title: Predicting family burden following childhood traumatic brain injury: a cumulative risk approach.
abstract: OBJECTIVE
  To examine the utility of a cumulative risk index (CRI) in predicting the family burden of injury (FBI) over time in families of children with traumatic brain injury (TBI).
  
  
  METHODS
  One hundred eight children with severe or moderate TBI and their families participated in the study.
  
  
  METHODS
  The measures used in the study include the Socioeconomic Composite Index, Life Stressors and Social Resources Inventory--Adult Form, Vineland Adaptive Behavior Scales, Child Behavior Checklist, Children's Depression Inventory, McMaster Family Assessment Device, Brief Symptom Inventory, and Family Burden of Injury Interview. In addition, information on injury-related risk was obtained via medical charts.
  
  
  METHODS
  Participants were assessed immediately, 6, and 12 months postinjury and at a 4-year extended follow-up.
  
  
  RESULTS
  Risk variables were dichotomized (ie, high- or low-risk) and summed to create a CRI for each child. The CRI predicted the FBI at all assessments, even after accounting for autocorrelations across repeated assessments. Path coefficients between the outcome measures at each time point were significant, as were all path coefficients from the CRI to family burden at each time point. In addition, all fit indices were above the recommended guidelines, and the chi statistic indicated a good fit to the data.
  
  
  CONCLUSIONS
  The current study provides initial support for the utility of a CRI (ie, an index of accumulated risk factors) in predicting family outcomes over time for children with TBI. The time period immediately after injury best predicts the future levels of FBI; however, cumulative risk continues to influence the change across successive postinjury assessments. These results suggest that clinical interventions could be proactive or preventive by intervening with identified "at-risk" subgroups immediately following injury.
authors.affiliation: Department of Behavioral Pediatrics and Psychology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA. Katherine. Josie@uhhospitals.org
authors.forename: Katherine Leigh
authors.initials: KL
authors.lastname: Josie
authors.forename: Catherine Cant
authors.initials: CC
authors.lastname: Peterson
authors.forename: Christopher
authors.initials: C
authors.lastname: Burant
authors.forename: Dennis
authors.initials: D
authors.lastname: Drotar
authors.forename: Terry
authors.initials: T
authors.lastname: Stancin
authors.forename: Shari L
authors.initials: SL
authors.lastname: Wade
authors.forename: Keith
authors.initials: K
authors.lastname: Yeates
authors.forename: H Gerry
authors.initials: HG
authors.lastname: Taylor
mesh_terms: D000223:Adaptation, Psychological; D001930:Brain Injuries / Q000191:economics* / Q000523:psychology / Q000534:rehabilitation; D002648:Child; D017281:Cost of Illness; D005190:Family; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008297:Male; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires