Predicting family burden following childhood traumatic brain injury: a cumulative risk approach.
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.
Josie
Katherine Leigh
KL
Department of Behavioral Pediatrics and Psychology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA. Katherine. Josie@uhhospitals.org
Peterson
Catherine Cant
CC
Burant
Christopher
C
Drotar
Dennis
D
Stancin
Terry
T
Wade
Shari L
SL
Yeates
Keith
K
Taylor
H Gerry
HG
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