Robert G. Knight

Psychometric properties of the Centre for Epidemiologic Studies Depression Scale (CES-D) in a sample of women in middle life.

The Centre for Epidemiologic Studies Depression Scale (CES-D) was completed by 675 women taking part in a longitudinal investigation of health-related issues. The data were submitted to confirmatory factor analysis using LISREL 7 and a 4-factor model was found to fit the data moderately well. A second-order depression factor was also identified. The results provide support for the construct validity of the total and subscale scores from this measure. The scale was found to have good reliability. Evidence was found that scores on the subscale measuring somatic features of depression may be inflated in women who have experienced a chronic health problem in the past 12 months.

Course of insight disorder and emotional dysfunction following closed head injury: A controlled cross-sectional follow-up study

Closed-head injury (CHI) patients at either 6 months (n = 24), 1 year (n = 19), or 2 to 3 years (n = 23) postinjury, were compared with a group of orthopedic control (OC) patients (n = 27). CHI patients assessed at 6 months postinjury experienced a Post-Traumatic Insight Disorder, in which they underreported the severity of their behavioural impairments. CHI patients in the 1 year and 2 to 3 year follow-up groups evidenced both greater insight about their level of behavioural impairment, and higher levels of emotional dysfunction. These findings suggested that the return of insight is associated with increased risk for emotional dysfunction. Implications of these findings for assessment and treatment of closed-head injury patients are discussed.

Caring for a family member with a traumatic brain injury

The responses to a questionnaire on subjective burden are reported for 52 primary caregivers of a group of persons with traumatic brain injuries sustained an average of 6 years previously. The aim of the study was to examine satisfaction with social support, perception of coping skills, and appraisal of symptoms as predictors of strain in the carers. A range of responses, both positive and negative, to the work of caring for a relative with a head injury was reported. A high prevalence rate of emotional and behavioural changes in the persons with head injuries was found and the amount of distress caused by these symptoms was found to be predictive of burden. The other factor important in predicting burden was the carers ratings of their satisfaction with their ability to cope with the work of caregiv ing. Social support, injury severity, and the demographic characteristics of the persons with head injury and their carers were not significant predictors. Depression in the carers was also investigated and the variable most predictive of elevated depression scores was coping satisfaction. These findings reinforce the importance of strengthening carers coping resources in rehabilitation work with head injured persons and their families.

The Drinking Expectancy Questionnaire: A revised measure of alcohol-related beliefs

Alcohol-related expectancies have been recently proposed as potentially important determinants of drinking behavior. This study describes the development of a New Zealand measure of such beliefs, the Drinking Expectancy Questionnaire (DEQ). Items selected through interviews, literature review, and the modification of other relevant questionnaires were piloted on 333 drinkers in a community sample and 275 college students. Factor analyses of both samples revealed nine alcohol reinforcement domains relating to assertiveness, affective change, sexual enhancement, social enhancement, relaxation, cognitive impairment, dependence, carelessness, and aggression. The potential clinical and research possibilities using this revised expectancy measure are briefly discussed, along with the scales strength and weaknesses.

Post-traumatic amnesia and Glasgow Coma Scale related to outcome in survivors in a consecutive series of patients with severe closed-head injury

A consecutive series of 93 severe closed-head injury (SCHI) patients, discharged from hospital in a conscious state, were rated on the Glasgow Outcome Scale at 6 and 12 months post-injury. Patients were included in this study if they had a period of post-traumatic amnesia (PTA) exceeding 24 h. Approximately 80% of patients had made a good recovery by 12 months post-injury; a better outcome than has been found in studies using the presence of coma during the first 6 h post-admission to hospital to define severe head injury. When analysed individually, duration of PTA and Glasgow Coma Scale scores on admission to hospital were both strongly correlated with outcome. Only duration of PTA, however, contributed significantly to outcome variance when potential outcome predictors were assessed using a stepwise multiple regression analysis. The definition of severe head injury, the higher than usual incidence of good recovery in the present study, and the relationship between injury severity and outcome are discussed.

Caregiver depression following traumatic brain injury (TBI): a consequence of adverse effects on family members?

