Often referred to as the ‘silent epidemic’, traumatic and other forms of acquired brain injury are now considered to represent a significant and growing public health problem worldwide. Beyond the direct impacts of acquired brain injury on injured persons, this disability likewise impacts families. While medical personnel and acute rehabilitation services deliver an incredible array of high quality and sophisticated techniques to treat acute injuries, a concomitant service delivery system to support the needs of families is lacking. This is especially unfortunate given the extensive array of instrumental and affective forms of care families provide to their injured family members, often resulting in high levels of caregiver burden, depression and anxiety.

Scant research has examined health-related quality of life (HRQoL) in family members of patients with severe brain injury, even less has been done in Scandinavian countries, and none has examined this construct longitudinally. The current study therefore used multilevel modelling to investigate the trajectories of HRQoL in 94 Danish family members of patients with severe brain injury at five time points, beginning at the patient's stay in a neuro intensive care unit through one year after injury. The family members’ HRQoL scores significantly and strongly increased over time, and Role Limitations – Emotional scores were higher when patients had high Rancho Los Amigos Scale scores at admission to early intensive rehabilitation in hospital. These results suggest that the acute and sub-acute periods after brain injury are an extremely difficult time psychologically for many families, and family-based mental health interventions during the acute and sub-acute phases are critical, especially for families who have a patient with severe deficits.

Acquired brain injury (ABI) causes numerous problems, including cognitive and personality changes, which can be quite stressful for caregivers. In this study, we aimed to adapt an instrument to measure caregivers’ distress, the Relative Version of the Head Injury Behaviour Scale (HIBS; Godfrey et al., 2003) to the Spanish language and to determine whether the positive aspects of caregiving moderate the effects of the psychological problems of ABI on caregivers’ distress. Moderation analyses indicated that positive aspects of caregiving involving one's outlook on life reduced the association between psychological problems and caregivers’ distress. The findings suggest that although the caregiver role is a source of distress, this role can also become a source of satisfaction, actually contributing to reducing caregivers’ distress. The importance of promoting the positive aspects of caregiving in rehabilitation programmes is discussed.

This study recruited 90 traumatic brain injury (TBI) caregivers from Guadalajara, Mexico to examine influences of five domains of TBI impairment and related caregiver stress on five types of family needs. Canonical correlations suggested that greater social impairment in individuals with TBI and related caregiver stress were associated with higher informational, household and health needs in families. Meanwhile greater physical impairments in individuals with TBI and related caregiver stress were associated with higher household needs. Additionally, greater emotional impairments in individuals with TBI and related caregiver stress were associated with higher informational needs. Caregiver interventions targeting specific TBI impairments and related caregiver stress may meet family needs and thereby improve the quality of informal care for their family members with TBI.

Parenting following acquired brain injury (ABI) has received little empirical or clinical investigation. The current study aimed to explore the challenges facing fathers following ABI and identify their needs for support. Interviews were conducted with three men with ABI, two partners and three rehabilitation coordinators. Five themes emerged from the data and a preliminary model of parenting for fathers following injury was developed. The interactive effects of the ABI and associated impairment on family relationships/functioning, perceptions/identity of parenting role, parenting knowledge/skills and confidence/self efficacy are described. Interventions should be flexible, individualised and tailored to address the unique parenting needs of the father within each family.

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.

The present study describes coping strategies in a sample of 37 relatives of patients with severe brain injury and analyses associations between coping strategies and symptoms of anxiety depression and health-related quality of life one year after injury. The participants used the strategies active coping and use of emotional support most frequently. Less used strategies were humour, substance use, behavioural disengagement and self-blame. The results suggest that use of the strategies positive reframing and acceptance was associated with less anxiety, depression and better health-related quality of life one year after injury, whereas the use of the coping strategy denial was associated with a poorer outcome in the relatives.

This study investigated the rehabilitation and services needs, rehabilitation goals and barriers of individuals with brain injury (n = 81, males = 59%, females = 41%, age range 18 to 87), and their family members (n = 19; females = 75%, age range 18 to 65), (ethnicity = white = 89%). Data were collected using a survey instrument and focus group interviews. A descriptive analysis of the quantitative data was conducted, while content analysis was used to analyse the qualitative data. Results suggest that individuals with brain injury and their families experience many unmet needs across the domains of employment, independent living, financial resources and housing. Family involvement was found to be important to community participation after brain injury.