Purpose
To examine change in health-related quality of life (HRQOL) during the COVID-19 pandemic in caregivers of service members/veterans (SMVs) with traumatic brain injury (TBI), by comparing HRQOL ...during the first year of the pandemic to HRQOL 12 months pre-pandemic.
Methods
Caregivers (
N
= 246) were classified into three COVID-19 Pandemic Impact groups based on impact ratings of the pandemic on HRQOL: No Impact (
n
= 50), Mild Impact (
n
= 117), and Moderate-Severe Impact (
n
= 79). Caregivers completed 19 measures across physical, social, caregiving, and economic HRQOL domains, and a measure of SMV Adjustment. T-scores were used to determine individual symptom trajectories for each measure as follows: Asymptomatic (pre + during < 60 T); Developed (pre < 60 + during ≥ 60 T); Improved (pre ≥ 60 T + during < 60 T); and Persistent (pre + during ≥ 60 T).
Results
Using ANOVA, during the pandemic, the Moderate-Severe Impact group reported worse scores on 19 measures (
d
= 0.41–0.89) compared to the No Impact group and 18 measures (
d
= 0.31–0.62) compared to the Mild Impact group (
d
= 0.31–0.38). The Mild Impact group reported worse scores on two measures compared to the No Impact group (
d
= 0.42–0.43). Using the entire sample, the majority of HRQOL measures were classified as Asymptomatic (47.2–94.7%), followed by Persistent (2.4–27.2%). Few were classified as Developed (0.4–12.6%) or Improved (2.4–13.8%). Using repeated measures ANOVA, no meaningful effects sizes were found for mean scores on all measures completed pre-pandemic compared to during the pandemic (
d
≤ 0.17).
Conclusion
The vast majority of caregivers reported stability in HRQOL pre-pandemic compared to during the pandemic. The COVID-19 pandemic was not associated with a high prevalence of decline in caregiver HRQOL.
PURPOSETo examine a the association of caregiver health-related quality of life (HRQOL) and service member/veteran (SMV) neurobehavioral outcomes with caregiver resilience; b longitudinal change in ...resilience at the group and individual level; and c the magnitude of change at the individual level.METHODSCaregivers (N = 232) of SMVs with traumatic brain injury completed a resilience measure, and 18 caregiver HRQOL and SMV neurobehavioral outcome measures at a baseline evaluation and follow-up evaluation three years later. Caregivers were divided into two resilience groups at baseline and follow-up: 1 Low Resilience (≤ 45 T, baseline n = 99, follow-up n = 93) and 2 High Resilience (> 45 T, baseline n = 133, follow-up n = 139).RESULTSAt baseline and follow-up, significant effects were found between Low and High Resilience groups for the majority of outcome measures. There were no significant differences in resilience from baseline to follow-up at the group-mean level. At the individual level, caregivers were classified into four longitudinal resilience groups: 1 Persistently Low Resilience (Baseline + Follow-up = Low Resilience, n = 60), 2 Reduced Resilience (Baseline = High Resilience + Follow-up = Low Resilience, n = 33), 3 Improved Resilience (Baseline = Low Resilience + Follow-up = High Resilience, n = 39), and 4 Persistently High Resilience (Baseline + Follow-up = High Resilience, n = 100). From baseline to follow-up, approximately a third of the Reduced and Improved Resilience groups reported a meaningful change in resilience (≥ 10 T). Nearly all of the Persistently High and Persistently Low Resilience groups did not report meaningful change in resilience (< 10 T).CONCLUSIONResilience was not a fixed state for all caregivers. Early intervention may stall the negative caregiving stress-health trajectory and improve caregiver resilience.
Purpose
To examine factors related to resilience in military caregivers across caregiver health-related quality of life (HRQOL), caregiver sociodemographic variables, and service member/veteran (SMV) ...injury and health status.
Methods
Caregivers (
N
= 346, Female = 96.2%; Spouse = 91.0%; Age:
M
= 40.6 years, SD = 9.3) of SMVs following a mild, moderate, severe, or penetrating TBI were recruited from U.S. military treatment facilities and via community outreach. Caregivers completed select TBI-CareQOL and NIH Toolbox scales, the Caregiver Appraisal Scale, Caregiver Questionnaire, and Mayo-Portland Adaptability Inventory-4. Caregivers were divided into three groups using the TBI-QOL Resilience scale: (1) Low-Moderate Resilience (
n
= 125), (2) Moderate Resilience (
n
= 122), and (3) Moderate-High Resilience (
n
= 99).
