Coping styles within the family system in the chronic phase following acquired brain injury: its relation to families’ and patients’ functioning

OBJECTIVE: To investigate how the functioning of family members and the coping styles they use are related to the psychosocial functioning both of the family members and of the person who has sustained a brain injury. DESIGN: Cross-sectional study. SUBJECTS: Primary caregivers (n = 61) and other family members (n = 15) of 61 patients with brain injury. METHODS: Primary caregivers completed the Utrecht Coping List, the Life Satisfaction Questionnaire 9, and the Caregiver Strain Index. All family members completed the Family Assessment Device. Data for the patients were collected retrospectively. RESULTS: Primary caregivers who had a preference for passive coping styles reported that they experienced a lower level of family functioning, a lower quality of life, and a higher strain. Neither the coping styles nor the psychosocial outcomes of the primary caregivers were significantly associated with patients' self-reported quality of life. Furthermore, there was no correlation between the level of family functioning and a patient's quality of life. CONCLUSION: Coping styles of caregivers are important determinants for their own psychosocial functioning, but not for patients' psychosocial functioning, although causality cannot be inferred. To enhance caregivers' psychosocial functioning, rehabilitation should focus on changing their coping styles into ones that are less passive. Furthermore, distinct or additional interventions may be needed to change the patient's coping style

Effectiveness of a process-oriented patient-tailored outpatient neuropsychological rehabilitation programme for patients in the chronic phase after ABI

The objective of this prospective cohort study was to examine the effectiveness of an outpatient neuropsychological rehabilitation programme for patients with acquired brain injury (ABI) and their relatives. The participants were 26 ABI patients with a mean age of 44.7 (SD 11.7) years and 24 caregivers. Mean time since injury was 3.0 (SD 3.6) years. The intervention consisted of a patient-tailored process-oriented neuropsychological rehabilitation programme focusing on facilitation of the adaptation process. Repeated measurements were taken prior to treatment (T0), directly after treatment (T1) and 6 months later (T2). Primary outcome measures were cognitive failures (CFQ), quality of life (SA-SIP30), and individualised goals (GAS). Patients improved significantly on individualised goals between T0 and T1 (p<.01). This effect retained at T2. There were no significant differences on CFQ and SA-SIP30. The programme had a positive effect on attainment of the patient's individual goals. This was not associated with a higher level of participation or a better quality of life

Coping following acquired brain injury: predictors and correlates

Objective: To examine the determinants and correlates of coping styles in the chronic phase following acquired brain injury. Design: Chart review. Setting: Outpatient rehabilitation center. Participants: One hundred thirty-six persons with an acquired brain injury who were more than 6 months postinjury. Measures: Utrecht Coping List, Symptom Checklist 90, Stroop Color Word Test, and the 15-Word Learning Test. Results: Neuropsychological performance did not influence the use of coping styles. Persons with higher levels of educational attainment most often reported active problem-focused coping styles. Persons with a long time period since injury most often used passive reactions. More use of passive coping styles and less seeking of social support contributed significantly to higher levels of subjective complaints. Conclusions: Cognitive functions do not influence coping style. Passive emotion-focused coping styles in the chronic phase after injury are maladaptive. These findings emphasize the importance of training of adaptive coping styles as rehabilitation targets in the chronic phase, especially for persons with lower educational attainment

Coping stijlen van patiënten met hersenletsel en familieleden in een revalidatiesetting

Acquired brain injury is a major health problem with an annual incidence in the netherlands alone varying between 1 and 2 per 1000 cases. Not only the patients’ lives, but also those of the caregivers, change dramatically and often permanently because of the patients’ brain injury, and they have to adjust to the new reality. Little is known about the factors that predict successful adjustment. The way one deals with everyday problems (coping) seems to play an important role. In this article, we briefly describe what is known about coping after brain injury in both patients and family members. Furthermore, we describe a study we have performed in a rehabilitation population with brain injury (n = 136). Our results showed that there was no association between the patients’ coping style and their cognitive functioning profile after the injury, that patients with a higher education most often reported active (adaptive) coping styles, and that patients at a later stage post injury most often used passive (maladaptive) coping styles. Passive styles were associated with lower psychosocial functioning in both patients and caregivers. Passive styles increased and active styles decreased over the course of and after rehabilitation. Finally, we discuss implications for further research and for clinical practice

Coping styles within the family system in the chronic phase following acquired brain injury: its relation to families' and patients' functioning

OBJECTIVE: To investigate how the functioning of family members and the coping styles they use are related to the psychosocial functioning both of the family members and of the person who has sustained a brain injury. DESIGN: Cross-sectional study. SUBJECTS: Primary caregivers (n = 61) and other family members (n = 15) of 61 patients with brain injury. METHODS: Primary caregivers completed the Utrecht Coping List, the Life Satisfaction Questionnaire 9, and the Caregiver Strain Index. All family members completed the Family Assessment Device. Data for the patients were collected retrospectively. RESULTS: Primary caregivers who had a preference for passive coping styles reported that they experienced a lower level of family functioning, a lower quality of life, and a higher strain. Neither the coping styles nor the psychosocial outcomes of the primary caregivers were significantly associated with patients' self-reported quality of life. Furthermore, there was no correlation between the level of family functioning and a patient's quality of life. CONCLUSION: Coping styles of caregivers are important determinants for their own psychosocial functioning, but not for patients' psychosocial functioning, although causality cannot be inferred. To enhance caregivers' psychosocial functioning, rehabilitation should focus on changing their coping styles into ones that are less passive. Furthermore, distinct or additional interventions may be needed to change the patient's coping style

Assessments of coping after acquired brain injury: a systematic review of instrument conceptualization, feasibility, and psychometric properties

OBJECTIVE:: To identify measures of coping styles used by patients with acquired brain injury; to evaluate the conceptualization, feasibility, and psychometric properties of the instruments; and to provide guidance for researchers and clinicians in the choice of a suitable instrument. DESIGN:: Systematic review. RESULTS:: The search identified 47 instruments, of which 14 were selected. The instruments focused on dispositional coping, situation-specific coping, or domain-specific coping. Psychometric properties were scarcely investigated. The COPE stood out in terms of psychometric properties but had low feasibility. The brief COPE, Coping Scale for Adults-short form, and Utrecht Coping List stood out in terms of feasibility, and the available psychometric properties of these instruments were good. Only the Coping With Health Injuries and Problems was used as other report. CONCLUSION:: Information on psychometric properties of coping instruments in acquired brain injury is scarcely available and limits the strength of our recommendations. For patients with mild injuries, we cautiously recommend the COPE and for patients with more severe injuries the brief COPE, Coping Scale for Adults-short form, Utrecht Coping List, and Coping With Health Injuries and Problems-other-report. Other instruments may be used to address particular issues such as coping with a specific stressful situation or illness