A Multi-Site Study of Traumatic Brain Injury in Mexico and Colombia: Longitudinal Mediational and Cross-Lagged Models of Family Dynamics, Coping, and Health-Related Quality of Life.

Latin America has high rates of traumatic brain injury (TBI), yet reduced mental and physical health outcomes due to limited rehabilitation services. To understand the psychosocial adjustment process in TBI patients in Latin America, the incorporation of cultural values including family-based variables is imperative. The current study examined relations among healthy family dynamics, coping, and mental and physical health related quality of life (HRQL) among a sample of TBI patients across three sites and two countries over the first 4 months post-injury. A sample of 109 acute TBI patients from Mexico and Colombia were recruited, and a series of longitudinal mediation and cross-lag panel analyses were run. Mental and physical HRQL were positively associated with each other, as well as healthy family dynamics and coping. Coping partially mediated the effects of healthy family dynamics on both mental and physical HRQL. Family dynamics showed the strongest cross-lag relationships with coping going from 2 months to 4 months. Similarly, coping showed the strongest cross-lag relationships with both mental and physical HRQL going from baseline to 2 months. Results provide empirical support for the importance of a rehabilitation workforce that has been trained in and can effectively implement family-based interventions for individuals with TBI in Latin America.

Relationship Satisfaction and Depression After Traumatic Brain Injury: An Actor-Partner Interdependence Model of Patients and Caregivers in Mexico and Colombia.

OBJECTIVE: Traumatic brain injury represents a major public health concern, particularly in low- and middle-income countries like in Latin America. Family members are often caregivers for individuals with traumatic brain injury, which can result in significant stress. Research is needed to examine depression and quality of the caregiving relationship in these dyads. This study examined relationship quality and depression longitudinally after traumatic brain injury within the caregiving relationship. DESIGN: Dyads (N = 109) composed of individuals with traumatic brain injury and their caregivers were recruited from three hospitals in Mexico and Colombia. They self-reported depression and relationship satisfaction during hospitalization and at 2 and 4 mos after hospitalization. RESULTS: A 2-lag Actor Partner Interdependence Model demonstrated that patients and caregivers reporting high relationship satisfaction at baseline experienced lower depression 2 mos later, which then predicted higher caregiver relationship satisfaction at 4 mos. Moreover, patients with high relationship satisfaction at baseline had caregivers with lower depression at 2 mos, which was then associated with patients' higher satisfaction at 4 mos. CONCLUSIONS: Within individuals with traumatic brain injury and caregivers, depression and relationship satisfaction seem to be inversely related. Furthermore, patients' and caregivers' depression and relationship satisfaction impact each other over time, demonstrating interdependence within the caregiving relationship.

Predictors of longitudinal depression trajectories after traumatic brain injury in Latin America: A multi-site study.

BACKGROUND: Latin America has exceptionally high rates of traumatic brain injury (TBI), but very little research has been conducted on longitudinal TBI outcomes in this global region. OBJECTIVE: This study examined whether cognitive dysfunction and social disadaptation in individuals with TBI in Latin America at hospital discharge predict longitudinal trajectories of depression at baseline, 2 months, and 4 months. METHODS: A sample of 109 people with a new TBI was recruited from three hospitals: Mexico City, Mexico, Cali, Colombia and Neiva, Colombia. Participants completed measures of cognitive dysfunction and social disadaptation before hospital discharge and measures of depression at baseline, 2 months, and 4 months. RESULTS: Results suggested that depression scores were found to decrease over time in a quadratic (or U-shaped) fashion, and more significant cognitive dysfunction at hospital discharge was associated with higher longitudinal depression trajectories. Social disadaptation did not exert a unique effect on depression trajectories after controlling for cognitive dysfunction. Depression trajectories changed differentially over time as a function of baseline cognitive dysfunction, such that for those with high cognitive impairment, depression scores started high and then dropped to a moderated range and plateaued, but for individuals with low cognitive dysfunction, depression scores started lower and decreased linearly but moderately. CONCLUSIONS: The results suggest a strong need for neuropsychological assessments and evidence-based cognitive rehabilitation strategies to be implemented immediately after TBI in Latin America, which could exert salubrious effects on depression trajectories over time.