Results
Factors related to low caregiver resilience were strain on employment, financial burden from out-of-pocket expenses, caring for children, less personal time, caring for both verbal and physical irritability, anger, and aggression, and lower SMV functional ability (all
p
’s < .05). The Low-Moderate Resilience group had consistently worse HRQOL scores compared to the Moderate and Moderate-High Resilience groups (
p
s < .001;
d
= .50–1.60), with the exception of Caregiving Ideology.
Conclusion
Lower resilience among caregivers of SMVs following TBI is associated with poorer caregiver HRQOL. Programs aimed at promoting and maintaining resilience in military caregivers long-term is important for their own health, the health of the SMV, and the health of their children.
Objective: The current study examines health-related quality of life (HRQOL) and family functioning in a sample of spouse caregivers assisting post-9/11 service members and veterans (SMV) following ...traumatic brain injury (TBI). Method: Participants were 316 spouse (and partner) caregivers of SMVs following a mild, moderate, severe, or penetrating TBI. Caregivers completed the Family Assessment Device General Functioning subscale, 24 HRQOL questionnaires, and the Mayo-Portland Adaptability Inventory (4th ed.; MPAI-4). The sample was divided into two family functioning groups: Healthy Family Functioning (HFF; n = 162) and Unhealthy Family Functioning (UFF; n = 154). Scores on HRQOL measures that generate T scores using normative data were classified as "clinically elevated," using a cutoff of >60T. Results: Compared with the HFF group, caregivers in the UFF group reported worse scores on all HRQOL measures and worse SMV functional ability on the MPAI-4 Adjustment Index and Anxiety, Depression, and Irritability/Anger/Aggression items (all ps < .001, ds = .41-1.36). A significantly higher proportion of the UFF group had clinically elevated HRQOL scores compared with the HFF group on the majority of measures (Hs = .24-.75). When examining all HRQOL measures simultaneously, the UFF group consistently had a significantly higher cumulative percentage of clinically elevated scores compared with the HFF group (e.g., ≥5 clinically elevated scores: UFF = 53.9% vs. HFF = 22.2%; H = .68). Conclusions: Caring for a SMV following TBI with comorbid mental health problems may have negative implications for their family functioning and the caregiver's HRQOL. Family-centered interventions could be beneficial for military families experiencing distress following SMV TBI and mental health comorbidity.
Clinical Impact StatementClose to one in two spouse caregivers assisting service members and veterans (SMVs) following traumatic brain injury reported unhealthy family functioning. Unhealthy family functioning was related to worse caregiver health-related quality of life (HRQOL), whereas healthy family functioning was associated with factors that may mitigate poor HRQOL. Despite increasing evidence of the burden of caregiving, military policy continues to mandate that family services may only be provided in support of the SMV treatment plan. Money spent on caregiver and family-focused programs might improve outcomes for military families and could be achieved at a relatively modest cost with focused goals.
The purpose of this study was to examine long-term neurobehavioural symptom reporting following mild, moderate, severe, or penetrating TBI in U.S. military service members and veterans (SMV). ...Participants were 445 SMVs divided into four groups: 158 uncomplicated mild TBI ("unMTBI" group), 105 penetrating, severe, moderate, or complicated mild TBI ("smcTBI" group), 101 injured controls (IC), and 81 non-injured controls (NIC). Two independent cohorts were examined that included participants 5-years or 10-year post-injury. Participants completed the TBI-Quality of Life, Neurobehavioural Symptom Inventory, and Post-traumatic Stress Disorder Checklist. At 5-years and 10-years post-injury, there were significant main effects for the majority of measures (all p's < .005). At 10-years post-injury, the NIC group had consistently better scores compared to the IC, unMTBI, and smcTBI groups. At 5-years post-injury, either (a) the IC and NIC group had better scores compared to both TBI groups, or (b) the NIC group had better scores compared to the IC, unMTBI, and smcTBI groups. A high proportion of SMVs reported poor long-term neurobehavioural symptoms following TBI or bodily injury without TBI. Injured SMVs (regardless of injury type) can have long-term symptoms that impact mental health and overall quality of life requiring long-term follow-up and care.
