Author ORCID Identifier


Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Dr. Paul Perrin

Second Advisor

Dr. Chelsea Williams

Third Advisor

Dr. Bruce Rybarczyk

Fourth Advisor

Dr. Natalie Dautovish

Fifth Advisor

Dr. Scott McDonald



Traumatic brain injury (TBI) is the greatest global contributor to death and disability among all trauma-related injuries. The leading causes of TBI globally are road traffic injuries/violence and as violence is a principle cause of death in Latin America, TBI in that region is a pressing public health and medical problem. Comorbid presentations of mental health disorders is common among TBI patients. TBI results in permanent and transient types of impairment impacting patient health related quality of life (HRQL) post-injury. In TBI patients, sense of coherence (SOC) focuses on successful personal coping and contributes to psychosocial functioning. In order to more fully understand the psychosocial adjustment process in TBI including comorbid mental health concerns and health related quality of life in Latin America, it is important to incorporate cultural values including family-based variables. TBI not only affects the patient but the entire family system, and rehabilitation outcomes for TBI patients are closely associated with family functioning. Although rehabilitation from TBI is a source of prolonged stress on the patient and their family, understanding the impact of family dynamics, salient in Latin American families with TBI, on patient mental and physical HRQL through patients’ SOC is imperative. Thus, the purpose of the current study was to examine the relationships among healthy family dynamics, SOC, and mental and physical HRQL among a sample of TBI patients across three sites and two countries in Latin America over the first four months after injury. The secondary aim was to examine if family functioning over time is found to impact TBI patients’ SOC and HRQL more than the reverse causal direction. A sample of 109 TBI patients from Mexico and Colombia were recruited. A series of longitudinal mediation and cross-lag panel analyses were run in order to test the study’s research questions. Mental and physical HRQL were positively associated with each other, as well as healthy family dynamics and SOC. Congruent with hypotheses, SOC partially mediated the effects of healthy family dynamics on both mental and physical HRQL. Family dynamics showed larger cross-lag relationships with SOC going from 2 months to 4 months than SOC to family dynamics over the same intervals. Similarly, SOC showed larger cross-lag relationships with both mental and physical HRQL going from baseline to 2 months than mental and physical HRQL to SOC. Results from this study provide empirical support for the importance of family-systems approaches to TBI rehabilitation services in Latin America, as improved family functioning may exert salubrious effects on SOC and mental and physical HRQL.


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Available for download on Saturday, March 04, 2220