Stancin Terry, Wade Shari L, Walz Nicolay C, Yeates Keith O, Taylor H Gerry
Department of Pediatrics, Division of Pediatric Psychology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio 44109, USA.
J Dev Behav Pediatr. 2008 Aug;29(4):253-61. doi: 10.1097/DBP.0b013e31816b6b0f.
The purpose of this study was to examine factors that affect parental burden and distress during the first few months following a traumatic brain injury (TBI) in young children.
Participants were consecutively enrolled children ages 3 through 6 years with either a TBI (n = 89; 21 severe, 22 moderate, and 45 complicated mild) or orthopedic injury (OI; n = 119) requiring hospitalization. During the post-acute period, parents provided information regarding the preinjury family environment and current caregiver functioning and injury-related burden.
Compared with parents of young children with OI, parents of children with TBI reported greater overall caregiver burden and greater burden related to the injury. Parents of children with severe TBI also reported more stress with spouses and siblings and higher levels of parental depression and global distress relative to the OI comparison group. Parents of 5- to 6-year-old children reported significantly higher levels of both injury-related burden and distress than parents of 3- to 4-year-old children. Parents of children with mild TBI based on the Glasgow Coma Scale (GCS) who also had positive neuroimaging findings reported greater injury-related burden than parents of children with moderate TBI. Parents reported using a variety of coping strategies, with higher levels of denial and disengagement corresponding with greater injury-related burden and distress.
Consistent with previous research on family adaptation to TBI in school-age children, chronic life stresses and interpersonal resources accounted for significant variance in measures of acute injury-related burden and parental distress in parents of younger children, although differences were small. TBI severity defined by GCS scores alone may not be sufficient to identify families at risk of increased burden. Findings suggest that services aimed at facilitating family adjustment following TBI in young children may need to consider a broader definition of risk factors when identifying families who would benefit from interventions.
本研究旨在探讨幼儿创伤性脑损伤（TBI）后头几个月影响父母负担和痛苦的因素。
连续纳入3至6岁因TBI（n = 89；21例重度、22例中度和45例复杂轻度）或需要住院治疗的骨科损伤（OI；n = 119）而入院的儿童。在急性后期，父母提供有关伤前家庭环境、当前照料者功能以及与损伤相关负担的信息。
与OI患儿的父母相比，TBI患儿的父母报告的总体照料者负担更大，且与损伤相关的负担更大。与OI对照组相比，重度TBI患儿的父母还报告了与配偶和兄弟姐妹之间更多的压力，以及更高水平的父母抑郁和总体痛苦。5至6岁患儿的父母报告的与损伤相关的负担和痛苦水平显著高于3至4岁患儿的父母。基于格拉斯哥昏迷量表（GCS）为轻度TBI且神经影像学检查结果呈阳性的患儿的父母报告的与损伤相关的负担比中度TBI患儿的父母更大。父母报告使用了多种应对策略，否认和脱离接触程度较高与更大的与损伤相关的负担和痛苦相对应。
与先前关于学龄儿童家庭对TBI适应情况的研究一致，慢性生活压力和人际资源在幼儿父母急性损伤相关负担和痛苦测量指标中占显著差异，尽管差异较小。仅由GCS评分定义的TBI严重程度可能不足以识别负担增加风险的家庭。研究结果表明，旨在促进幼儿TBI后家庭适应的服务在确定哪些家庭将从干预中受益时可能需要考虑更广泛的风险因素定义。
