Andrea T. Underhill

Depression and life satisfaction in patients with traumatic brain injury: a longitudinal study

Primary objective: To assess the relationship between depression and life satisfaction among survivors of traumatic brain injury (TBI) over a 3-year period after injury. It was hypothesized that survivors of TBI with depression would have decreased life satisfaction. Research design: Two groups (depression vs no depression) longitudinal design. Methods and procedures: Interviewed survivors of TBI (n ¼ 324) by telephone at 24, 48 and 60 months after hospitalization. At the 24-month interview, 90 (27.8%) respondents reported a post-injury diagnosis of depression and 234 (72.2%) reported no diagnosis. Respondents then completed the Life Satisfaction Index I-A, which was repeated at the 48- and 60-month interviews. Main outcomes and results: The depression group had significantly lower life satisfaction than the no depression group at 24-, 48- and 60-month interviews. Conclusions: Depression and diminished life satisfaction among survivors of TBI are persistent problems that require the close attention of medical and rehabilitation professionals.

Life satisfaction following spinal cord injury: long-term follow-up.

Abstract Objective: T o determine the course of self-reported life satisfaction in a spinal cord injury (SCI) cohort. Design: Prospective study using longitudinal data from the lnjury Control Research Center. Participants: Adult persons with traumatic-onset SCI (n = 207) evaluated at 1, 2, 4, and 5 years postinjury using the Life Satisfaction lndex-A. Results: A nonsignificant (P > 0.0 5) main effect of time was found using a repeated-measures analysis controlling for education and employment status. Several methods were used that provided a range of liberal to conservative estimates for missing data (ie, 3 8% retention rate at year 5). Subsequent missing data analyses tended to corroborate the finding of a nonsignificant effect of time, although the most conservative methods showed a significant decrease in life satisfaction between year 1 and year 5 postinjury (P < 0.05). Examination of numerous demographic, injury, and treatment-related characteristics at each follow-up time point suggested that the main findings of the study were not merely the result of differential dropout rates. Conclusion: Life satisfaction after the first year of injury remains largely the same over the next 4 years. Methodologie and analytic recommendations are discussed.

Family satisfaction predicts life satisfaction trajectories over the first 5 years after traumatic brain injury

OBJECTIVES Examined the influence of functional impairment, stable marital status, and family satisfaction on life satisfaction trajectories for 609 individuals (435 men, 174 women) over the first 5 years after traumatic brain injury (TBI). MEASURES Participants completed the Family Satisfaction Scale (FSS), Functional Independence Measure (FIM), and the Life Satisfaction Index (LSI) at years 1, 2, 4, and 5 after sustaining a TBI. RESULTS Trajectory modeling revealed that higher family satisfaction was associated with increases in life satisfaction for individuals with less functional impairment. Stable marital status was not significantly associated with life satisfaction trajectories. IMPLICATIONS Family satisfaction appears to have pronounced beneficial effects on life satisfaction for persons with less functional impairment after TBI regardless of marital status. In contrast, a stable marriage appears to have no apparent benefits to self-reported life satisfaction over the first 5 years post-TBI. Theoretical and clinical implications of these results are discussed.

The reliability and validity of the Life Satisfaction Index-A with survivors of traumatic brain injury

Primary objective: To investigate the internal consistency, long-term stability and validity of the Life Satisfaction Index-A (LSI-A) in a sample of survivors of traumatic brain injury (TBI). Research design: Cohort study. Methods and procedures: LSI-A was administered to survivors of TBI at 12, 24, 48 and 60 months post-injury during telephone interviews. Participants rated their quality of life, independence and participation in activities as well as health status at 24 months. Internal consistency was evaluated with Coefficient α. Pearsons r was used to investigate score stability. Test validity was explored with Pearsons r and Analysis of Covariance with age and sex as covariates. Experimental interventions: None. Main outcomes and results: Coefficient αs ranged from 0.85–0.92. Test–re-test coefficients ranged from 0.42–0.77. The LSI-A was positively correlated with self-reported quality of life, independence, activity level and health status. Conclusions: The LSI-A is a reliable and valid measure of the construct of life satisfaction among survivors of TBI.

Predictors of health-related quality-of-life following traumatic brain injury

Abstract Primary objective: To examine the predictive associations of family satisfaction, functional impairment, pain, and depression on health-related quality-of-life (HRQoL) among persons with traumatic brain injury (TBI) through structural equation modelling (SEM). Research design: Participants were part of a larger longitudinal study of adjustment following TBI. Direct and indirect effects of predictor variables on HRQoL were analyzed through SEM. Methods and procedures: The sample included 131 participants with TBI (89 men, 42 women) who had been discharged from an acute care hospital. The Sickness Impact Profile was administered to measure HRQoL at or beyond 24 months post-discharge. Predictor variable measures included the Functional Independence Measure, Family Satisfaction Scale and single items assessing the presence of pain and depression. Main outcomes and results: SEM revealed direct effects of functional impairment (p < 0.001), family satisfaction (p < 0.01), depression (p < 0.05) and pain (p < 0.01) on HRQoL. Indirect effects from functional impairment (p < 0.05) and pain (p < 0.05) to HRQoL through depression were also present. Conclusions: The presence of pain and depression, greater functional impairment and lower family satisfaction were predictively associated with lower HRQoL. Depression further mediated the effects of pain and functional impairment on HRQoL. The present study advances understanding of the ways in which pain, depression and functional impairment predict HRQoL.

Reliability and validity of the Family Satisfaction Scale with survivors of traumatic brain injury.