Family dynamics and psychosocial functioning in children with SCI/D from Colombia, South America.

OBJECTIVE: The purpose of this study was to examine the connections between family dynamics and the psychosocial functioning of children with spinal cord injuries and disorders (SCI/D). DESIGN: Cross-sectional. SETTING: Participants were recruited from communities in Neiva, Colombia. PARTICIPANTS: Thirty children with SCI/D and their primary caregiver participated. Children were between 8 and 17 years of age, and had sustained their injury at least six months prior to data collection. INTERVENTIONS: NA. OUTCOME MEASURES: Participating children completed measures assessing their own psychosocial functioning (Children's Depression Inventory, Revised Children's Manifest Anxiety Scale-2, Pediatric Quality of Life Inventory), and their primary caregiver completed measures of family dynamics (Family Adaptability and Cohesion Evaluation Scale- Fourth Edition, Family Communication Scale, Family Assessment Device- General Functioning, Family Satisfaction Scale, Relationship-Focused Coping Scale). RESULTS: A correlation matrix showed a number of significant bivariate correlations between child and family variables, and three multiple regressions showed that family satisfaction, empathy, and flexibility significantly explained 27% of the variance in child worry; family satisfaction and communication explained 18% of the variance in child social anxiety; and family cohesion and communication explained 23% of the variance in child emotional functioning. CONCLUSIONS: These findings highlight the importance of rehabilitation professionals considering the association between family dynamics and the psychosocial functioning of children with SCI/D when working with this population.

Depressive and anxiety symptoms and social support are independently associated with disease-specific quality of life in Colombian patients with rheumatoid arthritis.

OBJECTIVE: To examine the relationship between disease-specific Quality of Life (QOL) and socio-demographic, medical, and psychosocial factors in Colombian patients with Rheumatoid Arthritis (RA). METHODS: One hundred and three RA patients recruited from ambulatory centers in Neiva, Colombia were administered the Disease Activity Scale 28 (DAS-28), QOL-RA, Zung Self-Rating Depression Scale, State-Trait Anxiety Inventory (STAI), Interpersonal Support Evaluation List-12 (ISEL-12), and Symptom Checklist-90 Revised (SCL-90R). RESULTS: Lower QOL-RA was associated with lower socio-economic status (SES; r=0.26, p<0.01), higher likelihood of using opioids (t=-2.51, p<0.05), higher likelihood of comorbid pulmonary disease (t=-2.22, p<0.05), and lower ISEL-12 sub-scales (r's=0.41-0.31, p's<0.001). Lower QOL-RA was associated with higher DAS-28 (r=-0.28, p<0.01), Visual Analog Scale (VAS; r=-0.35, p<0.001), Zung Depression (r=-0.72, p <0.001), STAI-State (r=-0.66, p<0.001), STAI-Trait (r=-0.70, p<0.001), SCL-90R Global Severity Index (r=-0.50, p<0.001), SCL-90R Positive Symptom Total (r=-0.57, p<0.001), and all SCL-90R sub-scales (r's=-0.54--0.21, p's<0.01). A multivariate linear regression model indicated that SES (B=2.77, p<0.05), Zung Depression (B=-0.53, p<0.001), STAI-State (B=-0.26, p<0.05), and ISEL-12 Belonging (B=1.15, p<0.01) were independently associated with QOL-RA, controlling for significant associations. CONCLUSIONS: More depressive and anxiety symptoms were independently associated with lower disease-specific QOL, while higher perceptions of having people to do activities with (belonging social support) and higher SES were independently associated with higher disease-specific QOL. Psychosocial factors impact QOL in RA above and beyond disease activity. Additional research into the benefits of psychosocial assessment of RA patients and provision of comprehensive care to improve QOL is warranted.

