Max J E, Castillo C S, Robin D A, Lindgren S D, Smith W L, Sato Y, Mattheis P J, Stierwalt J A
Department of Psychiatry, University of Iowa, Iowa City, USA.
J Am Acad Child Adolesc Psychiatry. 1998 Jan;37(1):83-90. doi: 10.1097/00004583-199801000-00021.
To assess factors predictive of family outcome in the first 2 years after traumatic brain injury (TBI) in children and adolescents.
Subjects were children aged 6 to 14 at the time they were hospitalized after TBI. The study used a prospective follow-up design. Assessments of preinjury factors (psychiatric family functioning, and family life events), injury factors (severity of injury), and postinjury factors (coping and development of a psychiatric disorder, never before present, i.e., "novel") were conducted using standard clinical scales. The outcome measure was family function as assessed with standardized family functioning interviews (at 12 and 24 months after TBI) and primary caretaker self-report questionnaires (at 3 and 6 months after TBI).
Fifty subjects enrolled, and the analyses focused on 37, 41, 43, and 42 subjects assessed at the 3-, 6-, 12-, and 24-month follow-up evaluations, respectively. The strongest influences on family functioning after childhood TBI are preinjury family functioning, the development of a "novel" psychiatric disorder in the child, and preinjury family life events or stressors.
These data suggest that there are families, identifiable through clinical assessment, at increased risk for family dysfunction after a child's TBI. Early identification and treatment of the child's psychopathology and family dysfunction may attenuate the associated morbidity.
评估儿童和青少年创伤性脑损伤（TBI）后最初2年内家庭结局的预测因素。
研究对象为TBI后住院时年龄在6至14岁的儿童。本研究采用前瞻性随访设计。使用标准临床量表对伤前因素（精神科家庭功能和家庭生活事件）、损伤因素（损伤严重程度）和伤后因素（应对方式以及出现一种之前从未有过的精神障碍，即“新发”精神障碍）进行评估。结局指标是通过标准化家庭功能访谈（在TBI后12个月和24个月时）以及主要照料者自我报告问卷（在TBI后3个月和6个月时）评估的家庭功能。
共纳入50名研究对象，分析分别聚焦于在3个月、6个月、12个月和24个月随访评估时接受评估的37名、41名、43名和42名研究对象。儿童TBI后对家庭功能影响最大的因素是伤前家庭功能、儿童出现“新发 ”精神障碍以及伤前家庭生活事件或压力源。
这些数据表明，通过临床评估可识别出一些家庭，其在儿童TBI后出现家庭功能障碍的风险增加。对儿童精神病理学和家庭功能障碍进行早期识别和治疗可能会减轻相关的发病率。