For this study, we investigated the reliability and validity of the FSS (Family Satisfaction Scale) in survivors of traumatic brain injury (TBI). The FSS was administered during the 12- and 60-month follow-up interviews. Data analyses included Cronbachs Alpha to determine internal consistency and analysis of variance to determine the relationship of FSS total score to Life Satisfaction Index-A (LSI-A) total scores, marital status, living arrangement, and number of family contacts outside the home. Cronbachs Alphas were 0.94 (12 months, N = 541) and 0.95 (60 months, N = 340). FSS total score and marital status were significantly related at both 12 months (F(3, 534) = 6.04, p < 0.001) and 60 months postdischarge (F(3, 335) = 4.52, p < 0.005). FSS total scores are correlated with the number of family contacts (r(342) = 0.12, p < 0.03) and with LSI-A total scores (r(337) = 0.43, p < 0.001). The FSS has excellent internal consistency with survivors of TBI. We also demonstrated the evidence of convergent validity.

Accuracy of world-wide-web death searches for persons with traumatic brain injury

Primary objective: Determine (1) the sensitivity of world-wide-web searches for deaths among persons with traumatic brain injuries and (2) factors associated with the likelihood of identifying deceased persons with traumatic brain injuries. Research design: Stratified case series. Methods and procedures: Sequential submission of 371 deceased persons with traumatic brain injuries to a world-wide-web site to determine inclusion in the Social Security Death Index (SSDI). Main outcomes and results: Almost 87% of deceased persons ages 50+ were found, 69.8% of persons ages 30–49 and 34.6% of persons younger than age 30. Other factors influencing the likelihood of finding deceased persons in the SSDI were male gender, white race, being married, knowing the Social Security number and survival of 1+ years post-injury. Conclusions: The SSDI provides useful information for mortality studies among persons with traumatic brain injuries, but does a poor job of identifying deaths among younger persons. Sole reliance on the SSDI may result in under-ascertainment of mortality.

Modeling the Prospective Relationships of Impairment, Injury Severity, and Participation to Quality of Life Following Traumatic Brain Injury

Identifying reliable predictors of positive adjustment following traumatic brain injury (TBI) remains an important area of inquiry. Unfortunately, much of available research examines direct relationships between predictor variables and outcomes without attending to the contextual relationships that can exist between predictor variables. Relying on theoretical models of well-being, we examined a theoretical model of adjustment in which the capacity to engage in intentional activities would be prospectively associated with greater participation, which in turn would predict subsequent life satisfaction and perceived health assessed at a later time. Structural equation modeling of data collected from 312 individuals (226 men, 86 women) with TBI revealed that two elements of participation—mobility and occupational activities—mediated the prospective influence of functional independence and injury severity to optimal adjustment 60 months following medical discharge for TBI. The model accounted for 21% of the variance in life satisfaction and 23% of the variance in self-rated health. Results indicate that the effects of functional independence and injury severity to optimal adjustment over time may be best understood in the context of participation in meaningful, productive activities. Implications for theoretical models of well-being and for clinical interventions that promote adjustmentafter TBI are discussed.

Distracted driving in teens with and without attention-deficit/hyperactivity disorder

OBJECTIVE This study is among the first to examine the effect of talking on a cell phone or text messaging while driving in teens with and without attention deficit/hyperactivity disorder (ADHD). METHOD Teens (average age 17years) with a diagnosis of ADHD (N=16) were matched with typically developing controls (N=18). All participants operated a driving simulator while (1) conversing on a cell phone, (2) text messaging, and (3) with no distraction during a baseline condition. Six indicators of driving performance were recorded: (a) time to complete the drive; (b) lane deviations; (c) variability in lane position (i.e., root mean square [RMS]); (d) reaction time; (e) motor vehicle collisions; and, (f) speed fluctuation. RESULTS Significantly greater variation in lane position occurred in the texting task compared to no task and the cell phone task. While texting, in particular, teens with ADHD took significantly less time to complete the scenario. No significant main effects of group were found. CONCLUSIONS Generally, those with ADHD did not differ in regard to driving performance, when compared to controls, with the exception of one outcome: time to complete scenario. These findings suggest that distracted driving impairs driving performance of teen drivers, regardless of ADHD status. Texting while driving had the greatest negative impact on driving performance, particularly with regard to variability in lane position (i.e., RMS). This study sheds light on key issues regarding injury prevention, with the intent of providing pediatric care providers with the knowledge to inform teen drivers of risks associated with distracted driving which will ultimately result in reduced rates of motor vehicle crashes and concomitant injuries.

Trajectories of life satisfaction five years after medical discharge for traumatically acquired disability.

OBJECTIVES We studied the predictive impact of family satisfaction, marital status, and functional impairment on the trajectories of life satisfaction over the first 5 years following medical treatment for traumatic spinal cord injury, burns, or interarticular fractures (total N = 662). It was anticipated that fewer functional impairments, being married, and greater family satisfaction would predict higher life satisfaction trajectories. METHOD The Functional Independence Measure, the Family Satisfaction Scale, and the Life Satisfaction Index were administered 12, 24, 48, and 60 months postdischarge. RESULTS Trajectory modeling revealed that greater functional impairment significantly predicted lower life satisfaction, regardless of injury type. However, this association diminished when marital status and family satisfaction were entered into the models. Greater family satisfaction and being married predicted greater life satisfaction across time. Moreover, there was no evidence for increases in life satisfaction trajectories over time: Trajectories were stable across time for all injury groups. CONCLUSIONS Results suggest that being married and greater family satisfaction promote life satisfaction among those who traumatically acquire disability, and these beneficial effects may be more salient than the degree of functional impairment imposed by the condition.