Relatives' criticism influences adjustment and outcome after traumatic brain injury.
OBJECTIVE
To apply some of the methods developed to study the effects of relatives' expressed emotion (EE) on psychiatric relapse rates and to test the prediction that relatives' criticism and psychiatric distress would be associated with outcome and emotional distress after traumatic brain injury (TBI).


METHODS
Retrospective cohort design with correlational analyses of quantitative and qualitative measures of TBI outcomes.


METHODS
The author interviewed participants in the hospital. The research assistant interviewed close relatives at home.


METHODS
Participants and relatives (N=78) were interviewed 34.3+/-15.2 months (mean +/- SD) after a severe TBI.


METHODS
None.


METHODS
Dependent variables in a series of hierarchical linear regression models were participants' scores on the Zung Depression Scale, Spielberger Trait Anxiety Inventory, State-Trait Anger Expression Inventory, an Anger Towards Relative questionnaire constructed for this study, and Extended Glasgow Outcome Scores. Participant-independent variables were social class, posttraumatic amnesia, Wechsler Memory Scale-Delayed Recall score, WAIS-R intelligence quotient, and a short version of the Smell Identification Test. Relative independent variables were the number of critical comments directed toward participants in the interview and psychiatric distress as measured by the General Health Questionnaire.


RESULTS
The contributions of variance associated with relative independent variables (predominantly criticism) were significant in stage 2 of most hierarchical regression analyses after the adjustments for variance associated with participant independent variables made in stage 1.


CONCLUSIONS
Future application of EE research methods is warranted. If the present results are replicated, then evidence-based family interventions developed by EE researchers to reduce criticism might also improve TBI outcomes.
Department of Neuropsychology, Morriston Hospital, Abertawe Bro Morgannwg University Health Board and Department of Psychology, University of Wales, Swansea, West Glamorgan, UK. r.wedd@yahoo.co.uk
Rodger A
RA
Weddell
D000328:Adult; D000786:Anger; D001930:Brain Injuries / Q000523:psychology*; D003863:Depression / Q000523:psychology; D004644:Emotions; D005190:Family / Q000523:psychology*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007407:Interviews as Topic; D007600:Judgment; D016014:Linear Models; D008297:Male; D012189:Retrospective Studies; D012903:Smell; D011795:Surveys and Questionnaires