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Objective: We examined the degree to which a resilient personality prototype predicted adjustment among war Veterans with and without a traumatic brain injury (TBI) while covarying the level of combat exposure., Method: A total of 127 war Veterans (107 men, 20 women; average age = 37 years) participated. Personality prototypes were derived from the Multidimensional Personality Questionnaire (Patrick, Curtain, & Tellegen, 2002). Measures were administered at baseline, and a subset was administered at 4- and 8-month follow-ups., Results: Veterans with resilient personalities reported less sleep disturbance, more health-promoting behaviors, psychological flexibility, and emotional distress tolerance than Veterans with undercontrolled or overcontrolled prototypes. Path models revealed that resilience significantly predicted posttraumatic stress disorder (PTSD), depression, quality of life, and social support over time. TBI had unique and consistent effects only on PTSD., Conclusion: Personality characteristics influence distress and quality of life among war Veterans with and without TBI. Implications for assessment, interventions, and research are discussed., (© 2016 Wiley Periodicals, Inc.)

This study examined whether blood fatty acid levels, vitamin D status, and/or physical activity are associated with physical fitness scores; a measure of mood, Patient Health Questionnaire-9; and a measure of resiliency, Dispositional Resiliency Scale-15 in active duty Soldiers. 100 active duty males at Fort Hood, Texas, underwent a battery of psychometric tests, anthropometric measurements, and fitness tests, and they also provided fasting blood samples for fatty acid and vitamin D analysis. Pearson bivariate correlation analysis revealed significant correlations among psychometric tests, anthropometric measurements, physical performance, reported physical inactivity (sitting time), and fatty acid and vitamin D blood levels. On the basis of these findings, a regression equation was developed to predict a depressed mood status as determined by the Patient Health Questionnaire-9. The equation accurately predicted depressed mood status in 80% of our participants with a sensitivity of 76.9% and a specificity of 80.5%. Results indicate that the use of a regression equation may be helpful in identifying Soldiers at higher risk for mental health issues. Future studies should evaluate the impact of exercise and diet as a means of improving resiliency and reducing depressed mood in Soldiers., (Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.)

Objective: Individuals who assume caregiving duties for a family member disabled in a traumatic injury often exhibit considerable distress, yet few studies have examined characteristics of those who may be resilient in the initial year of caregiving. Reasoning from the influential Pearlin model of caregiving (Pearlin & Aneshensel, 1994) and the resilience process model (Bonanno, 2005), we expected a significant minority of caregivers would be chronically distressed and another group would be resilient throughout the inaugural year of caregiving for a person with a traumatic spinal cord injury (SCI), and these groups would differ significantly in primary and secondary stress and in personal resources and mediators., Method: Twenty men and 108 women who identified as caregivers for a family member who incurred a traumatic SCI consented to complete measures during the inpatient rehabilitation and at 1 month, 6 months, and 12 months postdischarge., Results: Latent growth mixture modeling of depression symptoms over time revealed 3 groups of caregivers: chronic (24%), recovery (24%) and resilient (48%). The chronic group reported more anxiety, negative affect, and ill health than the other 2 groups throughout the year. The resilient group was best characterized by their enduring levels of positive affect and supportive social networks., Conclusions: A large percentage of individuals are resilient in the initial year of caregiving, and those who have problems adapting exhibit significant distress soon following the traumatic event. Early detection of and psychological interventions for individuals who have difficulty adjusting are indicated, as their distress is unlikely to abate untreated over the year.

