Melbourne School of Psychological Sciences - Theses
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ItemAdjustment in life after traumatic brain injury: the impact of cognition, employment, and perceived sense of purpose in life( 2013)Traumatic brain injury (TBI) affects the most wide-ranging domains of survivors’ lives, markedly reducing emotional health and quality of life. The primary objective of this study was to explore the widely proclaimed therapeutic effect of employment on psychological wellbeing (PWB) and quality of life (QoL) relative to perceived sense of purpose in life (PIL). An additional aim was to examine the influence of factors involving cognitive function, injury severity, age at time of injury, gender, and preinjury education, on survivors’ work ability and return to work (RTW). A mixed methods design was used for an in-depth and comprehensive understanding about adjustment in life post-TBI. Method: Participants (N=40; 10-18 months post-TBI) were grouped according to age: 18-39 years (younger group), 40-55 years (older group) and injury severity (Glasgow Coma Scale scores): mild TBI (n=25), moderate-severe TBI (n=15). Quantitative Component: Neuropsychological testing and questionnaire surveys were performed to evaluate participants’ cognitive function, levels of perceived work gainfulness, PIL, PWB, and QoL. Data was analysed using bivariate and multivariate analyses of variance, aided by SPSS computer software. Qualitative Component: 12 participants (6 from each severity group) were randomly selected for digitally recorded semi-structured interviews, predominantly concerning the impact of work and life meaningfulness on adjustment process. Interviews were analysed using grounded theory methodology, aided by NVivo 10 computer package. Results and Discussion: PIL, in comparison to employment, cognitive function, and injury severity, made the strongest unique contribution in explaining PWB and QoL (p < 0.001). Employment potential was largely affected by memory and injury severity, with increased memory deficits (p < 0.01) and injury severity (p < 0.05) respectively associated with deteriorated employment potential. Main Conclusion: Having a strong sense of life as purposeful, notwithstanding employment, cognitive function, and injury severity, encourages survivors to focus on their lives and important life goals and to ultimately, achieve a promising life with healthy wellbeing.
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ItemSpeaking for themselves: how do adolescents define their quality of life after a traumatic brain injury?( 2013)Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in young people (Yeates et al., 2002). The status of quality of life (QoL) in paediatric TBI is mixed. Our recent meta-analysis of paediatric QoL (Di Battista et al., 2012) found that good QoL outcomes are contingent on milder injuries, proxy reporting and early assessment whereas poor outcomes reflect more severe injuries and later assessment. Available paediatric QoL data is largely based on the health-related quality of life (HRQoL) paradigm; where a good outcome is contingent on what one can accomplish or achieve, as assessed by proxies. Information on the subjective well-being (SWB) component of QoL is limited. When estimating the HRQOL in adolescents, the presence of anxiety and depression and the quality of social relationships are important considerations, because adolescents are entrenched in social development during this phase of maturation. The influence of anxiety, depression and loneliness on HRQOL in adolescent survivors of TBI has not been documented. The goal of this study was to explore the adolescent experience of quality of life, anxiety, depression and loneliness after a traumatic brain injury. This study is a mixed-methods assessment of the impact of mood states and loneliness on quality of life (QoL) in adolescents who have survived a traumatic brain injury (TBI). METHOD: mixed method/cohort pilot study (11 adolescents, mild to severe TBI; 9 parents), using self-report (anxiety, depression, HRQoL, loneliness) and proxy-report measures (anxiety, depression and HRQoL) and clinical psychiatric interviews (adolescent only). The adolescent experience of these states is not accurately reflected by parental proxy. Self-reported depression and age at injury were associated with health-related quality of life outcomes, while anxiety was not. Severity of injury was not related to secondary outcomes. Adolescent narratives revealed that having experienced a TBI does not a priori impact upon perceived QoL. The impact of a TBI on QoL could be positive or negative. Post-injury changes in ability were not always attributed to the injury, but rather to a sense of normal age-related changes as identified by the adolescent. Changes as a result of the injury were not always considered important to the adolescent’s view on QoL. Adolescents identified social and inter-personal discrepancies and the emotional consequences of these discrepancies. Ultimately, the individual’s appraisal of their identity from pre to post injury life related to their current sense of well-being. Friendships were very important considerations for post-injury well-being. Processes of post-traumatic growth were identified in the adolescent narrative. The findings of this study are novel and have important implications for both research study design and clinical care settings involving adolescent survivors of a TBI.