Factor analysis of the Spanish Multidimensional Attitudes Scale Toward Persons with Disabilities.

PURPOSE/OBJECTIVE: To study the psychometric properties of a Spanish version of the Multidimensional Attitudes Scale toward Persons with Disabilities (MAS) and examine its factor structure using confirmatory and exploratory factor analyses on data from a Colombian collegiate sample. RESEARCH METHOD/DESIGN: Five hundred students from Sur Colombia University in Neiva, Colombia, completed the Multidimensional Attitudes toward People with Disability scale. Forty-eight percent were male, and the average age for the entire sample was 21.25 years (SD = 3.50). Ninety-eight percent were undergraduates, 23% of whom were business majors and 33% of whom were education majors. RESULTS: An exploratory factor analysis (EFA) of data from half of participants suggested the retention of 4 factors and the deletion of 4 items. A confirmatory factor analysis (CFA) on the data from the second half of participants using the 30 retained items and 4-factor structure suggested that the 4-factor model fit adequately with the remaining 30 items. High internal consistency was found for the overall scale (α = .77, .78) and for the 4 resulting subscales: Affect (α = .88, .87), Cognition (α = .92, .90), Behavior (α = .88, .88), and Calm (α = .90, .89). CONCLUSIONS/IMPLICATIONS: This study modified the MAS to assess attitudes toward persons with disabilities in Colombia. The adequate reliability and fit of the factor structure of the Spanish MAS suggests that it holds promise to help researchers investigate attitudes toward persons with disabilities in Latin America, an important topic to the global disability community.

Perfil multidimensional de personas que han realizado intento de suicidio / Multidimensional profile of people who have attempted to commit suicide

Establecer el perfil multidimensional de personas con intento de suicidio. Seestudiaron 116 personas reportadas con intento de suicidio en servicios de urgenciase instituciones educativas del departamento del Huila. Diseño descriptivo; conentrevista semi-estructurada, prueba de personalidad, inventario de depresión,evaluación de alcoholismo, evaluación de ideación e intento de suicidio. Elperfil multidimensional se caracterizó: adolescentes rurales, adultos citadinos;son de consideración: ama de casa, con relación de pareja estable, y personassolas, divorciadas, desempleadas. La relación neuroticismo bajo y piscoticismoalto podría ayudar a explicar que el intento de suicidio haya sido realizado de“repente” sin existir ningún síntoma previo. La estructura y dinámica familiardisfuncional están altamente asociadas a la persona con intento de suicidio.

The purpose of this study is to establish a multidimensional profile of peoplewho have attempted to commit suicide. 116 cases of people with reported suicideattempts in emergency rooms and educational institutions in the department ofHuila were studied. This was a descriptive study, with a semi-structured interview,personality test, depression inventory, alcohol evaluation, ideation and suicideattempt evaluations. The multidimensional profile consisted of adolescents fromrural areas, city-dwelling adults, also taking into account housewives with stablerelationships, single, divorced and unemployed persons. The relationship betweenlow neuroticism and high psychoticism could help to explain ‘unexpected’suicide attempts without previous symptoms. The structure and dynamics ofdysfunctional families are strongly associated with suicide attempts.

Estabelecer o perfil multidimensional de pessoas com tentativa de suicídio.Se estudaram 116 pessoas reportadas com tentativa de suicídio em serviços deurgências e instituições educativas do departamento do Huila. Foi um estudodescritivo, com uma entrevista semi-estruturada, teste personalidade, o inventariode depressão, avaliações do álcool, da ideação suicida e tentativa de suicidio.O perfil multidimensional se caracterizou: adolescentes rural, adultos citadinos;são de consideração dona de casa, com relação de casal estável; e pessoas sós,divorciadas, desempregadas. A relação neuroticismo baixo e piscoticismo alto,poderia ajudar a explicar que a tentativa de suicídio tenha sido realizado de“repente” sem existir nenhum sintoma prévio. A estrutura e dinâmica familiardisfuncional estão altamente associadas à pessoa com tentativa de suicídio.