Education regarding the impact of TBI on intimacy should be integrated into rehabilitation. Health professionals should be sensitized as to the needs that persons with TBI and their partners have regarding intimacy and how to make appropriate referrals to assist them.

This study examined individuals either personally or indirectly exposed to disaster and hypothesized that social involvement would differentially mediate the effect of exposure on the mental health of male and female victims. The study reinterviewed individuals previously interviewed just prior to disastrous floods and the discovery of unsafe levels of dioxin. Results indicated that males and females differ in their response to disaster exposure. Males showed increased symptoms of alcohol abuse and depression as a result of either personal, or both personal and indirect, exposure to disaster. In contrast, females' s]ymptomatology was not directly elevated by personal disaster exposure. Both sexes were sensitive to demands for support as a mediator of disaster effects. That is, victims both personally exposed to disaster and heavily relied upon by network members were far more likely to somatize (females) or abuse alcohol (males) than personally exposed individuals subject to more moderate network demands. Although excellent spouse support attenuated male symptomatology, its presence was associated with an exacerbation of symptoms in personally exposed females. Results suggest the importance of considering both the positive and negative consequences of social involvement because, for women in particular, very strong social ties may be more burdensome than supportive in times of extreme stress.