Affiliations: [a] Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA | [b] Rainbow Babies and Children's Hospital and Case Western Reserve University, Cleveland, OH, USA | [c] MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH, USA | [d] Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA | Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
Correspondence:
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Address for correspondence: Shari L. Wade, Ph.D., Division of Pediatric Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, 3333, Burnet Avenue, Cincinnati, OH 45229-3039, USA. E-mail: shari.wade@cchmc.org
Abstract: Introduction:Research suggests that pediatric TBI results in injury-related stress and burden and psychological distress for parents. However, existing studies have focused almost exclusively on mothers, so that we know relatively little about the impact of childhood TBI on fathers. Specific aims:The aims were to prospectively examine differences in maternal and paternal response to early childhood TBI over time relative to a comparison cohort of mothers and fathers of children with orthopedic injuries (OI). Methods:The concurrent cohort/prospective research design involved repeated assessments of children aged 3–6 years with TBI or OI requiring hospitalization and their families. Shortly after injury and at 6, 12, and 18 months post injury, parents of 48 children with TBI (11 severe and 37 moderate) and 89 with OI completed standardized assessments of injury-related stress and burden, parental distress, and coping strategies. Mixed models analyses and Generalized Estimating Equations examined differences in maternal versus paternal burden, distress, and coping over time. The analyses included interactions of parent sex with group (severe TBI, moderate TBI, OI) and time since injury, to examine the moderating effects of injury severity on parental response to injury over time. Results:Fathers were more likely than mothers to use denial to cope following moderate and severe TBI, but not OI. Conversely, mothers were more likely to prefer acceptance and emotion-focused strategies than fathers regardless of the type of injury. The use of active coping strategies varied as a function of injury type, parent sex, and time since injury. Fathers reported greater injury-related stress and distress than mothers over time, with pronounced differences in the severe TBI and OI groups. Conclusions:Mothers and fathers appear to respond differently following TBI. The different types of responses may serve to exacerbate emerging family dysfunction.
