Nina A. Nabors

Predictors of caregiver burden following traumatic brain injury

Primary objective : To investigate the relationship of demographic characteristics of the caregiver (i.e. race, age, household income, education) to caregiver burden, family needs, family functioning and social support to assess the predictors of caregiver burden. Research design : Information was obtained through mailed surveys and follow-up phone interviews. Methods and procedures : Participants were 24 African American and 21 White caregivers of individuals with traumatic brain injury who were at least 1-year post-injury. Measures administered included the Head Injury Family Interview, Family Needs Questionnaire, Family Assessment Device and the NON, a measure of social support. Main outcomes and results : Regression analyses revealed that importance of needs and percentage of needs met accounted for a significant amount of the variance in predicting affective/behavioural, cognitive and physical/dependency burden. Conclusions : Rehabilitation professionals need to provide support that includes ongoing assessment of needs and provides a resource for steering caregivers to potential sources for meeting those needs.

Impact of Minority Status on Functional Outcome and Community Integration Following Traumatic Brain Injury

Objective:To determine whether minority status affected short-term and 1-year functional outcome and community integration for patients with traumatic brain injury (TBI) in the TBI Model Systems National Data Base. Design:Prospective study, consecutive sample. Setting:Four tertiary care rehabilitation centers. Patients:Five hundred and eighty-six patients with TBI admitted to one of four TBI Model Systems programs from February 1989 through June 1995. Inclusion criteria for the study included evidence of a TBI, admission to the system hospital emergency department within 8 hours of injury, 19 years of age or older, and acute care and inpatlent rehabilitation within the system hospitals. Information was collected for demographics such as race, age, gender, education, employment status, marital status, and data related to the injury such as injury severity, etiology of injury, and payer source. Over half of the sample was white (53.4%) with the 46.6% of minorities composed of blacks (37.2%), Hispanics (7.3%), and Asians (2.0%). Main Outcome Measures:Functional outcome was measured with the Functional Independence Measure (FIM), Disability Rating Scale (DRS), and Community Integration Questionnaire (CIQ). The FIM and DRS were measured at inpatient rehabilitation admission, discharge, and 1 year post injury. The CIQ total score and subscale scores for Home Integration, Social Integration, and Productivity were obtained at 1-year post injury. It was hypothesized that minority status would not predict functional outcome after acute rehabilitation but would predict functional outcome and community integration at 1 year post injury. Results:There were no significant differences between whites and minorities for DRS and FIM scores at acute rehabilitation discharge. There were also no significant differences between whites and minorities on FIM scores 1 year post injury, but there were significant differences between whites and minorities on the Social Integration and Productivity subscales and total score of the CIQ. Multiple regression indicated that minority status predicted functional outcome for CIQ total score (r=-.28) and two subscales, Social Integration (=-.28) and Productivity ( r= -.23) even after controlling for etiology, severity of injury, age, gender, and functional status at rehabilitation discharge. Conclusions:Although minority status does not negatively impact recovery of basic mobility and daily living skills, it may impact long-term outcome related to community integration as measured by productivity and social integration. Greater outreach and access to postdischargc services and support may be needed to optimize community integration outcomes. Further studies are needed to determine how best to serve the needs of this segment of the population with TBI

African American acculturation and neuropsychological test performance following traumatic brain injury

The present study examined the influence of African American acculturation on the performance of neuropsychological tests following traumatic brain injury (TBI). Seventy one participants already enrolled in a larger-scale study assessing the impact of TBI (i.e., the South Eastern Michigan Traumatic Brain Injury Model Systems project) completed a self-report measure of African American acculturation (African American Acculturation Scale-Short Form; Landrine & Klonoff, 1995) in addition to a standardized battery of neuropsychological tests. Hierarchical regression analyses were conducted to evaluate the relationship between level of acculturation and test performance after controlling for injury-related (initial Glasgow Coma Scale score, time since injury) and demographic variables (age, sex, years of education, and socioeconomic status). Lower levels of acculturation were associated with significantly poorer performances on the Galveston Orientation & Amnesia Test, MAE Tokens test, WAIS-R Block Design, Rey Auditory Verbal Learning Test, and Symbol Digit Modalities Test. Decreased levels of acculturation were also significantly related to lower scores on a composite indicator of overall neuropsychological test performance. In addition, the examiners ethnicity (Black or White) was related with scores on a few of the tests (i.e., Block Design, Trail Making Test), but was not significantly associated with the overall neuropsychological test performance. Overall, these findings suggest that differences in cultural experience may be an important factor in the neuropsychological assessment of African Americans following TBI, and provide additional support for the hypothesis that cultural factors may partially account for the differences among ethnic/cultural groups on neuropsychological tests.

Attention Deficits in Children with Sickle Cell Disease

Previous research has suggested that children with sickle cell disease may exhibit cognitive deficits even in the absence of direct cerebrovascular involvement (stroke). This study was designed to assess specific attentional deficits in children with sickle cell disease. 12 children with sickle cell disease (Hb SS) with a prior history of stroke, 14 children with sickle cell disease (Hb SS) without evidence of stroke, and 13 similar aged siblings (Hb AA or Hb AS) were compared on measures of attention, intellectual functioning, achievement, and adaptive Functioning, Significant differences were found between children with sickle cell disease (with or without stroke) and healthy controls on a timed test of visual scanning, the Coding subtest of the Wechsler Intelligence Scale for Children—Revised, and subtests of Reading, Arithmetic, and Spelling from the Wide Range Achievement Test-Revised. The differences between children with sickle cell disease and their healthy siblings appear to be the result of strokes rather than sickle cell disease itself as children with sickle cell disease without strokes did not significantly differ from controls. Implications for the effects of sickle cell disease and stroke on academic performance are discussed.

