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Rattray NA, Flanagan M, Mann A, Danson L, Do AN, Natividad D, Spontak K, True G. Conceptualizing care partners' burden, stress, and support for reintegrating Veterans: a mixed methods study. Front Public Health 2024; 11:1295627. [PMID: 38440161 PMCID: PMC10910616 DOI: 10.3389/fpubh.2023.1295627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/07/2023] [Indexed: 03/06/2024] Open
Abstract
Background People who support Veterans as they transition from their military service into civilian life may be at an increased risk of psychological distress. Existing studies focus primarily on paid family caregivers, but few studies include spouses and informal non-family "care partners." We sought to identify key challenges faced by care partners of Veterans with invisible injuries. Methods Semi-structured interviews were conducted with 36 individuals involved in supporting a recently separated US military Veteran enrolled in a 2-year longitudinal study. CPs completed validated measures on perceived stress, caregiving burden, quality of their relationship, life satisfaction, and flourishing. Independent t-tests were used to compare cases in these groups on caregiving burden, quality of their relationship, life satisfaction, and flourishing. Care partners were categorized as reporting high and low levels of stress. Exemplar cases were used to demonstrate divergences in the experiences of CPs with different levels of stress over time. Results Care partners reported shifts in self-perception that occurred from supporting a Veteran, emphasizing how they helped Veterans navigate health systems and the processes of disclosing health and personal information in civilian contexts. Exemplar cases with high and low burdens demonstrated divergent experiences in self-perception, managing multi-faceted strain, and coping with stress over time. Case studies of specific care partners illustrate how multi-faceted strain shifted over time and is affected by additional burdens from childcare, financial responsibilities, or lack of education on mental health issues. Conclusions Findings suggest the unique needs of individuals who support military Veterans with invisible injuries, highlighting variations and diachronic elements of caregiving. This sample is younger than the typical caregiver sample with implications for how best to support unpaid care partners caring for Veterans in the early to mid-period of their use of VA and civilian health services.
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Affiliation(s)
- Nicholas A. Rattray
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
- Regenstrief Institute, Inc., Indianapolis, IN, United States
- Department of General Internal Medicine and Geriatrics, Indiana School of Medicine, Indianapolis, IN, United States
| | - Mindy Flanagan
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
| | - Allison Mann
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
- Department of Psychological Services, University of Indianapolis, Indianapolis, IN, United States
| | - Leah Danson
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
- Department of Psychological Services, University of Indianapolis, Indianapolis, IN, United States
| | - Ai-Nghia Do
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
| | - Diana Natividad
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
| | - Katrina Spontak
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
- Department of Psychological Services, University of Indianapolis, Indianapolis, IN, United States
| | - Gala True
- South Central Mental Illness Research, Education, and Clinical Center, Southeast Louisiana Veterans Health Care System, New Orleans, LA, United States
- Section of Community and Population Medicine, Louisiana State University School of Medicine, New Orleans, LA, United States
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Brickell TA, Wright MM, Sullivan JK, Varbedian NV, Tippett CE, Byrd AM, French LM, Lange RT. Health outcomes before and during the COVID-19 pandemic in caregivers of service members and veterans with traumatic brain injury. Qual Life Res 2023; 32:3463-3474. [PMID: 37572244 DOI: 10.1007/s11136-023-03491-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/14/2023]
Abstract
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.
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Affiliation(s)
- Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
- General Dynamics Information Technology, Silver Spring, MD, USA.
| | - Megan M Wright
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Ciconix, Annapolis, MD, USA
| | - Jamie K Sullivan
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- General Dynamics Information Technology, Silver Spring, MD, USA
| | - Nicole V Varbedian
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Ciconix, Annapolis, MD, USA
| | - Corie E Tippett
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Ciconix, Annapolis, MD, USA
| | - Anice M Byrd
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Ciconix, Annapolis, MD, USA
- Traumatic Brain Injury Center of Excellence, Naval Medical Center San Diego, San Diego, CA, USA
| | - Louis M French
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Rael T Lange
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- General Dynamics Information Technology, Silver Spring, MD, USA
- University of British Columbia, Vancouver, BC, Canada
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Brickell TA, Wright MM, Sullivan JK, Varbedian NV, Nose KA, Rather LM, Tien NK, French LM, Lange RT. 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; 18:2577-2588. [PMID: 35912703 PMCID: PMC9622982 DOI: 10.5664/jcsm.10164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To 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). METHODS Caregivers (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). RESULTS The 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. CONCLUSIONS While 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. CITATION Brickell 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.