Objective: Intervention trials for stroke caregivers after the early poststroke period are lacking. To address this gap, we examined the effectiveness of a problem-solving intervention (PSI) for stroke caregivers who provided care for at least 6 months and who experienced significant strain in their role., Method: One hundred twenty-two family caregivers (age = 66.2 years, 77.9% female) were randomly allocated to a PSI or control group. The PSI was composed of 2 home visits and 18 telephone calls delivered over a 3-month intensive intervention and a 9-month maintenance period. PSI and control groups received monthly information letters in addition to usual care. Primary caregiver outcomes were depressive symptoms (measure: Center for Epidemiologic Studies-Depression Scale) and sense of competence (measure: Sense of Competence Questionnaire)., Results: In covariance analyses, caregivers of the PSI group showed significantly lower levels of depressive symptoms after 3 months (p < .01, d = -.48) and after 12 months (p < .05, d = -.37), but no better sense of competence compared with the control group. Latent growth curve analyses revealed positive significant (p < .05) linear and quadratic effects of PSI on both primary outcomes. No effects, however, were found on caregiver social-problem-solving abilities., Conclusions: Although beneficial effects were observed among caregivers in the PSI group, the lack of effects on problem-solving abilities implies other characteristics of the intervention might account for these benefits. The relative intensity and therapeutic contact during the first 3 months of the intervention may be particularly helpful to caregivers of stroke survivors., (PsycINFO Database Record (c) 2014 APA, all rights reserved.)

Objectives: Examined the severity of depressive symptoms and the rates of probable depression assessed by different instruments that were included in two separate surveys of residents in a predominately rural region of the United States., Method: Surveys of the Brazos Valley region in south central Texas were conducted and responses to the short form of the Center for Epidemiological Studies-Depression scale (in the 2006 survey) and the Patient Health Questionnaire-9 (in the 2010 survey) were analyzed., Results: Regardless of instrument used, results indicate that women and African Americans are at greater risk for depression in this underserved region, but no unique effects were found for rural residency., Implications: Implications for research, assessment, program planning, and policy are discussed., (2013 Wiley Periodicals, Inc)

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.

We examined the rate of depression among 110 parents of children with disabilities and tested a model to determine the unique factors associated with parental depression. Consenting parents completed measures of depression, family satisfaction, physical health, problem-solving abilities, stress appraisals, and child functional impairment. Participants were categorized as depressed or nondepressed based on their responses to the Patient Health Questionnaire (PHQ9; Kroenke, Spitzer, & Williams, 2001). Nineteen percent of the parents met screening criteria for depression. Regression analyses revealed that threat appraisals, poorer physical health, and lower family satisfaction were uniquely associated with depression status with 83.3% accuracy. These findings highlight the importance of family satisfaction, problem solving ability, physical health, and the influence of appraisal processes on depression among parents of children with disabilities.

Objective: Examined cognitive appraisals of interference and tolerance in the prediction of distress and self-reported disability among persons presenting for low vision rehabilitation., Design: Cross-sectional; correlational and path analyses., Methods: One-hundred and thirteen patients (mean age, 71 years; 52 men and 61 women) presenting for low vision rehabilitation at a university-based centre for low vision rehabilitation participated in an initial clinical vision examination and completed several questionnaires to evaluate cognitive appraisals, emotional distress and self-reported disability., Results: Path analyses indicated that greater tolerance was associated with less interference imposed by vision loss. Greater tolerance was also associated with less emotional distress and symptom severity (visual acuity) was associated with self-reported disability. Cognitive appraisals (tolerance and interference) indirectly influenced self-reported disability through emotional distress., Conclusions: The data indicate that appraisals of personal ability to tolerate vision loss and the perceived interference of vision loss on goal-directed behaviour and expected activities have greater influence on distress and are subsequently predictive of disability in comparison with objective symptoms (visual acuity). Implications for clinical interventions and further 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.

Primary Objective: This study examined sociodemographic, physical and psychosocial characteristics of family caregivers of stroke survivors at risk for depression., Research Design: A correlational study., Methods and Procedures: Data were collected from 52 family caregivers and care recipients with ischemic stroke. Data were collected 1-2 days before discharge from a rehabilitative facility and at 5, 9 and 13 weeks post-discharge., Main Outcomes and Results: Compared to African Americans, Caucasians had approximately 3.7 times higher odds of being at risk. The odds of being at risk for depressive behaviour decreased by 30% for each unit increase in belonging and increased by 5% for each unit increase in burden., Conclusions: Family caregivers who are isolated from others may benefit from therapeutic interventions that facilitate social interaction and decrease caregiver burden. Ethnic differences in caregiver depression merit further research.

