Trajectories of Posttraumatic Stress Symptoms in Significant Others of Patients With Severe Traumatic Brain Injury

Abstract

Long-term psychological distress has been reported among significant others of patients who sustained a traumatic brain injury (TBI). This study examined the course and potential predictors of posttraumatic stress symptoms in a relative sample (N = 135) drawn from a national cohort study on severe TBI in Switzerland. Latent growth mixture model analyses revealed two main groups: Across 3, 6, and 12 months after the accident, 63% of the sample indicated fairly low symptom severity (“resilient” course), whereas 37% showed persistence of “higher distress” as indicated by elevated scores on the Impact of Event Scale–Revised. Group membership was significantly associated with self-reported dysfunctional disclosure style. Implications for research and practice are discussed.

KEYWORDS:

• PTSD
• significant others
• symptom trajectories
• traumatic brain injury

Acknowledgments

We thank all of the participants who took part in this study. We appreciate the support that has been provided by the PEBITA research network and thank all local collaborators at the University Hospitals of Zurich and Basel; the Inselspital Berne; the Cantonal Hospitals of Graubünden, St. Gallen, Winterthur, Aarau, and Lucerne; and Patrizia Gallati, Chiara Haller, Désirée Piller, Marie My Lien Rebetez, and Rahel Schumacher for their contributions in data collection. This study was funded by Loterie Romande, Fondation Eagle, the Gottfried and Julia Bangerter Rhyner Foundation, the Swiss Insurance Association, the Swiss National Accident Insurance Fund, and Fragile Suisse.

Notes

Note. IES-R = Impact of Event Scale–Revised; GOS = Glasgow Outcome Scale.

^a Not assessed in 33 proxies (24%) at 3 months, 6 (4%) at 6 months, and 10 (7%) at 12 months.

^b Not assessed in 10 patients (7%) at 3 months, 12 (9%) at 6 months, and 1 (1%) at 12 months.

^c Not assessed in 18 patients (13%) at 3 months and 13 (10%) at 6 months.

Note. T1 = 3 months; T2 = 6 months; T3 = 12 months. Fit indices for two-class growth mixture models were as follows: (a) intrusions, ssaBIC = 793.29, entropy =.91, LRT p < .01, BLRT p < .001; (b) avoidance, ssaBIC = 615.12, entropy =.97, LRT p = .14, BLRT p < .001 (not replicated in 14 out of 20 drawings); and (c) hyperarousal, ssaBIC = 706.02, entropy =.84, LRT p = .36, BLRT p < .001.

*p < .05; **p < .01 (indicates estimates significantly different from zero).

^a Resilient group.

Note. Resilient group, n = 71; higher distress group, n = 34. GOSE 3 = Glasgow Outcome Scale Extended at 3 months; DTQ = Disclosure of Trauma Questionnaire total score. Step 1, R2 = .08 (Hosmer and Lemeshow), .09 (Cox and Snell), .13 (Nagelkerke); model χ2(4) = 9.98, p < .05. Step 2, R2 = .22 (Hosmer and Lemeshow), .24 (Cox and Snell), .33 (Nagelkerke); model χ2(5) = 28.55, p < .001.

^a Reference category.

**p < .01.

Additional information

Notes on contributors

Laura Pielmaier

Laura Pielmaier completed her education in psychology at the University of Freiburg, Germany, and her PhD at the University of Zurich, Switzerland. Her research interests are PTSD and trauma-related interpersonal processes. She now works as clinical psychologist at the Division of Insurance Medicine, Swiss National Accident Insurance Fund, Lucerne, Switzerland.

Anne Milek

Anne Milek completed her education in psychology at Freie Universitaet Berlin, Germany, and worked as a research/teaching assistant at Max Planck Institute for Human Development in Berlin, Germany, and at the Sports University of Cologne, Germany. She is now completing her PhD at the University of Zurich. Her main research interests are couple and family research and, in particular, shared family time processes.

Fridtjof W. Nussbeck

Fridtjof W. Nussbeck received his PhD at Freie Universitaet Berlin, Germany. He is a full professor of psychological methods and evaluation at the University of Bielefeld, Germany. His main research interests are dyadic data analysis, psychometric model building, and longitudinal data analysis.

Bernhard Walder

Bernhard Walder is a consultant in anesthesia at the University Hospitals of Geneva. He is director of the Post-Anaesthesia Care Unit and the Anaesthesia Service for Interventional Medicine. He is lecturer at Medical Faculty of the University of Geneva. His interests are outcome research in traumatic brain injury, research in clinical quality, and monitoring improvement.

Andreas Maercker

Andreas Maercker received his M.D. at Humboldt University and his Ph.D. at Max Planck Institute for Human Development in Berlin, Germany. He is a full professor of psychopathology and clinical intervention at the University of Zurich and co-director of the institute's outpatient clinic services. His main research interests are traumatic stress research, clinical gerontopsychology, and Internet-assisted mental health.