title: A structured multicomponent group programme for carers of people with acquired brain injury: Effects on perceived criticism, strain, and psychological distress.
abstract: OBJECTIVE
  The purpose of this study was to examine whether a brief structured multicomponent group programme for carers of people with acquired brain injury (ABI) was effective in reducing carer distress, strain, and critical comments between carer and person with an ABI compared to a waiting list control condition.
  
  
  METHODS
  Waiting list controlled study. Pre- and post-test design with outcomes measured at induction, at the end of the intervention, and at the 3-month follow-up.
  
  
  METHODS
  One hundred and thirteen carers took part in the study: 75 carers in the intervention group and 38 in the waiting list control group (2:1 ratio). All participants completed assessments of caregiver strain (Caregiver Strain Index), perceived criticism towards and from the person with an ABI (Perceived Criticism Scale), and psychological distress (Hospital Anxiety and Depression Scale). The person with an ABI was also assessed on the Functional Independence Measure/Functional Assessment Measure.
  
  
  RESULTS
  Using an intention to treat analysis, there were significant effects of group (intervention vs. waiting list control) at the 3-month follow-up on carers' perceptions of stress and strain resulting from caring, and perceptions of criticism received by the carer from the person with an ABI. A subsequent per-protocol analysis showed an additional reduction at 3 months in levels of criticism expressed towards the person with an ABI by the carer. There was no significant effect of the intervention on psychological distress.
  
  
  CONCLUSIONS
  The structured multicomponent carers programme showed beneficial effects in terms of reducing carer strain and in the reduction of elements of perceived criticism at the 3-month follow-up; however, it did not significantly affect psychological distress in carers, suggesting the need for additional support for this group of carers.
  What is already known on this subject? A number of studies have suggested that carers of people with acquired brain injury (ABI) experience greater levels of carer burden and mental health difficulties than carers of other patient groups. Previous interventional studies on ABI are few, and such studies have diverged in the extent to which they have been oriented towards education, psychological support, or management of behavioural difficulties, making results somewhat difficult to apply in community health settings with this potential client group. What does this study add? We develop, describe, and evaluate a brief structured multicomponent carers' training and support programme for carers of people with ABI. Not all outcomes were affected positively by the intervention. While the intervention successfully reduced carer strain and critical comments, distress did not significantly reduce compared to people in a waiting list control group. Carers who were spouses/partners and carers who were parents exhibited comparable levels of strain, distress, and perceived criticism. Younger carers reported significantly higher levels of distress and carer strain at induction to the programme. The positive effects of the programme were maintained for at least 3 months, suggesting that it may have initial validity for improving some of the negative aspects of the carer experience.
authors: Centre for Social Issues, Department of Psychology, University of Limerick, Ireland.|Acquired Brain Injury Ireland, Dun Laoghaire, Co Dublin, Ireland.
authors: Dónal G
authors: http://orcid.org/0000-0002-1007-5896
authors: DG
authors: Fortune
authors: Acquired Brain Injury Ireland, Dun Laoghaire, Co Dublin, Ireland.
authors: Carol R
authors: CR
authors: Rogan
authors: Department of Psychology, Mercy University Hospital, Cork, Ireland.
authors: Helen L
authors: HL
authors: Richards
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D001930:Brain Injuries / Q000523:psychology / Q000534:rehabilitation*; D017028:Caregivers / Q000523:psychology* / Q000706:statistics & numerical data; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation / Q000706:statistics & numerical data*; D011788:Quality of Life / Q000523:psychology; D013315:Stress, Psychological / Q000523:psychology* / Q000628:therapy; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: anxiety; carers; criticism; depression; group intervention; strain