Background: The COVID-19 pandemic has a detrimental effect on the health and well-being of health care workers (HCWs). The extent to which HCWs may differ in their experience of depression and anxiety is unclear, and longitudinal studies are lacking. The present study examined theorized differences in distress between resilient and non-resilient HCWs over time, as reported in a national online survey. We also examined possible differences in distress as a function of sex and doctoral-level status. Methods: A national sample responded to an online survey data that included the study measures. Of the HCWs who responded, 666 had useable data at the two time points. A longitudinal structural equation model tested an a priori model that specified the relationship of a resilient personality prototype to self-reported resilience, coping, depression and anxiety at both measurement occasions. Additional invariance models examined possible differences by sex and doctoral-level status. Results: The final model explained 46.4% of the variance in psychological distress at Time 1 and 69.1% at Time 2. A non-resilient personality prototype predicted greater depression and anxiety. A resilient personality prototype was predictive of and operated through self-reported resilience and less disengaged coping to effect lower distress. No effects were found for active coping, however. The final model was generally invariant by sex and HCWs status. Additional analyses revealed that non-doctoral level HCWs had significantly higher depression and anxiety than doctoral-level HCWs on both occasions. Conclusions: HCWs differ in their susceptibility to distress imposed by COVID-19. Those who are particularly vulnerable may have characteristics that contribute to a lower sense of confidence and efficacy in stressful situations, and more likely to rely on ineffective, disengaged coping behaviors that can exacerbate stress levels. Individual interventions and institutional policies may be implemented to support HCWs at risk. [ABSTRACT FROM AUTHOR]

Objectives: Although many Iraq/Afghanistan warzone veterans report few problems with adjustment, a substantial proportion report debilitating mental health symptoms and functional impairment, suggesting the influence of personal factors that may promote adjustment. A significant minority also incur warzone-related traumatic brain injury (TBI), the majority of which are of mild severity (mTBI). We tested direct and indirect pathways through which a resilient personality prototype predicts adjustment of warzone veterans with and without mTBI over time. Method: A sample of 264 war veterans (181 men) completed measures of lifetime and warzone-related TBIs, personality traits, psychological adjustment, quality of life, and functional impairment. Social support, coping, and psychological flexibility were examined as mediators of the resilience-adjustment relationship. Instruments were administered at baseline, 4-, 8-, and 12-month assessments. Structural equation models accounted for combat exposure and response style. Results: Compared with a nonresilient personality prototype, a resilient prototype was directly associated with lower PTSD, depression, and functional disability, and higher quality of life at all time-points. Warzone mTBIs frequency was associated with higher scores on a measure of functional disability. Indirect effects via psychological flexibility were observed from personality to all outcomes, and from warzone-related mTBIs to PTSD, depression, and functional disability, at each time-point. Conclusions: Several characteristics differentiate veterans who are resilient from those who are less so. These findings reveal several factors through which a resilient personality prototype and the number of mTBIs may be associated with veteran adjustment. Psychological flexibility appears to be a critical modifiable factor in veteran adjustment. The present study indicates that the beneficial effects of a resilient personality prototype occur among warzone veterans with and without mTBI. Several of the characteristics associated with a resilient personality prototype can be addressed in psychological interventions to facilitate psychological adjustment of veterans who are experiencing difficulties with depression, posttraumatic stress symptoms, and quality of life. Of these characteristics, psychological flexibility appears to be a particularly important mechanism through which resilience promotes adjustment, and psychological flexibility is a central element of acceptance and commitment therapy. [ABSTRACT FROM AUTHOR]