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Affiliation(s)
- Tracey A. Brickell
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland
| | - Megan M. Wright
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland
| | - Jamie K. Sullivan
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland
| | - Nicole V. Varbedian
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland
| | - Kathryn A. Nose
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland
| | - Lauren M. Rather
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland
| | - Nicole K. Tien
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland
| | - Louis M. French
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Rael T. Lange
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Contractor, General Dynamics Information Technology, Silver Spring, Maryland
- University of British Columbia, Vancouver, British Columbia, Canada
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Is Traumatic Brain Injury Severity in Service Members and Veterans Related to Health-Related Quality of Life in Their Caregivers? J Head Trauma Rehabil 2022; 37:338-349. [PMID: 35862894 DOI: 10.1097/htr.0000000000000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To examine the relationship between service member/veteran (SM/V) traumatic brain injury (TBI) severity with caregiver health-related quality of life (HRQOL). SETTING Military treatment facility. PARTICIPANTS 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. DESIGN Prospective cohort. MAIN MEASURES Caregivers completed 15 HRQOL measures. RESULTS 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. CONCLUSION 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.
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Brickell TA, Wright MM, Ferdosi H, French LM, Lange RT. Pain interference and health-related quality of life in caregivers of service members and veterans with traumatic brain injury and mental health comorbidity. Qual Life Res 2022; 31:3031-3039. [PMID: 35594013 DOI: 10.1007/s11136-022-03153-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine (1) the relationship between caregiver pain interference with caregiver health-related quality of life (HRQOL), caregiver age, and service member/veteran (SMV) functional ability, and (2) change in caregiver pain interference longitudinally over 5 years. METHOD Participants were 347 caregivers of SMVs diagnosed with traumatic brain injury (TBI). Caregivers completed the SF-12v2 Health Survey Bodily Pain scale at an initial baseline evaluation and up to four annual follow-up evaluations. Caregivers were divided into three pain interference groups: High Pain Interference (n = 104), Neutral Pain Interference (n = 117), and Low Pain Interference (n = 126). Caregivers also completed 15 HRQOL measures and a measure of SMV functional ability. RESULTS The High Pain Interference group reported more clinically elevated scores on 13 measures compared to the Low Pain Interference group, and seven measures compared to the Neutral Pain Interference group. The Neutral Pain Interference group had more clinically elevated scores on three measures compared to the Low Pain Interference group. The High and Neutral Pain Interference groups were older than the Low Pain Interference group. Parent caregivers were older than intimate partner/sibling caregivers, but did not report worse pain interference. Caregiver age, and measures of Fatigue, Strain, Perceived Rejection, and Economic QOL were the strongest predictors of pain interference (p < .001), accounting for 28.2% of the variance. There was minimal change in Bodily Pain scores over five years. The interaction of time and age was not significant (X2 = 2.7, p = .61). CONCLUSION It is important to examine pain in the context of HRQOL in caregivers, regardless of age.
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Affiliation(s)
- Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA. .,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA. .,Uniformed Services University of the Health Sciences, Bethesda, MD, USA. .,General Dynamics Information Technology, Silver Spring, MD, USA.
| | - Megan M Wright
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,General Dynamics Information Technology, Silver Spring, MD, USA
| | - Hamid Ferdosi
- General Dynamics Information Technology, Silver Spring, MD, USA.,Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,The George Washington University, Washington, DC, USA
| | - Louis M French
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Rael T Lange
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,General Dynamics Information Technology, Silver Spring, MD, USA.,University of British Columbia, Vancouver, BC, Canada
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