Relationship Stability After Traumatic Brain Injury Among Veterans and Service Members: A VA TBI Model Systems Study

Abstract

Objective To explore stability of relationships and predictors of change in relationship status two years following TBI/Polytrauma. Setting Five Department of Veterans Affairs Polytrauma Rehabilitation Centers (VA PRCs). Participants 357 active duty service members and Veterans enrolled in the VA PRCs Traumatic Brain Injury Model Systems (TBIMS) database with complete marital status information at two-year post-injury. Design Prospective, longitudinal, multi-site. Main Measures Relationship status change was defined as change in marital status (single/never married; married; divorced/separated) at 2-year follow-up, compared to status at injury. Results At the time of injury, 134 participants (38%) were single/never married; 151 (42%) were married, and 72 (20%) were divorced/separated. Of those married at enrollment, 78% remained married at Year 2 while 22% underwent negative change. Multivariable analyses revealed that age and education at the time of injury, and mental health utilization prior to injury, were significant predictors of relationship change. Among those who were single/divorced/separated at the time of injury, 87% remained so at Year 2 while 13% underwent positive change. Injury during deployment significantly predicted positive relationship change. Conclusions The unmalleable, pre-injury characteristics identified may be used as potential triggers for education, prevention, surveillance and couples therapy, if needed.

Exploration of Factors Related to Depressive Symptomatology in Family Members of Military Veterans With Traumatic Brain Injury

“…The present study aims to extend earlier work with civilians to family members of veterans with the goal to ultimately improve family-focused care for this population. Veteran families may be more vulnerable than civilian families because they have experienced stress from multiple and extended deployments prior to the veteran’s return home (Dausch & Saliman, 2009; Stevens et al, 2017). Furthermore, veterans with TBI often have other comorbidities, such as posttraumatic stress disorder (PTSD), other anxiety disorders, depression, pain, and polytrauma that heighten family vulnerability (Hoge et al, 2008; Nampiaparampil, 2008; Tanielian, Jaycox, Adamson, & Metscher, 2008).…”

The Traumatic Brain Injury Model Systems National Database: A Review of Published Research

“…32 Other trauma registries, [18][19][20][21]23,30,38,39,57 hospital records, [25][26][27][28][29] death indices, 22,30,31 and inmate databases 22 were used to collect additional information. In some cases, studies used VA-TBIMS-specific variables including: PTSD variables 42,58 and the PTSD checklist-civilian (PCL-C), [59][60][61][62][63] deployment status at the time of injury, 42,60,64 the Neurobehavioral Symptom Inventory (NSI), 61 the Mayo-Portland Adaptability Inventory-4 (MPAI-4), 63 and blast injury. 64 In summary, certain variables found more usage than the others.…”

“…17,39,65 In addition, difficulties to generalizability were seen in studies with specific foci, having limited sample sizes available that satisfied their inclusion criteria. 14,18,20,23,27,28,[32][33][34]38,40,50,53,55,[57][58][59][60][61][62]64,[66][67][68][69][70][71] Thirty of 74 articles (41%) reported their limited ability to generalize to the overall TBI population, including those under-represented in the TBIMS data sets due to loss of follow-up or by database collection methods. Other factors impacting generalizability include sample size and missing data, which is a limitation in itself.…”

“…Other factors impacting generalizability include sample size and missing data, which is a limitation in itself. 14,18,20,23,27,28,[32][33][34]38,40,50,53,55,[57][58][59][60][61][62]64,[66][67][68][69][70][71] In addition, certain variable groups such as ''race'' were under-or over-representative of the U.S. population overall, therefore serving as a limitation to generalizability in results due to the unequal representation of groups within variables. 60 In many studies, cohorts were dichotomized into sub-cohorts based on specific thresholds 21,23,[28][29][30][31]34,37,41,45,55,60,61,68,69,72,73 ; therefore caution is required when applying these findings to a more general population.…”

Thirty Years of National Institute on Disability, Independent Living, and Rehabilitation Research Traumatic Brain Injury Model Systems Center Research—An Update

“…To date, DVA researchers have initiated 27 analyses of the VA PRC database, with eight already published; three analyses comparing the TBIMSCs NDB to PRC NDB data have been completed or are under way. [3][4][5][6][7][8][9][10]…”