Objective: We examined predictors of clinically significant levels of psychological distress among individuals with upper limb loss (ULL).Design: A multisite, cross-sectional study completed at six prosthetic rehabilitation centres throughout the United States.Methods: Oral administration of a brief assessment battery to 307 participants with ULL including demographic variables, injury information, screening instruments for PTSD and depression, pain interference, and activity restriction measures. Hierarchical multinomial logit models were conducted. Outcome groups were created using recommended cut-off scores on brief screening measures of depression and PTSD. Final models were assessed including relative risk ratios and marginal effects.Results: Over half of the sample screened positive for depression, PTSD, or both. Eight individuals exceeded the recommended cut-off score indicative of PTSD only (2.6%), and 106 participants (34.5%) screened positive for depression only. Moreover, 64 participants (20.8%) reported co-occurring PTSD and depression. Subsequent models revealed women and ethnic minority participants were more likely to have clinically significant levels of depression and PTSD. Greater restriction in activity and increased pain interference also predicted psychological distress.Conclusions: These findings indicate a significant number of individuals with ULL experience clinically significant levels of psychological distress, and routine clinical assessment of depression and PTSD is warranted. Women and individuals from ethnic minorities may be particularly at risk, regardless of the severity and cause of ULL. Restrictions in preferred and goal-directed activities and persistent pain are also contributing factors. Psychological interventions that address these issues are indicated. Statement of contribution What is already known on this subject? Research investigating psychological reactions and adjustment after limb loss has primarily focused on lower limb loss. Little research has investigated psychological adjustment or distress following upper extremity loss. Lower extremity limb loss is more likely to be from a disease process while upper extremity limb loss is more likely to be due to traumatic injuries. Upper extremity limb loss possesses a qualitatively different experience as upper limb amputation is more readily apparent to others, impacts activities of daily living, and limits instrumental function in social and non-verbal communication. What does this study add? A significant percentage of individuals with upper limb loss report significant levels of depression, PTSD, and mixed depression and PTSD. Moreover, women and minority clients were more likely to report clinically significant levels of depression and mixed PTSD and depression. Activity restriction and pain interference's contributions in the final model helped to elucidate the clinical picture of psychological distress for persons with upper extremity limb loss. Greater activity restriction and limitations from pain interference increased the likelihood of reporting clinically significant levels of psychological distress. [ABSTRACT FROM AUTHOR]

Objective: We examined the prospective influence of the resilient, undercontrolled, and overcontrolled personality prototypes on depression and posttraumatic stress disorder (PTSD) symptoms among Iraq/ Afghanistan war veterans. After accounting for the possible influence of combat exposure, we expected that the resilient prototype would predict lower depression and PTSD over time and would be associated with adaptive coping strategies, higher social support, lower psychological inflexibility, and higher self-reported resilience relative to overcontrolled and undercontrolled prototypes, independent of traumatic brain injury (TBI) status. Method: One hundred twenty-seven veterans (107 men, 20 women; average age = 37) participated in the study. Personality was assessed at baseline, and PTSD and depression symptoms were assessed 8 months later. Path analysis was used to test the direct and indirect effects of personality on distress. Results: No direct effects were observed from personality to distress. The resilient prototype did have significant indirect effects on PTSD and depression through its beneficial effects on social support, coping and psychological inflexibility. TBI also had direct effects on PTSD. Conclusions: A resilient personality prototype appears to influence veteran adjustment through its positive associations with greater social support and psychological flexibility, and lower use of avoidant coping. Low social support, avoidant coping, and psychological inflexibility are related to overcontrolled and undercontrolled personality prototypes, and these behaviors seem to characterize veterans who experience problems with depression and PTSD over time. A positive TBI status is directly and prospectively associated with PTSD symptomology independent of personality prototype. Implications for clinical interventions and future research are discussed. [ABSTRACT FROM AUTHOR]

