The experience of families following traumatic brain injury in adult populations: A meta-synthesis of narrative structures

BACKGROUND

Traumatic brain injury has a significant effect on uninjured family members. Typically, this has been examined with a focus on psychopathological outcomes including stress, depression and anxiety. However, in recent years there has been increasing interest in the subjective experiences of families post-injury leading to a plethora of qualitative studies. Therefore, an in-depth examination and synthesis of this literature is now relevant and timely.

OBJECTIVE

To examine the subjective experiences of families following traumatic brain injury in adult populations in the sub/post-acute period through the synthesis of original qualitative research.

DESIGN

This paper presents a meta-synthesis using Thomas and Harden's framework of 'thematic synthesis' rooted in a critical realist philosophy.

DATA SOURCES

In July 2019 five electronic databases, were searched for the terms 'traumatic brain injury', 'family' and 'qualitative'. Studies were included if the primary research reported qualitative data about the subjective experiences of family members of adults with traumatic brain injury and had been published in a peer reviewed journal. Studies with mixed brain injury samples, child or adolescent traumatic brain injury or disorders of consciousness were excluded. Hand searching and citation searches were also completed.

REVIEW METHODS

Two reviewers screened titles, abstracts and full text and reached consensus through critical discussion. Thirty papers were finally agreed for inclusion in this review. Each study was then assessed for relevance, resonance and rigour using the Critical Appraisal Skills Programme (CASP) tool. Line by line coding of the findings in each paper was conducted as the basis for a thematic analysis and synthesis.

RESULTS

Descriptive themes were identified followed later by analytical themes. This final stage was informed by a narrative lens and from these, eight narrative functions belonging to four dimensions were identified from the subjective experiences of families post-traumatic brain injury. Specifically, these were: (1) Displacing and Anchoring; (2) Rupturing and Stabilising; (3) Isolating and Connecting; (4) Harming and Healing.

CONCLUSIONS

The interpretation of the narrative functions revealed the substantial existential work involved in negotiating lives, maintaining family system equilibrium and moving forward. As such, family members have their own unique narrative needs. Despite contemporary service models built around the injured person, service providers are well placed to support families in this everyday narrative work through actively attending to narrative structures and understanding the implications of these for family experience. The study protocol was registered with PROSPERO (International prospective register of systematic reviews) in July 2018 (Registration number: CRD42018085824). Tweetable abstract: This synthesis showed the immense and invisible work required for family members to maintain family system equilibrium and negotiate their lives post-TBI.

A systematic review of siblings' psychosocial outcomes following traumatic brain injury

Purpose: To investigate the psychosocial impact of TBI on siblings and to identify the factors associated with their psychosocial functioning.Methods: A systematic search of six databases (CINAHL, Medline, Scopus, PsychINFO, Web of Science and Embase) was conducted from 1980 to May 1st, 2020. Studies involving siblings of a child or adult with TBI that employed validated self-report measures of psychosocial functioning were included. Quality of methodology was appraised by two reviewers.Results: Thirteen articles were identified, reporting on 11 cross-sectional studies. Although there were mixed findings overall, siblings typically reported greater mood symptoms and distress related to family functioning as compared to the norms and control samples. Siblings' psychosocial functioning was comparable to other family members, although they were less likely to be primary caregivers. Having a brother or sister with behavioural problems and low levels of social support were the factors most consistently related to poor psychosocial functioning in siblings.Conclusions: Siblings of individuals with TBI may experience negative changes in psychosocial functioning. They are at greater risk of poor psychosocial functioning when their brother or sister with TBI has behavioural problems and when they perceive low social support. Longitudinal studies on siblings' adjustment trajectory over time and research on support interventions for siblings are recommended.Implications for RehabilitationTraumatic brain injury can have a negative impact on siblings' psychosocial functioning with respect to mood and distress related to family functioning.As siblings experience similar impacts on their psychosocial functioning to other family members, specific focus on their adjustment to role changes may be needed.Siblings with a brother or sister with behavioural problems and those perceiving lower social support may particularly benefit from monitoring and support.

Our Ultimate Fellow Travelers: A Pilot Exploration of Sibling Support for Adults With Developmental Disabilities

People with developmental disabilities often experience needs for support that extend beyond the caregiving capacity of their aging parents and their siblings tend to be looked to as next-generation support providers. Yet, sibling support relationships are distinct for their simultaneously obligatory and voluntary nature. This pilot exploration, using in-depth focus group data from five siblings of people with developmental disabilities, is aimed at enriching understandings of the nature of, and expectations surrounding, sibling support for brothers and sisters with developmental disabilities. Findings reflect how sibling support evolves over time and can manifest in siblings assuming roles of: (1) companion and protector; (2) follower; (3) caregiver; and (4) within family protector. Siblings are a vital resource, yet not one that can be assumed as automatically forthcoming.

