Measuring emotional suppression in caregivers of adults with traumatic brain injury.

Objective: Caregivers of individuals with traumatic brain injury (TBI) often feel pressure to maintain the appearance that they are emotionally well adjusted, despite feelings to the contrary. Because there are currently no measures examining this construct, this article focuses on the development of a new measure that is specific to caregivers of people with TBI. Design: A total of 533 caregivers of civilians with TBI (n = 218) or service members/veterans (SMVs) with TBI (n = 315) completed 43 emotional suppression items, as well as other patient-reported outcomes and an estimate of the functional ability of the person with TBI. Results: Exploratory and confirmatory factor analyses supported the retention of 25 items. Graded response model (GRM) analyses and differential item functioning (DIF) studies supported the retention of 21 items in the final measure. Expert review and GRM calibration data were used to develop a 6-item static short form (SF) and program a computer adaptive test (CAT). Internal consistency was excellent for both the CAT and SF (reliabilities ≥ 0.91); 3-week test–retest stability was good (all intraclass correlations ≥ 0.89). Convergent validity was supported by moderate associations between TBI-CareQOL Emotional Suppression and related measures (rs from 0.47 to 0.59); discriminant validity was supported by small correlations between Emotional Suppression and positive aspects of caregiving and physical health (rs from 0.14 to 0.28). Known-groups validity was also supported. Conclusions: The new TBI-CareQOL Emotional Suppression CAT and 6-item short form is the first self-report measure of this construct in this population. Our findings suggest this new measure has strong psychometric properties.