Neurobehavioural predictors of family functioning and psychological distress in spouses versus parents of relatives with severe traumatic brain injury (TBI) in Australia.
Malcolm I Anderson, Avondale College; Grahame Simpson, Liverpool Hospital; Magdalena Mok, The Hong Kong Institute of Education; Tamera Gosling, Avondale College; Peter Morey, Avondale College
A contemporary model of psychological stress, which is based on the amalgamation of Conservation of Resources theory and the McMaster Model of Family Functioning was used as a framework to compare the effects of neurobehavioural impairments on family functioning and psychological distress in spouses and parents of relatives with severe TBI. The model proposed that chronic stressors (Neurobehavioural impairments) would have both direct in indirect effects on family member distress, as well as indirect effects as mediated by disrupted family functioning.
This multi-site study used an ex post facto design with a sample of 122 family members (64 spouses and 58 parents) from New South Wales. Measures included the Neurobehavioural Problem Checklist, Family Assessment Device and the Brief Symptom Inventory. Structural equation modeling was used to test the hypothesised model for the combined sample, which formed the platform to apply multigroup analysis. Multigroup analysis was used to determine whether a group-variant or group-invariant model be used for examining differences in structural weights for spouses of partners with TBI and parents supporting adult children with TBI.
Structural equation modeling supported the model of stress for the combined sample as indicated by very acceptable goodness-of-fit indices. Multigroup analysis revealed the variant model was appropriate as it was more parsimonious and better fitting than the invariant model. For spouses, cognitive and behavioural impairments had a direct effect on family functioning and social impairments had a direct effect on psychological distress in spouses. Furthermore, disrupted family functioning was associated with high levels of psychological distress. Significantly, the indirect effect of cognitive and behavioural impairments on psychological distress in spouses was intensified by the mediating effect of disrupted family functioning. In contrast, cognitive and behavioural impairments did not significantly disrupt family functioning in parents. For parents cognitive impairments had a direct effect on psychological distress. Furthermore, ineffective family functioning was associated with high levels of psychological distress. The critical ratio of differences test to test for group differences in path coefficients showed that cognitive impairments were more influential on the level of distress in parents when compared to spouses.
This is one of the first studies to use structural equation modeling and multigroup analysis to examine the direct and indirect effects of neurobehavioural impairments on family functioning and psychological distress in spouses and parents of relatives with TBI. These findings indicate that there may to be a significant difference in the impact of neurobehavioural factors on psychological distress for spouse caregivers when compared to parent caregivers, which researchers and clinicians are advised to consider in future research and rehabilitation.