This paper presents a conceptual model describing the relationships between quality of life outcomes following traumatic brain injury (TBI), coping patterns, and beliefs regarding self-efficacy to assist health-care professionals in understanding the complexity of social and psychological sequelae of TBI. The mode hypothesizes that long-lasting cognitive, behavioural, emotional psychiatric, and interpersonal after-effects of TBI may create a real life 'learned helplessness' with consequent deficits in coping, and altered locus of control beliefs. As a result, TBI patients are at risk for developing self-limiting belief systems about their effectiveness in altering significant events that may result in over-generalizing the effects that TBI has in their day-to-day lives. Subsequently, a feedback loop may be set up where their beliefs in not being able to influence outcomes are not tested, life chances are further restricted, outcomes are suboptimal, and quality of life is reduced. The clinical and theoretical implications of this model are discussed, and an expanded model with future research directions is suggested.

Head injury frequently produces physical and psychological sequelae involving cognitive, behavioural, and personality disturbances which are chronic and perhaps even permanent. Clinically, it is apparent that the marital relationships of head injury patients face initial disruption as well as ongoing challenges in dealing with the physical, neuropsychological, and emotional changes post-injury. However, there is little empirical data to substantiate these observations. In this study, the marital relationships of 55 male head injury patients were assessed, based on the spouse's self-report obtained through interview and questionnaires. The sample was divided into three groups according to the severity of the injury: mild (N = 10), moderate (N = 25) and severe (N = 20). Based on a one-way multivariate analysis of variance, dyadic consensus, affectional expression, and overall dyadic adjustment were significantly lower for wives in the severe group than the moderate group. Affectional expression was also lower in the severe group than the mild group. Stepwise multiple regression analysis determined that 47% of the variance of overall dyadic adjustment could be accounted for by three variables (multiple R = 0.69, p less than 0.001). Dyadic adjustment was greater when wives reported a lower level of financial strain, perceived their spouse to have a relatively low level of general psychopathology or maladjustment, and when the injury was relatively mild based on GCS scores. The implications for intervention in rehabilitation at the marital level are highlighted.

Survival from significant closed head injury (CHI) is frequently associated with cognitive defects, physical impairment, personality change, interpersonal difficulty and, in general, some degree of social dependence. Here we report a multidimensional assessment of quality of life of a sample of 131 male head-injury patients suffering a range of severities of insult with specific emphasis on vocational outcome. Of those patients who sustained a severe injury and were employed full-time prior to the CHI, only 55% were able to return to this level of employment. No differences were found between the moderate and severe groups in pre- or post-CHI occupational status, as measured by the Blishen (1967) quantitative social economic index, although both groups declined from pre- to post-CHI. Lower post-CHI occupational status was associated with lower GCS on admission and longer lengths of post-traumatic amnesia, with patient self-report of physical, cognitive and psychosocial difficulties, including spousal reports of confusion, belligerance, verbal expansiveness and the decreased ability to perform socially-expected activities. Stepwise multiple regression analysis accounted for 38% of variance in post-injury vocational status, with lower pre-injury vocational status, greater age, high physical and psychological difficulties and lower admission Glasgow Coma Scale score variables forming the regression equation. Implications are discussed in terms of rehabilitation issues, including vocational programming and planning.

Cluster-analytic techniques were used to categorize coping strategies (CS) measured by the Ways of Coping--Revised Scale, and locus of control (LOC) beliefs measured by the Multidimensional Health Locus of Control Scale in 53 male traumatically brain-injured (TBI) persons. A cluster characterized by comparatively higher use of self-controlling and positive reappraisal CS and lower external LOC was associated with significantly lower mood disturbance and physical difficulties and a trend to be less depressed. The age of the neurologically injured patient and Taylor's (1983) cognitive adaptation theory may be important aspects of recovery from TBI and other neurological conditions.

This study examined the effects of coping strategies as moderators of long-term psychosocial and emotional adjustment following closed-head injury. Cluster analysis was used to separate 69 CHI patients into three clinically relevant groups on the basis of responses to the revised Ways of Coping questionnaire. The groups were then compared on a series of validation measures. There were no differences apparent between the three clusters in age, Glasgow Coma Scale score on admission to hospital, or in relatives' ratings of psychiatric symptomatology among the patients. However, the cluster characterized by a generally high use of a wide range of coping strategies had higher ratings of depression, as well as more psychosocial, cognitive and physical difficulties than the other groups. As with other chronic illnesses, it appears that the use of cognitive mechanisms that act as reality 'buffers' may be an important component of improved adjustment to closed-head injury.