Impact of Traumatic Brain Injury on the Family: A Critical Review

 The authors' goal is to present a critical overview of the literature of family psychosocial outcome after traumatic brain injury (TBI). Design: Thirty-seven family outcome studies were reviewed. Most of the data presented were on psychosocial outcome of primary caregivers, most often parents and spouses. A smaller amount of outcome literature on siblings and children of a parent with TBI was also considered. Main Outcome Measures: In the studies reviewed, 23 different standardized psychosocial outcome measures were used in addition to semistructured, in-depth interviews and indexes such as medication usage and counseling uptake. Results: A clear bias was evident in the literature whereby family outcome was likely to be viewed by researchers in terms of stress and burden on relatives. Conclusions: Recommendations were made for future family outcome research to develop a more theoretically coherent framework of family adaptation post-TBI to expand our understanding of relatives' psychosocial outcome and to shift the research focus to the resilience of families and their ability to work toward positive outcomes. There is a need to use standardized, TBI-specific measures with cross-cultural validity to have less variability in outcome measurement and more consensus in operationalizing outcome in order to enhance comparability between studies. Furthermore, future research should explore family adaptation within the one family, the impact on male relatives, and the differential impact between primary, secondary, and tertiary caregivers within the TBI population as a whole.