title: The impact of pediatric traumatic brain injury (TBI) on family functioning: a systematic review.
abstract: OBJECTIVE
  To explore the impact moderate to severe traumatic brain injury (TBI) in a child has on family functioning.
  
  
  METHODS
  The search was conducted using 9 bibliographic databases for articles published between 1980 and 2013. Two reviewers independently screened for inclusion and assessed study quality. Two reviewers extracted study data and a third checked for completeness and accuracy. Findings are presented by three domains: injury-related burden and stress, family adaptability, and family cohesion.
  
  
  RESULTS
  Nine observational studies were included. Across the studies, differences between study groups for family functioning varied, but there was a trend for more dysfunction in families whose child had a severe TBI as compared to families whose child had a moderate TBI or orthopedic injury. In three studies, injury-associated burden was persistent post-injury and was highest in families whose child had a severe TBI followed by families with a child who had a moderate TBI. One study found fathers reported more family dysfunction caused by their child's injury compared to mothers. Two studies found that mothers' adaptability depended on social support and stress levels while fathers' adaptability was independent of these factors and injury severity.
  
  
  CONCLUSIONS
  Moderate to severe TBI has a significant, long-standing impact on family functioning. Factors associated with family adaptability vary by parental role.
authors.affiliation: Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: Marghalara
authors.initials: M
authors.lastname: Rashid
authors.affiliation: Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: Helly R
authors.initials: HR
authors.lastname: Goez
authors.affiliation: Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: Neelam
authors.initials: N
authors.lastname: Mabood
authors.affiliation: Faculty of Agriculture, Forestry and Nutrition, University of Alberta, Edmonton, AB, Canada.
authors.forename: Samah
authors.initials: S
authors.lastname: Damanhoury
authors.affiliation: Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: Jerome Y
authors.initials: JY
authors.lastname: Yager
authors.affiliation: Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Joyce
authors.affiliation: Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Newton
mesh_terms: D000223:Adaptation, Psychological; D001930:Brain Injuries / Q000145:classification / Q000523:psychology*; D017028:Caregivers / Q000523:psychology; D002648:Child; D015331:Cohort Studies; D017281:Cost of Illness; D005190:Family / Q000523:psychology*; D006801:Humans; D015601:Injury Severity Score; D010290:Parents / Q000523:psychology*; D012380:Role; D012737:Sex Factors; D013315:Stress, Psychological / Q000523:psychology
keywords: Family function; TBI; family burden; family dysfunction; head injury; traumatic brain injury