Do spirituality, resilience and hope mediate outcomes among family caregivers after traumatic brain injury or spinal cord injury? A structural equation modelling approach

Issue title: Special Section: Religion, spirituality and neurorehabilitation

Guest editors: Simon Dein

Article type: Research Article

Authors: Simpson, Grahame Kenneth^{a; b; *} | Anderson, Malcolm Ikin^c | Jones, Kate Fiona^{d; e} | Genders, Michelle^{a; b} | Gopinath, Bamini^b

Affiliations: [a] Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney NSW, Australia | [b] John Walsh Centre of Rehabilitation Research, Kolling Institute, Sydney University, Sydney NSW, Australia | [c] Faculty of Nursing, Avondale University College, Sydney NSW, Australia | [d] Royal Rehab, Ryde NSW, Australia | [e] Menzies Health Institute, Griffith University, Gold Coast QLD, Australia

Correspondence: [*] Address for correspondence: Grahame Simpson PhD, Brain Injury Rehabilitation Research Group, Ingham Institute of Applied Medical Research, Locked Bag 7103, Liverpool BC NSW 1871, Australia. Tel.: + 61 2 8738 5495; E-mail: grahame.simpson@health.nsw.gov.au.

Abstract: BACKGROUND:A deficits approach to understanding psychological adjustment in family caregivers of individuals with a neurological disability is extensive, but further research in the field of positive psychology (spirituality, resilience, hope) may provide a potential avenue for broadening knowledge of the family caregiver experience after traumatic brain injury (TBI) or spinal cord injury (SCI). OBJECTIVE:To test a proposed model of spirituality among family caregivers of individuals with TBI or SCI, using structural equation modelling (SEM). METHODS:A cross-sectional design was employed to survey ninety-nine family participants (TBI = 76, SCI = 23) from six rehabilitation units from NSW and Queensland. Assessments comprised Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale-Expanded, Connor –Davidson Resilience Scale, Herth Hope Index, and three measures of psychological adjustment including Caregiver Burden Scale, Positive and Negative Affect Scale, and Depression Anxiety Stress Scale. RESULTS:SEM showed the proposed model was a good fit. The main findings indicated spirituality had a direct negative link with burden. Spirituality had a direct positive association with hope which, in succession, had a positive link with resilience. Spirituality influenced positive affect indirectly, being mediated by resilience. Positive affect, in turn, had a negative association with depression in caregivers. CONCLUSIONS:This study contributes to better targeting strength-based family interventions.

Keywords: Traumatic brain injury, spinal cord injury, spirituality, resilience, hope, family caregiver, burden, depression, psychological adjustment

DOI: 10.3233/NRE-192945

Journal: NeuroRehabilitation, vol. 46, no. 1, pp. 3-15, 2020