Original article| Volume 94, ISSUE 2, P362-368, February 2013

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Moderated Mediation Path Analysis of Mexican Traumatic Brain Injury Patient Social Functioning, Family Functioning, and Caregiver Mental Health

Published:September 03, 2012DOI:



      To examine the system of connections among traumatic brain injury (TBI) patient social functioning, family functioning, and caregiver depression and burden in Mexico.


      Cross-sectional survey.


      A public medical facility.


      Mexican TBI patient-caregiver dyads (N=84) participated in this study. Most of the patients with TBI were men (81%), with an average age ± SD of 38.83±13.44 years. The majority of caregivers (86%) were women, with an average age ± SD of 51.74±11.29.


      Not applicable.

      Main Outcome Measures

      Outcomes assessed included family functioning (Family Satisfaction Scale), patient social functioning (Medical Outcomes Study 36-Item Short-Form Health Survey), and caregiver mental health (Patient Health Questionnaire-9 and Zarit Burden Interview).


      A moderated mediation path model found that patient social functioning and family functioning predicted caregiver burden, and caregiver burden mediated the effect of family functioning on caregiver depression. Caregivers with strong family functioning tended to have low burden, no matter the level of patient social functioning. This path model provided an excellent fit and explained 47% of the variance in caregiver burden and 36% of the variance in caregiver depression.


      In Mexico, strong family functioning is an important buffer in the relationship between TBI patient social functioning deficits and caregiver mental health, especially because familism is a core value in Latino culture. Rehabilitation interventions designed to strengthen family functioning may improve caregiver mental health, thereby influencing the quality of informal care that caregivers are able to provide.


      List of abbreviations:

      CFI (comparative fit analysis), FSS (Family Satisfaction Scale), IQR (interquartile range), RMSEA (root mean square error of approximation), SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey), TBI (traumatic brain injury), ZBI (Zarit Burden Interview)
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