Relatives' Criticism Influences Adjustment and Outcome After Traumatic Brain Injury

Objectives: To apply some of the methods developed to study the effects of relatives' expressed emotion (EE) on psychiatric relapse rates and to test the prediction that relatives' criticism and psychiatric distress would be associated with outcome and emotional distress after traumatic brain injury (TBI). Design: Retrospective cohort design with correlational analyses of quantitative and qualitative measures of TBI outcomes. Setting: The author interviewed participants in the hospital. The research assistant interviewed close relatives at home. Participants: Participants and relatives (N=78) were interviewed 34.3 +/- 15.2 months (mean +/- SD) after a severe TBI. Interventions: None. Main Outcome Measures: Dependent variables in a series of hierarchical linear regression models were participants' scores on the Zung Depression Scale, Spielberger Trait Anxiety Inventory, State-Trait Anger Expression Inventory, an Anger Towards Relative questionnaire constructed for this study, and Extended Glasgow Outcome Scores. Participant-independent variables were social class, posttraumatic amnesia, Wechsler Memory Scale Delayed Recall score, WAIS-R intelligence quotient, and a short version of the Smell Identification Test. Relative independent variables were the number of critical comments directed toward participants in the interview and psychiatric distress as measured by the General Health Questionnaire. Results: The contributions of variance associated with relative independent variables (predominantly criticism) were significant in stage 2 of most hierarchical regression analyses after the adjustments for variance associated with participant independent variables made in stage I. Conclusions: Future application of EE research methods is warranted. If the present results are replicated, then evidence-based family interventions developed by EE researchers to reduce criticism might also improve TBI outcomes.