A Conceptual Model of Irritability Following Traumatic Brain Injury: A Qualitative, Participatory Research Study.

BACKGROUND: Individuals with a history of traumatic brain injury (TBI) may have chronic problems with irritability, which can negatively affect their lives. OBJECTIVES: (1) To describe the experience (thoughts and feelings) of irritability from the perspectives of multiple people living with or affected by the problem, and (2) to develop a conceptual model of irritability. DESIGN: Qualitative, participatory research. PARTICIPANTS: Forty-four stakeholders (individuals with a history of TBI, family members, community professionals, healthcare providers, and researchers) divided into 5 focus groups. PROCEDURES: Each group met 10 times to discuss the experience of irritability following TBI. Data were coded using grounded theory to develop themes, metacodes, and theories. MEASURES: Not applicable. RESULTS: A conceptual model emerged in which irritability has 5 dimensions: affective (related to moods and feelings); behavioral (especially in areas of self-regulation, impulse control, and time management); cognitive-perceptual (self-talk and ways of seeing the world); relational issues (interpersonal and family dynamics); and environmental (including environmental stimuli, change, disruptions in routine, and cultural expectations). CONCLUSIONS: This multidimensional model provides a framework for assessment, treatment, and future research aimed at better understanding irritability, as well as the development of assessment tools and treatment interventions.

Relational dimension of irritability following traumatic brain injury: a qualitative analysis.

BACKGROUND: Irritability is a common long-term sequelae of traumatic brain injury (TBI). In a prior study on TBI irritability, relational interactions were one of four dimensions of irritability occurrence and precipitation. This present analysis examines these same data in greater detail. METHODS: Fifty focus group transcripts from a study on irritability were re-analysed to examine: (1) irritability in spousal relationships following TBI, (2) retrospective accounts of spousal interactions contributing to irritability and (3) impact of irritability on marital relationships. Grounded Theory was used to develop themes, metacodes and theories. RESULTS: Several theories emerged regarding irritability with respect to spousal relations, all based on the overarching theory that irritability in people with TBI has a strong relational component involved in triggering, experiencing and preventing irritability. Sub-theories supporting this include: (1) irritability breeds further irritability, (2) spousal responses can trigger irritability among persons with TBI and vice versa, (3) difficulties making emotional connections may incite negative interactions, (4) expectations of others may contribute to irritable behaviour, and (5) communication breakdowns may provoke irritability. CONCLUSIONS: Irritability associated with TBI resides in the family system as well as the individual. In treating irritability one should include comprehensive assessment and assistance to improve interpersonal interactions.

Marital adjustment and stability following traumatic brain injury: a pilot qualitative analysis of spouse perspectives.

BACKGROUND: Traumatic brain injury (TBI), causing various impairments and functional changes, may adversely impact marital relationships. However, dynamics of the interactions that contribute to these marital difficulties are complex and poorly understood. There has been little research on marital quality and stability in families of a person with TBI. OBJECTIVE: By identifying themes of marital adjustment and stability, this qualitative exploratory study examines how a spouse who has experienced TBI affects the marital relationship. METHODS: Two gender-specific focus groups, each with 5 spouses of individuals living with the effects of TBI, were conducted to collect data on marital interactions that were analyzed for themes related to marital adjustment and stability. The data were analyzed using grounded theory, and then relational theories were applied as a framework for organizing the metacodes and concepts. RESULTS: This study suggests that, after TBI, changes in family dynamics and the way spouses perceive those dynamics affect movement toward pulling together or pulling apart. CONCLUSION: Changes in spousal perceptions, interactions, responsibilities, and reactions to brain injury may impact marital stability and satisfaction. Further study is warranted to better understand and determine whether and how awareness of these changes may be incorporated into treatment.