Use of the Neurobehavioral Cognitive Status Examination (Cognistat) in Traumatic Brain Injury

Objective:To examine the relationship between the Neurobehavioral Cognitive Status Examination (Cognistat) and established neuropsychological measures of related constructs in a traumatic brain injury (TBI) sample. Design:A retrospective study of 45 patients who were administered Cognistat as part of a neuropsychological evaluation. Setting:A tertiary care rehabilitation center. Patients:Forty-five TBI patients admitted to an inpatient rehabilitation unit from January 1994 through December 1995 and referred for a neuropsychological evaluation. Main Outcome Measure:Cognistat, a neuropsychological screening measure, that assesses orientation, attention, language, memory, calculation, construction, and reasoning. Pearson zero-order correlations were calculated between Cognistat subtests and selected standard neuropsychological measures. It was hypothesized that Cognistat would be associated with the standard neuropsychological measures. Results:The following Cognistat subtests were significantly associated with standard neuropsychological measures: Cognistat Memory with the California Verbal Learning Test and Logical Memory, Cognistat Comprehension with the Token Test, Cognistat Construction with Block Design, and Cognistat Attention with Trails A. No significant relationship was found between Cognistat reasoning subtests and the Wisconsin Card Sorting Test. Conclusion:Consistent with the hypotheses, Cognistat subtests were significantly associated with standard neuropsychological measures of related cognitive constructs. These findings suggest that general statements regarding specific domains of cognitive functioning can be made using Cognistat subtest scores.

Mental health stigma update: A review of consequences

Abstract Mental illness remains a pervasive social issue that aff ects the well-being of millions of individuals globally. Despite the overall prevalence of mental illness, increasing numbers of individuals needing mental health treatment do not receive it. Mental Health Stigma (MHS) has been proposed as a signifi cant barrier to seeking/obtaining mental health treatment. Mounting evidence suggests that MHS is experienced in virtually all life domains and that it may signifi cantly influence multiple health outcomes, including treatment seeking behavior. The current review paper uniquely contributes to the literature on MHS in at least four ways. First, this paper provides a recent overview of the prevalence and social costs of mental illness in society. Second, this paper presents a current literature review of MHS and helps to elucidate the impact of MHS on a range of individual outcomes, including psychological and physical health. Third, this paper specifically reviews existing literature on understanding the relationship between MHS and treatment seeking behavior. This is the fi rst known review paper to focus specifi cally on the MHS–treatment seeking relationship. Finally, the paper presents implications for future research on MHS and treatment seeking which may lead to the development of theory-based interventions to address MHS in clinical practice.

Neuropsychological Assessment and Intervention with African Americans

Attempts to address the impact of race and ethnicity on human behavior have increased in recent years. Race has been traditionally classified through genetically determined systems such as blood type or physical characteristics such as skin color (Kato, 1996). In its original definition developed to classify plants and animals, race was defined as an “inbreeding, geographically isolated population that differs in distinguishable physical traits from other members of the species” (Zuckerman, 1990). Social scientists attempted to take this definition and adapt it to the racial classification of human beings. The racial classification of human beings is generally fraught with problems, however, primarily due to a lack of empirically derived procedures to determine biologically distinct differences between different races. Ethnicity has been defined in several ways including national origin (i.e., Japanese American) and language (Hispanic American). Using this classification says little about the possible similarities between individuals within an ethnic classification. As with race, ethnicity has also been used to refer to distinguishing physical characteristics between groups of people. This has led to the tendency to use race and ethnicity interchangeably, further increasing the confusion. These differences in definition tend to decrease the ability to compare research findings across studies and have led to either a tendency to avoid using racial or ethnic categories altogether or to superficial use of the classification. As opposed to a more narrow biological classification, ethnicity has been more recently viewed as a “sociocultural” construction determined by the rules of the culture (Kato, 1996). A sociocultural definition of ethnicity focuses more on the values, customs, and rules that the members of an ethnic group share. Sociocultural definitions of ethnicity also recognize that a group of pepople may share the experience of being a minority (i.e., similar treatment at the hands of the majority society due to physical characteristics). This chapter will utilize black and African American interchangeably to refer to Americans who share common ancestral descent from people indigenous to sub-Saharan Africa (Jackson & Sellers, 1996). This definition relates to the socio-cultural aspects of being black or African American.

Womanist Therapy with African American Women with Disabilities

Abstract African American women are at increased risk for disabilities. There is very little information available, however, regarding psychological interventions with African American women with disabilities. The purpose of this article is to discuss psychological intervention in working with African American women with acquired disabilities from a womanist perspective. Themes and interventions will be discussed. Recommendations for working with African American women with disabilities in a therapeutic context will be offered.

Special Article: Multiple Minority Group Oppression: Divided We Stand?

Lesbian, gay, bisexual, and transgendered (LGBT) psychologists of color experience oppression from many sides. In addition to being negatively perceived by the majority society for being of different ethnicity, LGBT psychologists also experience oppression within their communities of color because of homophobia. In order to receive support from either community (people of color community of origin or European American gay, lesbian, bisexual, & transgendered community), multiple minority group members must deny important aspects of themselves, supported by one community and deemed as less important or unacceptable by the other. The double or triple oppression has a significant impact on their adjustment. This commentary focuses on the personal experiences and observations of LGBT psychologists of color as it relates to multiple oppression from the psychological community and society at large.