Objective: We examine the rates of major depressive disorder, single episode determined by the Inventory to Diagnose Depression (IDD) in a clinical sample of persons with recent-onset spinal cord injury (SCI; ⩽52 weeks) participating in an inpatient SCI rehabilitation program. We also analyzed the factor structure of the IDD measure in an attempt to replicate the factor structure reported by Frank et al. (1992), and we examined item endorsement patterns. Design: A retrospective chart review was conducted. Participants were 354 individuals (93 women, 261 men) in an inpatient SCI rehabilitation program. Results: Fifteen percent of the sample met criteria for a major depressive disorder (MDD). A higher rate of depression was observed among women. A "dysphoria" factor accounted for 24% of the variance in the final four-factor model. The four-factor solution explained a total of 35.5% of the variance, with an "anhedonia" factor contributing 4.6%, a "sleep" factor contributing 3.5%, and an "appetite" factor contributing 3.5%, respectively. Items assessing symptoms of insomnia, weight loss, worrying about health, and decreased energy had the highest percentage of endorsement to meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for clinical significance. Conclusions: The rate of single episodes of MDD determined by the IDD parallels the rate observed with the Patient Health Questionnaire-9 (PHQ-9). The factor structure of the IDD was similar to that reported by Frank et al. (1992). Information provided by the IDD about the presence and severity of MDD symptoms can inform interventions for persons with SCI. [ABSTRACT FROM AUTHOR]

Although much is known about the risks to health and well-being that occur among family caregivers of children with disability, little is known about the unique group of caregivers of children with severe neurodisabilities who require varying degrees of respiratory care including ventilator support. This present study examined the psychological adjustment of caregivers in these situations, and tested the prediction that caregiver coping and problem-solving styles would be predictive of their physical and emotional health. Hierarchical regression analyses revealed that demographic characteristics and the severity of pulmonary condition were unrelated to caregiver adjustment. A coping style characterized by developing relationships, pursuing activities that promote self-worth and individuality, and a lower negative orientation toward solving problems were significantly predictive of caregiver distress. These data indicate that care- giver adjustment in these situations is influenced by cognitive-behavioral characteristics that could be addressed in educational and therapeutic programs provided in the clinic and in the community. [ABSTRACT FROM AUTHOR]

Primary objective: To examine the prospective relation of caregiver problem-solving abilities and relationship satisfaction to caregiver depression 1 month following care recipient discharge from an inpatient stroke rehabilitation facility. Research design: Correlational, prospective design. Methods and procedures: Participants included 39 women (average age = 51.47, SD = 20.59) and four men (average age = 42.50, SD = 5.57) assuming caregiver roles for persons discharged from stroke rehabilitation. Main outcome measure: The Beck Depression Inventory was the outcome measure at discharge and 1 month later. Results: Caregivers experienced a significant decrease in depression scores between the discharge and 1-month assessments. Lower relationship satisfaction and dysfunctional problem-solving abilities were independently and significantly predictive of depression scores at discharge. Dysfunctional problem-solving abilities were indirectly predictive of depression 1 month later. Conclusions: Dysfunctional problem-solving abilities and low relationship satisfaction are associated with caregiver depression, but dysfunctional problem-solving abilities maintain an indirect association with depression over 1 month. Implications of these findings for developing problem-solving training programmes for caregivers post-discharge are discussed. [ABSTRACT FROM AUTHOR]

Objective: Examined the influence of mutual communal behaviors on the adjustment reported by persons with spinal cord injury (SCI) and their family caregivers. Previous research has found that persons who have a history of mutually communal behaviors in relationships may react differently to relationship changes after an acquired physical disability than dyads with few communal behaviors. Method: Family caregivers and persons with SCI were administered measures of mutual communal behaviors, depression, and life satisfaction. Structural equation modeling was used to test the relations among caregivers' communal behaviors and care recipients' communal behaviors, depression, and life satisfaction. Results: Caregiver and care recipient reports of communal behaviors were not significantly correlated. Significant paths indicated that care recipients' communal behavior scores were positively associated with their life satisfaction, and care recipients' depression was inversely associated with their life satisfaction. Caregivers' communal behavior scores were unrelated to their self-reported adjustment. Conclusions: Caregiver-care recipient dyads may differ in their perceptions of communal behaviors in their relationships. Although care recipient reports of communal behavior may be related to their life satisfaction, communal behaviors may not serve a similar function among caregivers of persons with SCI. [ABSTRACT FROM AUTHOR]

