The Impact of Pre-injury Psychiatric Difficulties on Caregiving Needs and Post-injury Emotional Distress in Care Partners of Persons with TBI.

Abstract

Objective: To examine differences in post-injury needs in traumatic brain injury (TBI) care partners with and without a pre-injury psychiatric history (PH+ vs. PH-).

Design: A multi-site, prospective, observational cohort study.

Setting: Community.

Participants: 258 care partners for persons with TBI meeting these criteria: ≥18 years old; non-paid caregiver; TBI care recipient criteria: ≥ 16 years old at time of injury, TBI requiring inpatient rehabilitation; acute hospitalization/admission at TBIMS-approved inpatient rehabilitation site.

Interventions: Not applicable, Main Outcome Measures: Family Needs Questionnaire-Revised (FNQ-R) assessed proportion of emotional (ES), instrumental (IS), professional (PS), and community (CS) support needs met at 6-months post-injury.

Secondary outcome measures: Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) assessed care partner depression and anxiety at 6, 12, and 24-months post-injury.

Results: At 6-months post-injury, care partners reported more met needs for community support relative to instrumental support needs (Estimates; 95% CI: 7.30; 3.91-10.69, p<.001). PH+ care partners did not differ from PH- care partners in the percentage of met needs across any need category. Number of psychiatric diagnoses (0 vs. 1 vs. 2 vs. 3+) was not associated with differences in met needs. PH+ care partners endorsed more depression and anxiety symptoms than PH- care partners from 6 to 24-months post-injury (Estimates; 95% CI: depression: 3.78; 2.55-5.00 p<.001; anxiety: 2.91; 1.58-4.24, p<.001).

Conclusions: PH+ TBI care partners do not appear have differing needs than PH- care partners at 6 months post-injury, but do experience persistent emotional distress. Evaluating care partners' psychiatric history is warranted to identify caregivers vulnerable to developing post-TBI emotional distress.