Klyce Daniel W, Marwitz Jennifer H, Perera Robert A, Dreer Laura E, Agtarap Stephanie D, Abbasi Katherine, Neumann Dawn M, Hammond Flora M, Bergquist Thomas F, Lengenfelder Jean
Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA; Psychology Service, Sheltering Arms Institute, Richmond, VA; Mental Health Service, Richmond VA Medical Center, Richmond, VA.
Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL.
Arch Phys Med Rehabil. 2025 Jan 28. doi: 10.1016/j.apmr.2025.01.464.
To examine: (1) the trajectory of caregiver resilience over 2 years after onset of a care-recipient's moderate-to-severe traumatic brain injury (TBI), (2) caregiver-related outcomes associated with resilience, and (3) changes in associations between caregiver resilience, other caregiver characteristics, and care-recipient variables across time.
Prospective cohort.
TBI Model System (TBIMS) centers.
TBIMS participants (care-recipients) were approached to enroll in this study and identify a caregiver. Two hundred fifty-eight (N=258) care-recipient and caregiver dyads were enrolled.
Not applicable.
Caregiver data included demographics, health history, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7, Zarit Burden Interview (ZBI), Family Needs Questionnaire-Revised, and Connor-Davidson Resilience Scale 10 (CD-RISC-10). All caregiver data were self-reported via phone interview or mailed surveys at 6, 12, and 24 months after injury. At all 3 timepoints, care-recipients with TBI also completed their own CD-RISC-10, PHQ-9, Generalized Anxiety Disorder-7, and Disability Rating Scale.
Linear mixed-effects models indicated that the trajectory of resilience was stable within caregivers over 2 years after injury. There were significant, positive associations for all caregiver Family Needs Questionnaire-Revised subscales (all P<.001) with care-recipient and caregiver CD-RISC-10 scores (P=.001), indicating that more caregiving needs endorsed as "met" corresponded with higher resilience. Caregiver PHQ-9 and ZBI scores were found to be negatively associated with resilience (both P<.001). When all covariates were included in the multivariable model, met emotional needs was positively associated with caregiver resilience (P<.0001). Negative associations with caregiver resilience included higher caregiver PHQ-9 scores (P=.001) and perceptions of caregiving burden (P=.003).
Caregiver levels of resilience were generally stable over 2 years post-TBI. Caregivers' resilience was positively associated with perceptions of their needs being met and negatively associated with caregiving burden and emotional distress. Further research is needed to develop and evaluate the utility and feasibility of interventions to enhance resilience, meet family needs, and improve long-term outcomes after brain injury.
研究：（1）受照顾者中度至重度创伤性脑损伤（TBI）发病后2年照顾者心理弹性的变化轨迹；（2）与心理弹性相关的照顾者相关结局；（3）照顾者心理弹性、其他照顾者特征和受照顾者变量之间的关联随时间的变化。
前瞻性队列研究。
TBI模型系统（TBIMS）中心。
邀请TBIMS参与者（受照顾者）参加本研究并确定一名照顾者。共纳入258对受照顾者和照顾者。
不适用。
照顾者数据包括人口统计学、健康史、患者健康问卷-9（PHQ-9）、广泛性焦虑障碍-7、扎里特负担访谈（ZBI）、家庭需求问卷修订版以及康纳-戴维森心理弹性量表10（CD-RISC-10）。所有照顾者数据均通过电话访谈或在受伤后6个月、12个月和24个月邮寄调查问卷的方式由照顾者自行报告。在所有这3个时间点，患有TBI的受照顾者也完成了他们自己的CD-RISC-10、PHQ-9、广泛性焦虑障碍-7和残疾评定量表。
线性混合效应模型表明，受伤后2年内照顾者的心理弹性轨迹是稳定的。照顾者家庭需求问卷修订版的所有子量表与受照顾者和照顾者的CD-RISC-10得分均呈显著正相关（所有P<.001）（P=.001），表明更多被认可为“得到满足”的照顾需求与更高的心理弹性相对应。发现照顾者的PHQ-9和ZBI得分与心理弹性呈负相关（均P<.001）。当所有协变量纳入多变量模型时，得到满足的情感需求与照顾者心理弹性呈正相关（P<.0001）。与照顾者心理弹性呈负相关的因素包括照顾者较高的PHQ-9得分（P=.001）和对照顾负担的感知（P=.003）。
TBI后2年照顾者的心理弹性水平总体稳定。照顾者的心理弹性与对自身需求得到满足的感知呈正相关，与照顾负担和情绪困扰呈负相关。需要进一步开展研究，以开发和评估增强心理弹性、满足家庭需求以及改善脑损伤后长期结局的干预措施的效用和可行性。