Social work-generated evidence in traumatic brain injury from 1975 to 2014: A systematic scoping review

The International Network for Social Workers in Acquired Brain Injury (INSWABI) commissioned a systematic scoping review to ascertain the social work-generated evidence base on people with traumatic brain injury (TBI) of working age. The review aimed to identify the output, impact and quality of publications authored by social workers on this topic. Study quality was evaluated through assessment frameworks drawn from the United Kingdom National Service Framework for Long-Term Conditions. In the 40-year period from 1975 to 2014, 115 items were published that met the search criteria (intervention studies, n = 10; observational studies, n = 52; literature reviews, n = 6; expert opinion or policy analysis, n = 39; and others, n = 8). The publications could be grouped into five major fields of practice: families, social inclusion, military, inequalities and psychological adjustment. There was a significant increase in the number of publications over each decade. Impact was demonstrated in that the great majority of publications had been cited at least once (80.6%, 103/115). Articles published in rehabilitation journals were cited significantly more often than articles published in social work journals. A significant improvement in publication quality was observed across the four decades, with the majority of studies in the last decade rated as high quality.

A Clarion Call for Social Work Attention: Brothers and Sisters of Persons With Acquired Brain Injury in the United States

This article presents a clarion call for increased social work attention to the needs of siblings of persons with acquired brain injury (ABI) in the United States. The article overviews how siblings are psychosocially affected, how they provide care to the injured brothers and sisters, and how they personally develop as a result of their experiences. The article highlights the fact that social workers and other professionals often overlook the needs of siblings of persons with ABI and makes an appeal for social workers to advance clinical practice and research to benefit this often neglected population.

Intimate Partner Violence and Traumatic Brain Injury: State of the Science and Next Steps

Women who receive traumatic brain injuries (TBI) from intimate partner violence (IPV) are gaining attention; however, research studies are lacking in this area. A review of literature conducted on TBI from IPV found prevalence of 60% to 92% of abused women obtaining a TBI directly correlated with IPV. Adverse overlapping health outcomes are associated with both TBI and IPV. Genetic predisposition and epigenetic changes can occur after TBI and add increased vulnerability to receiving and inflicting a TBI. Health care providers and community health workers need awareness of the link between IPV/TBI to provide appropriate treatment and improve the health of women and families.

The Rehabilitation Needs of Adult Siblings of Persons With Traumatic Brain Injury: A Quantitative Investigation

This study examined the post-injury rehabilitation needs of 158 adult siblings of persons with traumatic brain injury (TBI) in the United States. The mean age of participants was 37.0 years (SD= 10.0 years), and their ages ranged from 19 to 72 years. A total of 120 (75.9%) of the participants were female. Participants completed the Family Needs Questionnaire (FNQ) (Kreutzer, 1988), which measures the unique needs of families following TBI. The FNQ counts the types of needs rated as important and the frequency in which those needs have been met. Data were analysed via hierarchical multiple regression analysis with the number of met needs set as the outcome variable. A total of 15 predictor variables assessed direct and indirect markers of caregiving related stresses corresponding to position in the Pearlin stress process model. Participants indicated that health information was the most important need while needs for involvement with care were the most often met. Results also indicated that participant feelings of more restrictions in valued family activities and perceptions of greater cognitive-behavioural impairments with their injured siblings were associated with lower number of met rehabilitation needs. Participants reported that the use of effective coping behaviours and access to social support were associated with higher numbers of met rehabilitation needs. Findings suggest adult siblings share similar needs to parents and spouses (i.e., the most common primary caregivers) and require professional attention and support following TBI.

Quality of professional services following traumatic brain injury: adult sibling perspectives

This study examined the quality and availability of professional supports provided to individuals with traumatic brain injury (TBI) and their families from the perspective of a national sample of 267 adult siblings. Using a constant comparative approach to text analysis, the authors analyzed what siblings perceived to have been beneficial or in need of improvement with regard to the TBI professional services provided to their injured brother or sister and their family. The siblings' comments suggested that the system-level response to TBI serving injured people and their families was inadequate, that many professionals lacked the skills and understanding to provide effective services, and that professionals did not provide sufficient information to the people with TBI or their families. However, most siblings endorsed a positive view of at least one of the professional services provided. Clinical, advocacy, and research implications of these findings are discussed.

Future Concerns Among Families Following Brain Injury in the United States: Views from the Brain Injury Association of America State Affiliates

The objective of this study was to examine brain injury professionals’ perspectives on the future concerns of families of persons with brain injuries in the United States of America. A total of 28 persons in leadership positions with the Brain Injury Association of America (BIAA) participated. Through qualitative data analysis of an open-ended question in an electronic survey containing both qualitative and quantitative questions, participants identified future concerns related to future caregiving responsibilities, financial concerns, living arrangements, recovery, access to professional care, relationships and employment. The findings indicate that many families are unprepared to meet the future care and support needs of their injured family members.