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.
To examine the relationship between service member/veteran (SM/V) traumatic brain injury (TBI) severity with caregiver health-related quality of life (HRQOL).
Military treatment facility.
Caregivers ...( N = 316) of SM/Vs following a TBI divided into 2 groups based on SM/V TBI severity: (1) caregivers of SM/Vs following an uncomplicated mild TBI (UnMTBI Caregiver group, n = 246), and (2) caregivers of SM//Vs following a complicated mild, moderate, severe, or penetrating TBI (STBI Caregiver group, n = 70). The STBI Caregiver group was further divided into 2 subgroups: Parent ( n = 21) versus Intimate Partner ( n = 49). The UnMTBI Caregiver group consisted of intimate partners.
Prospective cohort.
Caregivers completed 15 HRQOL measures.
Using analysis of variance and chi-square analysis, the UnMTBI Caregiver group reported worse scores on 12 HRQOL measures and more clinically elevated scores for 6 of 15 comparisons than the STBI Caregiver group. The UnMTBI Caregiver group also reported worse scores on 10 HRQOL measures than intimate partners in the STBI Caregiver group and 5 measures than parents in the STBI Caregiver group. Parents reported worse scores on 3 measures than intimate partners in the STBI Caregiver group. The UnMTBI Caregiver group reported more clinically elevated scores for 7 of 15 comparisons than intimate partners in the STBI Caregiver group.
Intimate partner caregivers of an SM/V following a remote uncomplicated MTBI reported worse HRQOL than intimate partners and parent caregivers of an SM/V following a more severe TBI, mostly likely due to SM/V physical and mental health comorbidities. Interventions that focus on the SM/V's TBI and other comorbidities, the caregiver's behavioral health problems, and the relationship and family factors that interact with each other will likely have the most success in improving individual and family outcomes for military families.
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.
This study examined relationship satisfaction and health‐related quality of life (HRQOL) among spouse caregivers assisting service members and veterans (SMV) with comorbid uncomplicated mild ...traumatic brain injury (MTBI) and post‐traumatic stress disorder (PTSD). Spouse caregivers (N = 205) completed the Couples Satisfaction Index (CSI), 12 HRQOL measures, and the Mayo‐Portland Adaptability Inventory 4th Edition (MPAI‐4). T‐scores were classified as “clinically elevated” using a cutoff of ≥60T. The sample was also classified into “Satisfied” (≥13.5, n = 113, 55.0%) or “Dissatisfied” (<13.5, n = 92, 44.0%) relationship categories. Using stepwise regression analysis, Anxiety, Family Disruption, Vigilance, Emotional Support, Feeling Trapped, and MPAI‐4 Adjustment were identified as the strongest predictors of CSI total scores (p < 0.001), accounting for 41.6% of the variance. Squared semi‐partial correlations revealed that 18.1% of the variance was shared across all six measures, with 7.8% to 1.5% of unique variance accounted for by each measure separately. When comparing the number of clinically elevated measures simultaneously, the Dissatisfied group consistently had a higher number of clinically elevated scores compared to the Satisfied group (e.g., 3‐or‐more clinically elevated scores: Dissatisfied = 40.2%, Satisfied = 8.8%, OR = 6.93, H = 0.76). Caring for a SMV with comorbid TBI and PTSD can have a profound impact on the spouse caregiver's HRQOL, relationship satisfaction, and family functioning. The findings from the current study continue to support the need for family involvement in the SMV’s treatment plan, but more effort is needed to integrate behavioral health treatment that focuses on the family member's own issues into military TBI and PTSD systems of care.
Resumen
En este estudio se analizó la satisfacción con la relación y la calidad de vida relacionada con la salud entre cónyuges cuidadores que asisten a miembros del servicio militar y veteranos con lesión cerebral traumática leve sin complicaciones concomitante con trastorno por estrés postraumático. Los cónyuges cuidadores (N=205) completaron el Índice de satisfacción de las parejas (Couples Satisfaction Index, CSI), la Encuesta de 12 ítems sobre la calidad de vida relacionada con la salud (12 HRQQL) y la Encuesta de Adaptabilidad Mayo‐Portland 4.ª edición (Mayo‐Portland Adaptability Inventory 4th Edition, MPAI‐4). Los puntajes T se clasificaron en “clínicamente elevados” usando un valor de corte de ≥60T. La muestra también se clasificó en categorías de relaciones “satisfechas” (>13.5, n=113, 55.0%) o “insatisfechas” (<13.5, n=92, 44.0%). Utilizando un análisis de regresión paso a paso, se identificaron la ansiedad, la interrupción familiar, la vigilancia, el apoyo emocional, la sensación de estar atrapado y la adaptación de la MPAI‐4 como los factores pronósticos más fuertes de los puntajes totales del CSI (p<.001), que representaron el 41.6% de la varianza. Las correlaciones semiparciales al cuadrado revelaron que el 18.1% de la varianza se compartió entre las seis medidas, con una varianza única de 7.8% a 1.5% representada por cada medida separadamente. Cuando se comparó el número de medidas clínicamente elevadas de manera simultánea, el grupo insatisfecho tuvo sistemáticamente un número más alto de puntajes clínicamente elevados en comparación con el grupo satisfecho (p. ej.: 3 o más puntajes clínicamente elevados: insatisfecho=40.2%, satisfecho=8.8%, OR=6.93, H=.76). cuidar a un miembro del servicio militar o a un veterano con lesión cerebral traumática leve y trastorno por estrés postraumático concomitantes puede afectar enormemente la calidad de vida relacionada con la salud del cónyuge cuidador, la satisfacción con la relación y el funcionamiento familiar. Los resultados del presente estudio continúan respaldando la necesidad de la participación familiar en el plan de tratamiento del miembro del servicio militar o veterano, pero se necesita más esfuerzo para integrar un tratamiento de salud conductual que se centre en los problemas propios del familiar en los sistemas de atención de militares con lesión cerebral traumática leve y trastorno por estrés postraumático.
摘要
本研究考察了协助共病无并发症的轻度创伤性脑损伤 (MTBI) 和创伤后应激障碍 (PTSD) 的军人和退伍军人 (SMV) 其配偶照顾者的关系满意度和健康相关生活质量 (HRQOL) 。配偶照顾者 (N=205) 完成了夫妻满意度指数 (CSI) 、12项HRQOL测量, 以及MAYO‐PORTLAND适应性问卷第四版 (MPAI‐4) 。TSCORES以≥60T为分界点被分为 "临床升高"。样本还被分为 "满意" (>13.5, N=113, 55.0%) 或 "不满意" (<13.5, N=92, 44.0%) 关系类别。通过逐步回归分析, 焦虑、家庭干扰、警惕性、情感支持、被困感和MPAI‐4适应被确定为CSI总分的最强的预测因素 (p<0.001), 占总方差的41.6%。平方半偏相关显示, 18.1%的方差在所有六项测量中共享, 7.8%至1.5%的独特方差由每项测量单独解释。当同时比较临床升高的次数时, 不满意组的临床升高评分始终高于满意组(例如, 3分或3分以上的临床升高评分:不满意=40.2%, 满意=8.8%, OR=6.93, H=.76)。照顾患有创伤性脑损伤和创伤后应激障碍的SMV对配偶照顾者的HRQOL、关系满意度和家庭功能有深远的影响。目前的研究结果继续支持家庭参与SMV治疗计划的必要性, 但需要更多的努力, 将关注家庭成员自身问题的行为健康治疗整合到军事创伤性脑损伤和创伤后应激障碍的护理系统中。
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.
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)
