functional impairment on HRQoL. The present study advances understanding of the ways in which pain, depression and functional impairment predict HRQoL.

Identifying reliable predictors of positive adjustment following traumatic brain injury (TBI) remains an important area of inquiry. Unfortunately, much of available research examines direct relationships between predictor variables and outcomes without attending to the contextual relationships that can exist between predictor variables. Relying on theoretical models of well-being, we examined a theoretical model of adjustment in which the capacity to engage in intentional activities would be prospectively associated with greater participation, which in turn would predict subsequent life satisfaction and perceived health assessed at a later time. Structural equation modeling of data collected from 312 individuals (226 men, 86 women) with TBI revealed that two elements of participation--mobility and occupational activities--mediated the prospective influence of functional independence and injury severity to optimal adjustment 60 months following medical discharge for TBI. The model accounted for 21% of the variance in life satisfaction and 23% of the variance in self-rated health. Results indicate that the effects of functional independence and injury severity to optimal adjustment over time may be best understood in the context of participation in meaningful, productive activities. Implications for theoretical models of well-being and for clinical interventions that promote adjustment after TBI are discussed.

Objectives: Examined the influence of functional impairment, stable marital status, and family satisfaction on life satisfaction trajectories for 609 individuals (435 men, 174 women) over the first 5 years after traumatic brain injury (TBI)., Measures: Participants completed the Family Satisfaction Scale (FSS), Functional Independence Measure (FIM), and the Life Satisfaction Index (LSI) at years 1, 2, 4, and 5 after sustaining a TBI., Results: Trajectory modeling revealed that higher family satisfaction was associated with increases in life satisfaction for individuals with less functional impairment. Stable marital status was not significantly associated with life satisfaction trajectories., Implications: Family satisfaction appears to have pronounced beneficial effects on life satisfaction for persons with less functional impairment after TBI regardless of marital status. In contrast, a stable marriage appears to have no apparent benefits to self-reported life satisfaction over the first 5 years post-TBI. Theoretical and clinical implications of these results are discussed.

Objectives: The trajectories of life satisfaction for 609 individuals who sustained a traumatic brain injury (TBI) were studied. Hierarchical linear modeling analysis examined individual level growth trends over the first 5 years following TBI using gender, functional independence, age, and time to estimate life satisfaction trajectories., Measures: Participants completed the Functional Independence Measure and the Life Satisfaction Inventory at years 1, 2, 4, and 5 after sustaining TBI., Results: Participants who reported higher functional independence at year 1 also had higher life satisfaction at year 1. Participants with lower functional independence across the 5-year period had life satisfaction trajectories that decreased at significantly greater rates than the individuals with more functional independence. The life satisfaction trajectory declined for the sample, but participants reporting lower cognitive and motor functional independence had significantly greater declines in life satisfaction trajectories. Age and gender were not significant factors in predicting life satisfaction trajectories following TBI., Implications: Individuals with greater cognitive and motor impairments following TBI are likely to experience significant declines in life satisfaction within 5 years of living with TBI.

Objective: To test the hypothesis that a problem-solving training program would lower depression, health complaints, and burden, and increase well-being reported by community-residing family caregivers of persons with traumatic brain injuries (TBIs)., Design: Randomized controlled trial., Setting: General community., Participants: Of the 180 people who expressed interest in the study, 113 did not meet eligibility criteria. A consenting sample of family caregivers were randomized into a problem-solving training group (4 men, 29 women; average age, 51.3y) or an education-only control group (34 women; average age, 50.8y). Care recipients included 26 men and 7 women in the intervention group (average age, 36.5y) and 24 men and 10 women in the control group (average age, 37.2y)., Intervention: Problem-solving training based on the D'Zurilla and Nezu social problem-solving model was provided to caregivers in the intervention group in 4 in-home sessions and 8 telephone follow-up calls over the course of their year-long participation. Control group participants received written educational materials and telephone calls at set intervals throughout their 12 months of participation., Main Outcome Measures: Caregiver depression, health complaints, well-being, and social problem-solving abilities., Results: Hierarchical linear models revealed caregivers receiving problem-solving training reported significant decreases in depression, health complaints, and in dysfunctional problem-solving styles over time. No effects were observed on caregiver well-being, burden, or constructive problem-solving styles., Conclusions: Problem-solving training provided in the home appears to be effective in alleviating distress and in decreasing dysfunctional problem-solving styles among family caregivers of persons with TBI. Methodologic limitations and the implications for interventions and future research are discussed.

Objective: To test the hypothesis that ineffective problem-solving abilities would be significantly predictive of risk for depression in caregivers of persons with traumatic brain injury (TBI) after controlling for caregiver burden, caregiver health and demographic characteristics., Design: Correlational and logistic regression analyses of cross-sectional data., Participants: 57 women and 3 men (M age of caregivers=51.4, SD=10.1) caring for a relative with a TBI., Main Outcome Measure: Centers for Epidemiologic Studies - Depression scale (CES-D)., Results: Twenty-nine caregivers (48.3%) had CES-D scores that met the criteria for risk of depression. An ineffective approach to problem solving, characterized by negative, avoidant, and careless/impulsive styles, and self-reported caregiver physical symptoms were significantly predictive of caregiver depression regardless of length of time caregiving, perceived burden, or demographic variables., Conclusions: Caregivers of persons with TBI who report physical health problems and who exhibit ineffective problem solving area at greater risk for depression, regardless of the time they have spent in their role as a caregiver.

We studied the predictive impact of proxy 'outsider' reports, injury type, and functional independence on trajectories of happiness over the first 5 years following medical treatment for a traumatic spinal cord injury, brain injury, severe burns or inter-articular fractures (total N = 1,271). It was anticipated that lower functional independence and outsider status would predict lower happiness trajectories, with injury type having little effect over time. A measure of functional impairment and the life satisfaction index containing the items that assessed happiness were administered 12, 24, 48, and 60 months post-discharge. Trajectory modeling revealed that lower functional independence significantly predicted lower happiness, regardless of injury type. Outsider reports predicted significantly higher happiness scores than the insiders reported themselves. These differences persisted across time and injury type. Additional analyses found that insider/outsider status accounted for one percent of the variance in happiness scores and functional independence accounted for twenty percent of the variance. Moreover, for all injury groups, there was no evidence for changes in happiness trajectories over time. Outsider accounts differ significantly from insider estimations of variables of positive adjustment accounts but explain little variation in the reports of happiness overall and still have practical and clinical value as secondary sources of information about positive emotional experiences, particularly when reports from the 'insider' are not possible. [ABSTRACT FROM AUTHOR]