title: Predicting family functioning after TBI: impact of neurobehavioral factors.
abstract: OBJECTIVE
  To identify risk factors for poor family functioning and neurobehavioral problems after traumatic brain injury (TBI) or orthopedic injuries (OI).
  
  
  METHODS
  Longitudinal analyses of data from an inception cohort.
  
  
  METHODS
  Seventy-five patients with moderate/severe TBI, 47 patients with mild TBI, and 44 patients with OI at discharge; and 49 patients with moderate/severe TBI, 24 patients with mild TBI, and 33 patients with OI at 1-year follow-up.
  
  
  METHODS
  Measures of family functioning (Family Assessment Device) and Neurobehavioral Functioning Index at hospital discharge and 1-year follow-up.
  
  
  RESULTS
  At discharge, patients with moderate/severe TBI had more symptoms of depression, memory/attention problems, and motor impairments than patients with OI and greater communication difficulties than patients with OI or mild TBI. At follow-up, patients with moderate/severe TBI continued to have more problems in memory/attention, depression, and communication. Approximately one third of each group had unhealthy family functioning at each assessment period. Few patients reported both impaired family functioning and clinical depression. Distressed family functioning correlated strongly with increased rates of neurobehavioral symptoms. Family dysfunction at follow-up was best predicted by family dysfunction at discharge and depression or memory/attention deficits at follow-up.
  
  
  CONCLUSIONS
  After TBI, patients at the greatest risk for distress at follow-up were those with family dysfunction at discharge and continued neurobehavioral problems. High-risk families need to be identified so that necessary referrals and/or treatment can be offered.
authors.affiliation: Department of Psychiatry, Mayo Clinic, Rochester, MN 55905, USA. testa.julie@mayo.edu
authors.forename: Julie A
authors.initials: JA
authors.lastname: Testa
authors.forename: James F
authors.initials: JF
authors.lastname: Malec
authors.forename: Anne M
authors.initials: AM
authors.lastname: Moessner
authors.forename: Allen W
authors.initials: AW
authors.lastname: Brown
mesh_terms: D000328:Adult; D000374:Aggression / Q000523:psychology; D001930:Brain Injuries / Q000503:physiopathology* / Q000523:psychology* / Q000534:rehabilitation; D015331:Cohort Studies; D003142:Communication; D003863:Depression / Q000523:psychology; D005195:Family Relations; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008569:Memory Disorders / Q000503:physiopathology; D009048:Motor Skills / Q000502:physiology; D009483:Neuropsychological Tests; D012044:Regression Analysis; D012720:Severity of Illness Index