Objective: To test hypothesized relations between hope and self-efficacy for rehabilitation to depression and functional ability reported by individuals receiving joint replacement surgery. Study Design: Community-dwelling older adults (N = 100) from an orthopaedic clinic were administered measures of hope, self-efficacy for rehabilitation, pain, depression, body mass index (BDI), and mental status 1 month prior to their joint replacement surgery. These measures were completed by 62 participants 6 weeks after surgery. Demographic, health information, and functional outcome measures were obtained by medical personnel pre- and postsurgery. Main Outcome Measures: Functional outcome measures (Harris Hip and Knee Society Scores) and depressive symptomatology. Results: Hope was significantly predictive of presurgery depression, but it was not predictive of depression or functional ability after surgery. Higher levels of self-efficacy were predictive of lower postsurgery depression scores. Conclusions: Results imply that social-cognitive constructs may have utility in the prediction of emotional adjustment before and after joint surgery, but they may have limited value in anticipating functional abilities following these surgeries. Theoretical and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Examination information gained from a simple tactile analogue scale technique (10 cc syringe) of measuring psychological aspects of coping in a low vision patient population. Methods: In routine low vision rehabilitation evaluations, patients were asked to estimate the impact of their vision loss on emotional factors. A 10 cc syringe was used by the patient with closed (0 cc level) indicating no problem and totally open (10 cc level) indicating greatest difficulty. Results: The sample included 25 male and 29 female low vision patients. Mean scores (x /10) for emotional distress variables were frustration 7.4, anxiety 5.5, depression 4.8, fear 4.1, and anger 4.1. Mean scores (x /10) for cognitive appraisal variables were: interference 7.8 and intolerance 4.4. Younger age was associated with greater anger (r =−0.45, p <0.01). No other significant correlations between age or gender and emotional reactions were found. The two cognitive appraisals were better predictors of emotional distress than visual acuity or demographic information. Discussion: This technique demonstrated patients to have a noteworthy amount of distress which is important clinical information in low vision rehabilitation programs. Visual acuity and demographic factors did not predict the distress. This 10 cc syringe technique is inexpensive and easy to administer. It opens a helpful dialogue that may not occur otherwise. Support: Helen Keller Foundation for Research and Education [Copyright &y& Elsevier]

Objective: To determine the percentage of family caregivers of persons with spinal cord injury (SCI) with probable depression and to test the hypothesis that dysfunctional problem-solving abilities would be significantly predictive of risk status after taking into account important demographic characteristics and caregiver health. Design: Correlational and logistic regression analyses of data collected in a cross-sectional design. Participants: Eighteen men and 103 women caregivers (mean age of caregivers = 45.66 years, SD = 12.88) of individuals with SCI. Main Outcome Measure: The Inventory to Diagnose Depression. Results: Nineteen caregivers (15.7%) met criteria on the Inventory to Diagnose Depression for a major depressive disorder. A dysfunctional problem-solving style was significantly predictive of caregiver depression, regardless of the severity of physical impairment of the care recipient or the physical health of the caregiver and caregiver demographic variables. Conclusions: The percentage of caregivers with probable depressive disorder may parallel that observed among persons with SCI, using a more conservative self-report measure designed to assess symptoms associated with a depressive syndrome. Family caregivers with a dysfunctional problem-solving style and assisting individuals with more severe injuries may have probable depression. [ABSTRACT FROM AUTHOR]