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The effects of neurobehavioural impariments on family functioning and psychological well being of relatives of people with severe traumatic brain injury (TBI) in Australia: A mixed method approach

Malcolm I. Anderson1, Grahame Simpson2, Magdalena MC Mok3& Trevor R Parmenter4

1 Avondale College, Australia
2 Liverpool Hospital, Australia
3 The Hong Kong Institute of Education, Hong Kong
4 University of Sydney, Australia


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 (NB) impairments, family functioning and psychological distress in relatives of people with severe TBI. The model proposed that chronic stressors (i.e. NB impairments) would have both a direct effect on relative 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 104 relatives (40 parents and 64 spouses) from NSW. Measures included the 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.


Direct effects were found between all 3 components of the model: 1. Severe NB impairments had a direct effect on relative distress; 2. Relatives reporting high levels of NB impairments, also identified significant disruption in family functioning; 3. Disrupted family functioning was associated with high levels of distress. Significantly, relatively distress was intensified by the indirect effects of NB impairments mediated by the disruption to family functioning. The interview data supported the model, but also found the NB impairments disrupted affective relationships among family members, an issue no detected by the standardised scales.


There are at least two pathways by which NB 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.