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An exploration of the psychological well-being and relationship quality of partners and spouses after acquired brain injury

Whelan, Anne; (2004) An exploration of the psychological well-being and relationship quality of partners and spouses after acquired brain injury. Doctoral thesis (D.Clin.Psy), UCL (University College London). Green open access

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Historically, the acquired brain injury (ABI) literature has tended to address the negative outcomes of spouses and caregivers. As a result, the area of positive functioning, or 'flourishing', has been neglected. The field has also tended to focus on psychological outcomes to the exclusion of understanding relationships, particularly between spouses or partners, after ABI. The effect of 'awareness of deficit', a common consequence of ABI, on partners or spouses is also relatively unexplored. This study was intended to bridge these gaps. It aimed to explore the positive Psychological Well-Being (PWB) of partners of persons with ABI; the nature of the couple relationship; and what factors affect these outcomes. The sample consisted of 46 partners of patients with acquired non-progressive brain injury (traumatic brain injury, 50%; cerebrovascular accident, 37%; anoxia, 7%; infection, 4%; other, 2%) in the chronic phase of injury. Contacted through a neurorehabilitation unit and a charity, couples were required to complete postal questionnaires and partners, a follow up semi-structured telephone interview. Using three scales of Psychological Well-Being (e.g. Ryff, 1989), partners appeared able to achieve PWB in certain dimensions ('Personal Growth', PG; 'Positive Relations with Others', PR) but not others ('Environmental Mastery', EM). On the Dyadic Adjustment Scale (DAS; Spanier, 1976), certain relationship dynamics were also found to be preserved (cohesion, expression of affection) whilst others suffered (overall adjustment, consensus, satisfaction). About a third of the couple relationships were considered 'poorly adjusted' by commonly used cut-offs. The trend was for partners to be less satisfied with their relationship with the injured person now compared to before the injury, although a minority was more satisfied. Lower patient current functioning (particularly in activities of daily living; Patient Competency Rating Scale, PCRS) emerged as predictive of better partner PWB in one dimension (EM) although no brain injury factor was predictive of other dimensions (PG, PR). Similarly, more severe patient neurobehavioural symptoms (Neurobehavioural Rating Scale, NRS; Levin et al, 1979; particularly 'somatic/anxiety' symptoms) and lower satisfaction with preinjury relationship were predictive of poorer current relationship quality. Awareness of deficit, length of time since injury and injury severity were predictive neither of PWB nor relationship quality. Those with children/adolescents at home had greater relationship cohesion but were no different in other aspects of the relationship and partner PWB. Length of time in relationship preinjury had no association with outcomes. In exploring impaired awareness of deficit, patients rated themselves as having significantly fewer deficits than partners rated them, and 'awareness' was more impaired for cognitive and behavioural than physical deficits. Awareness was not associated with time since injury or severity. The strengths and limitations of the study and the implications for theory, research, professional and clinical practice are discussed.

Type: Thesis (Doctoral)
Qualification: D.Clin.Psy
Title: An exploration of the psychological well-being and relationship quality of partners and spouses after acquired brain injury
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Thesis digitised by ProQuest.
Keywords: Psychology; Psychological well-being
URI: https://discovery.ucl.ac.uk/id/eprint/10099476
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