STUDY OBJECTIVESTo examine the relationship between caregiver sleep impairment and/or service member/veteran (SMV) adjustment post-traumatic brain injury, with caregiver health-related quality of ...life (HRQOL).METHODSCaregivers (n = 283) completed 18 measures of HRQOL, sleep impairment, and SMV adjustment. Caregivers were classified into 4 sleep impairment/SMV adjustment groups: 1) Good Sleep/Good Adjustment (n = 43), 2) Good Sleep/Poor Adjustment (n = 39), 3) Poor Sleep/Good Adjustment (n = 55), and 4) Poor Sleep/Poor Adjustment (n = 146).RESULTSThe Poor Sleep/Poor Adjustment group reported significantly worse scores on most HRQOL measures and a higher prevalence of clinically elevated T-scores (≥ 60T) on the majority of comparisons compared to the other 3 groups. The Good Sleep/Poor Adjustment and Poor Sleep/Good Adjustment groups reported worse scores on the majority of the HRQOL measures and a higher prevalence of clinically elevated scores on 7 comparisons compared to the Good Sleep/Good Adjustment group. Fewer differences were found between the Good Sleep/Poor Adjustment and Poor Sleep/Good Adjustment groups. The Poor Sleep/Poor Adjustment group reported a higher prevalence of severe ratings for SMV Irritability, Anger, and Aggression compared to the Good Sleep/Poor Adjustment group.CONCLUSIONSWhile the presence of either caregiver sleep impairment or poor SMV adjustment singularly was associated with worse caregiver HRQOL, the presence of both sleep impairment and poor SMV adjustment was associated with further impairment in HRQOL. Caregivers could benefit from sleep intervention. Treatment of SMVs neurobehavioral problems may improve the SMV's recovery and lessen sleep problems, distress, and burden among their caregivers.CITATIONBrickell TA, Wright MM, Sullivan JK, et al. Caregiver sleep impairment and service member and veteran adjustment following traumatic brain injury is related to caregiver health-related quality of life. J Clin Sleep Med. 2022;18(11):2577-2588.
This study examined pediatric health-related quality of life (HRQOL) in families in which one parent was a service member or veteran (SMV) with traumatic brain injury (TBI) and the second parent was ...providing caregiving support to the SMV. Intimate partner caregivers (
N
= 168) of SMVs completed measures of HRQOL, SMV adjustment, and five parent proxy pediatric HRQOL measures for 350 children (M = 1.9 per caregiver). Caregivers were classified into four caregiver distress/SMV adjustment groups: 1 No Distress/Good Adjustment (
n
= 43, children = 79); 2 No Distress/Poor Adjustment (
n
= 19, children = 35); 3 High Distress/Good Adjustment (
n
= 18, children = 41); and 4 High Distress/Poor Adjustment (
n
= 88, children = 195). The High Distress/Good Adjustment and High Distress/Poor Adjustment groups reported worse scores on all pediatric HRQOL measures and a higher cumulative prevalence of clinically elevated scores (≥60 T) compared to the No Distress/Good Adjustment group; and on most comparisons compared to the No Distress/Poor Adjustment group. Fewer differences were found between the No Distress/Poor Adjustment and No Distress/Good Adjustment groups. There were no significant differences between the High Distress/Good Adjustment and High Distress/Poor Adjustment groups. Many caregivers reported clinically elevated scores on all five pediatric HRQOL measures in the total sample (23.1–53.7%) and in a 15 to 17-year-old subsample (23.6–61.1%). While poor SMV adjustment was associated with worse pediatric HRQOL, caregiver distress was associated with further impairment in pediatric HRQOL. Children of SMVs with neurobehavioral problems post-TBI and caregivers of SMVs experiencing high distress, may require intervention and long-term monitoring into adulthood.
Highlights
This study examined pediatric health-related quality of life (HRQOL) in families in which one parent was a service member or veteran (SMV) with traumatic brain injury (TBI) and the second parent was providing caregiving support to the SMV.
Over half the children were living in a military caregiving home with both parents experiencing high distress.
SMV distress was associated with worse HRQOL in their children. Caregiver distress was associated with further impairment in their children’s HRQOL.
Negative childhood health outcomes were on a trajectory to persist into adulthood.