Many studies have demonstrated that the behaviour of individuals with traumatic brain injury (TBI) predicts the emotional adjustment of their caregivers. The primary objective of the present study was to obtain an understanding of potential moderating and mediating variables between carer depression and analogous stressors. Seven sets of predictor variables (demographic variables, concurrent stressful life events, behavioural problems, social role problems, extent of adverse effects on family members, appraisal, and support) and the criterion variable of depression in caregivers were examined. Fifty-eight carers participated in the study at 6 months, 1 year, 2 years, or 3 years following injury. The number of adverse effects on family members (other than the informant) was the only stressor significantly related to carer depression. However, carer appraisal of adverse family effects was found to mediate the relationship between stressor and depression, and carer perception of support effectiveness was found to moderate the effect of adverse family effects on depression. Forty-six per cent of the variance in caregiver depression was accounted for by carers appraisal of adverse family effects and the interaction of adverse family effects and support effectiveness. These findings highlight the importance of supporting families as a whole in the rehabilitation of persons with TBI.Many studies have demonstrated that the behaviour of individuals with traumatic brain injury (TBI) predicts the emotional adjustment of their caregivers. The primary objective of the present study was to obtain an understanding of potential moderating and mediating variables between carer depression and analogous stressors. Seven sets of predictor variables (demographic variables, concurrent stressful life events, behavioural problems, social role problems, extent of adverse effects on family members, appraisal, and support) and the criterion variable of depression in caregivers were examined. Fifty-eight carers participated in the study at 6 months, 1 year, 2 years, or 3 years following injury. The number of adverse effects on family members (other than the informant) was the only stressor significantly related to carer depression. However, carer appraisal of adverse family effects was found to mediate the relationship between stressor and depression, and carer perception of support effectiveness was found to moderate the effect of adverse family effects on depression. Forty-six per cent of the variance in caregiver depression was accounted for by carers appraisal of adverse family effects and the interaction of adverse family effects and support effectiveness. These findings highlight the importance of supporting families as a whole in the rehabilitation of persons with TBI.

Some normative, reliability, and factor analytic data for the revised UCLA Loneliness scale

Normative statistics are provided for the UCLA Loneliness Scale based on the results of a sample of 978 adult subjects collected during a general population health survey. Factor analysis of the data revealed that the scale had a two factor structure; positively worded items loaded on one factor and negatively worded items on the other. Results from the factor analysis were used to construct two equivalent 10-item short forms of the scale. Previous findings that the scale is highly reliable were confirmed.

The effects of traumatic brain injury on the predicted and actual performance of a test of prospective remembering

Primary objective: The aim of the present study was to assess prospective memory (PM) with a video-based task using naturalistic stimuli, in a group with long-term disabilities resulting from traumatic brain injury (TBI). The specific focus of the research was on comparing the accuracy of the TBI and control groups’ estimates of successful completion of the prospective memory tasks. Research design: A group of 25 persons with TBI and 20 matched controls were compared on the video-based test of prospective remembering, on a test of retrospective memory (the Logical Memory sub-test of the Wechsler Memory Scale) and tests of executive dysfunction. Correlations between the neuropsychological and PM test scores were calculated and an item analysis of the PM test was undertaken. Procedures: For the PM test, participants were given a scenario involving a robbery, and a list of tasks to be completed in a nearby city centre. The instructions were given twice and on the second occasion they were asked to rate the likelihood of remembering each item. They then watched a videotaped segment showing the perspective of a person first driving and then walking through an unfamiliar city. Their task was to recall each instruction when a relevant cue appeared. Outcomes and results: The TBI group ratings of likelihood of recalling items were entirely equivalent to those made by the controls. On the PM test, however, their performance was significantly reduced. The performance of the TBI group on the PM test was correlated with scores on the Logical Memory and verbal fluency measures. Conclusions: The results showed that, although the TBI group performed more poorly on the PM task, their expectations about how much they would remember were comparable to those of the controls. The findings suggest that persons with TBI may have unrealistic expectations about how much they will remember in a novel situation. Awareness and acceptance of cognitive changes after TBI can be a significant issue for rehabilitation.

Verbal memory in non-demented patients withidiopathic Parkinsons disease

This study assessed the verbal memory functions of 20 patients with idiopathic Parkinsons Disease (PD) without any clinical evidence of dementia and 20 Medical Control (MC) patients with similar levels of physical disability. Performance was compared on tests of immediate recall, word list learning in intentional and incidental contexts, word completion priming, remote memory, metamemory and awareness of mnestic abilities. Significant differences were found in new learning of verbal material under incidental but not intentional learning conditions. Group differences were also observed on measures of remote memory and metamemory. The groups did not differ in word completion priming performance or recognition memory. These findings are consistent with other evidence suggesting that PD patients without dementia may have subtle cognitive deficits that affect memory performance. These may be attributable to impairments of attention allocation, formulation of retrieval strategies, and effortful learning associated with frontal lobe dysfunction. The group differences could not be attributed to impairments of intellectual functions, verbal fluency, level of physical disability, or mood disturbance.

Emotional Adjustment Following Traumatic Brain Injury: A Stress- Appraisal-Coping Formulation

This article conceptualizes emotional adjustment to traumatic brain injury (TBI) within a stress-appraisalcoping (SAC) model. In this model the emotional adjustment of the individual with TBI is seen as a response to neuropsychological symptoms and associated losses. This response is mediated, howev