Coping strategies in individuals after traumatic brain injury: associations with health-related quality of life

Abstract

Purpose: This study investigates coping strategies after traumatic brain injury (TBI) and their associations with health-related quality of life (HRQoL). Methods: Participants were 141 adults followed up 3 months to 15 years after TBI of all severity degrees. Coping was assessed by the Freiburg Questionnaire of Coping with Illness (FQCI) and HRQoL by the Quality of Life after Brain Injury (QOLIBRI) scale and the Short Form-36 Health Survey (SF-36). Coping dimensions were extracted by principal component analysis. Multiple linear regression analysis was used to identify predictors of coping strategies. Results: Two factors for coping after TBI were extracted: Action/Distraction and Trivialisation/Resignation. The Trivialisation/Resignation strategy was negatively correlated with all aspects of HRQoL, while relationships with the Action/Distraction strategy were positive and significant for two domains. These two factors also showed significant associations with anxiety, depression, recovery, cognitive status, mood states and trauma severity. Multiple regression analysis identified recovery status as a predictor for the maladaptive Trivialisation/Resignation strategy. Conclusion: Two coping factors were identified, which were differentially associated with HRQoL. Maladaptive coping strategies play a particularly important role, and less reliance on such strategies is associated with better HRQoL; use of adaptive strategies should correspondingly be fostered.

Implications for Rehabilitation

• This study highlights the relationship of coping strategies and HRQoL after TBI.

• For the assessment of HRQoL a novel disease-specific instrument was applied, that provides in detail TBI-relevant aspects of well-being and HRQoL.

• Individuals after TBI use two main sets of coping strategies that are differentially associated with HRQoL (and clinical variables). One is adaptive and the other maladaptive for HRQoL after TBI.

• Maladaptive and adaptive coping strategies used by the individual should be identified and considered in rehabilitation efforts to improve HRQoL after TBI.

• Coping with illness
• health-related quality of life
• traumatic brain injury

Acknowledgements

Recruitment of participants was supported by Prof. K. M. Stürmer, Department for Trauma Surgery, Plastic and Reconstructive Surgery, University Medical Centre Göttingen (UMG); Prof. V. Rohde, Department of Neurosurgery, UMG; Prof. R. Behr, Department of Neurosurgery, Klinikum Fulda; Prof. W. Deinsberger, Department of Neurosurgery, Klinikum Kassel and Dr. W. Puschendorf, Westend Neurological Clinic, Bad Wildungen. We thank Dr. Ester Villalonga Olives and Joy Backhaus for support during the preparation of the manuscript. We are especially grateful to all the individuals after TBI who participated in this study and to collaborators who made the study possible.