Lung cancer represents a major worldwide health concern; although advances in patient management have improved outcomes for some patients, overall 5-year survival rates are only around 15%.
studies ...and mouse models are commonly used to study lung cancer and their use has increased the molecular understanding of the disease. Unfortunately, mouse models are poor predictors of clinical outcome and seldom mimic advanced stages of the human disease. Animal models that more accurately reflect human disease are required for progress to be made in improving treatment outcomes and prognosis. Similarities in pulmonary anatomy and physiology potentially make sheep better models for studying human lung function and disease. Ovine pulmonary adenocarcinoma (OPA) is a naturally occurring lung cancer that is caused by the jaagsiekte sheep retrovirus. The disease is endemic in many countries throughout the world and has several features in common with human lung adenocarcinomas, including histological classification and activation of common cellular signaling pathways. Here we discuss the
and
OPA models that are currently available and describe the advantages of using pre-clinical naturally occurring OPA cases as a translational animal model for human lung adenocarcinoma. The challenges and options for obtaining these OPA cases for research purposes, along with their use in developing novel techniques for the evaluation of chemotherapeutic agents or for monitoring the tumor microenvironment in response to treatment, are also discussed.
Purpose/Objective: To examine health-related quality of life (HRQOL) in caregivers when providing care and no longer providing care to service members/veterans with traumatic brain injury. Research ...Method/Design: Participants included 466 caregivers enrolled in a 15-year longitudinal study. During an annual follow-up evaluation, a subsample of caregivers self-identified as no longer providing care and were retained in the study as a No Longer Caregiving group (n = 48). Scores on HRQOL measures when providing care (baseline) and no longer providing care (follow-up) were examined. Scores on HRQOL measures were also compared with the remaining 418 caregivers (Caregiving group). Results: The most frequent reasons for no longer caregiving were no longer being in a relationship with the SMV and the SMV had recovered/no longer required care. The No Longer Caregiving group at follow-up reported better scores on five measures compared to baseline, and three measures compared to the Caregiving group. There were no differences in the proportion of clinically elevated scores on HRQOL measures for the No Longer Caregiving group between baseline and follow-up. Compared to the Caregiving group, the No Longer Caregiving group reported a higher prevalence of clinical elevated scores on General Life Satisfaction at baseline and follow-up, and worse scores on Caregiving Relationship Satisfaction and the Couples Satisfaction Index at baseline. Conclusions/Implications: While some improvement in HRQOL was noted when caregivers were no longer providing care, many continued to report elevated scores. Services and supports are required for caregivers when providing care, but also when transitioning out of a caregiving role.
Impact and Implications
Many caregivers of service members and veterans (SMVs) with traumatic brain injury and comorbidities reported poor health-related quality of life (HRQOL). Over the first year of transitioning from providing care to no longer providing care, there was some improvement in scores on HRQOL measures. However, many participants continued to report clinically elevated HRQOL scores. Services and supports are required to help caregivers not only when they are in a caregiving role, but also when transitioning to no longer caregiving. Preparing military families with coping skills to help adapt to change and adversity related to deployment and combat-related physical and mental health conditions may help moderate or mediate the strength of the negative association of caregiving with HRQOL. Military caregivers may also benefit from couples therapy to improve relationship satisfaction, psychoeducation on TBI and mental health comorbidity, cognitive reframing of negative perceptions, and strategies to enhance sleep and social participation.
Objective: To examine elevated symptoms on health-related quality of life (HRQOL) measures over 2 years in caregivers of service members with traumatic brain injury (TBI). To compare outcomes to ...caregivers of veterans. Method: Caregivers ( N = 315) were classified into two groups: (a) service member caregiver group ( n = 55) and (b) veteran caregiver group ( n = 260). Caregivers completed 17 HRQOL measures at a baseline evaluation and follow-up evaluation 24 months later. Results: In the service member caregiver group, the highest frequency of clinically elevated T-scores (≥ 60 T) at baseline and follow-up were found on physical and psychological HRQOL measures (16.4%–30.9%). A higher proportion of the veteran caregiver group had clinically elevated scores on nine measures at baseline and seven measures at follow-up. Examining the number of clinically elevated scores simultaneously across all 17 measures, the service member caregiver group had multiple elevated scores (e.g., 4 or more: baseline = 25.5%, follow-up = 27.3%). A higher proportion of the veteran caregiver group had multiple clinically elevated scores for 13 comparisons at baseline ( h = .35–.82), but reduced to eight comparisons at follow-up ( h = .36–.63). In the service member caregiver group, the proportion of caregivers with clinically elevated scores at baseline and follow-up was equally dispersed across persistent and newly developed symptoms, but higher for persistent symptoms compared to developed symptoms in the veteran caregiver group. Conclusions: Many caregivers of service members reported clinically elevated scores across HRQOL domains and the prevalence increased over 2 years. More services for caregivers in the Department of Defense may be helpful in reducing the trajectory of newly developed symptoms long term. (PsycInfo Database Record (c) 2024 APA, all rights reserved) (Source: journal abstract)
PDF
