title: Diurnal cortisol and coping responses in close relatives of persons with acquired brain injury: a longitudinal mixed methods study.
abstract: OBJECTIVE
  To examine the impact of having a close relative experience a severe brain injury.
  
  
  METHODS
  Six-month longitudinal mixed methods concurrent embedded study. Quantitative data provided the primary database and qualitative data provided the secondary source.
  
  
  METHODS
  Assessment included psychosocial factors of perceived stress, traumatic stress symptoms, coping and social support in addition to salivary cortisol as a biological marker of stress. Written accounts of the experience were provided in response to an open-ended question. Participants composed 15 close relatives of adults with severe brain injury admitted to a specialist rehabilitation facility (mean age 49.4 years; SD 11.79). Assessments were conducted on admission, at 6 weeks, 3 months and 6 months post-admission.
  
  
  RESULTS
  Quantitative data revealed high traumatic stress at admission, with a non-significant decline at follow-up. Diurnal cortisol output declined significantly from baseline to all follow-up assessments. Coping sub-scales of acceptance and religion were repeated associated with cortisol indices at baseline, 6 weeks, 3 months and 6 months follow-up. Qualitative data revealed two themes; 'relational impact' and 'passage of time'.
  
  
  CONCLUSIONS
  Findings offer the potential for effective and timely intervention in family members of persons with severe brain injury.
authors.affiliation: Department of Psychology, University of Bath, Claverton Down, Bath, UK. pssjmtc@bath.ac.uk
authors.forename: Julie M
authors.initials: JM
authors.lastname: Turner-Cobb
authors.forename: Jenny
authors.initials: J
authors.lastname: Palmer
authors.forename: D
authors.initials: D
authors.lastname: Aronson
authors.forename: Louise
authors.initials: L
authors.lastname: Russell
authors.forename: Stephanie
authors.initials: S
authors.lastname: Purnell
authors.forename: Michael
authors.initials: M
authors.lastname: Osborn
authors.forename: David S
authors.initials: DS
authors.lastname: Jessop
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology*; D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000378:metabolism / Q000523:psychology* / Q000534:rehabilitation; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000378:metabolism / Q000523:psychology* / Q000534:rehabilitation; D008875:Middle Aged; D011594:Psychometrics; D036301:Qualitative Research; D012307:Risk Factors; D012944:Social Support; D013315:Stress, Psychological / Q000378:metabolism / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D006854:Hydrocortisone