Do spirituality, resilience and hope mediate outcomes among family caregivers after traumatic brain injury or spinal cord injury? A structural equation modelling approach

BACKGROUND:A deficits approach to understanding psychological adjustment in family caregivers of individuals with a neurological disability is extensive, but further research in the field of positive psychology (spirituality, resilience, hope) may provide a potential avenue for broadening knowledge of the family caregiver experience after traumatic brain injury (TBI) or spinal cord injury (SCI). OBJECTIVE:To test a proposed model of spirituality among family caregivers of individuals with TBI or SCI, using structural equation modelling (SEM). METHODS:A cross-sectional design was employed to survey ninety-nine family participants (TBI = 76, SCI = 23) from six rehabilitation units from NSW and Queensland. Assessments comprised Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale-Expanded, Connor –Davidson Resilience Scale, Herth Hope Index, and three measures of psychological adjustment including Caregiver Burden Scale, Positive and Negative Affect Scale, and Depression Anxiety Stress Scale. RESULTS:SEM showed the proposed model was a good fit. The main findings indicated spirituality had a direct negative link with burden. Spirituality had a direct positive association with hope which, in succession, had a positive link with resilience. Spirituality influenced positive affect indirectly, being mediated by resilience. Positive affect, in turn, had a negative association with depression in caregivers. CONCLUSIONS:This study contributes to better targeting strength-based family interventions.