title: Moderated mediation path analysis of Mexican traumatic brain injury patient social functioning, family functioning, and caregiver mental health.
abstract: OBJECTIVE
  To examine the system of connections among traumatic brain injury (TBI) patient social functioning, family functioning, and caregiver depression and burden in Mexico.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  A public medical facility.
  
  
  METHODS
  Mexican TBI patient-caregiver dyads (N=84) participated in this study. Most of the patients with TBI were men (81%), with an average age ± SD of 38.83±13.44 years. The majority of caregivers (86%) were women, with an average age ± SD of 51.74±11.29.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Outcomes assessed included family functioning (Family Satisfaction Scale), patient social functioning (Medical Outcomes Study 36-Item Short-Form Health Survey), and caregiver mental health (Patient Health Questionnaire-9 and Zarit Burden Interview).
  
  
  RESULTS
  A moderated mediation path model found that patient social functioning and family functioning predicted caregiver burden, and caregiver burden mediated the effect of family functioning on caregiver depression. Caregivers with strong family functioning tended to have low burden, no matter the level of patient social functioning. This path model provided an excellent fit and explained 47% of the variance in caregiver burden and 36% of the variance in caregiver depression.
  
  
  CONCLUSIONS
  In Mexico, strong family functioning is an important buffer in the relationship between TBI patient social functioning deficits and caregiver mental health, especially because familism is a core value in Latino culture. Rehabilitation interventions designed to strengthen family functioning may improve caregiver mental health, thereby influencing the quality of informal care that caregivers are able to provide.
authors.affiliation: Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Coy
authors.forename: Paul B
authors.initials: PB
authors.lastname: Perrin
authors.forename: Lillian F
authors.initials: LF
authors.lastname: Stevens
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hubbard
authors.forename: Dulce María
authors.initials: DM
authors.lastname: Díaz Sosa
authors.forename: Irma Guadalupe
authors.initials: IG
authors.lastname: Espinosa Jove
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Arango-Lasprilla
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000523:psychology*; D017028:Caregivers / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005195:Family Relations; D005260:Female; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D058992:Social Participation; D011795:Surveys and Questionnaires