To examine factors related to perceived caregiving burden in a sample of caregivers assisting service members and veterans (SMVs) across four areas: SMV injury and health status; caregiver life circumstances; caregiver duty and responsibilities; and caregiver needs. Research Method/Design: Participants were 214 caregivers (95.8% female; 86.0% spouse/partner; Age: M ϭ 38.6 years [SD ϭ 10.4]) of SMVs who sustained a mild, moderate, severe, or penetrating traumatic brain injury (TBI). Caregivers were recruited from Walter Reed National Military Medical Center and via community outreach. Participants completed the Caregiver Appraisal Scale, Mayo-Portland Adaptability Inventory-4, and Caregiver Questionnaire. The sample was divided into 2 Caregiver Burden groups: High (n ϭ 138) and Low Burden (n ϭ 76). Results: Factors significantly related to higher levels of perceived burden were (a) experiencing a greater caregiving time commitment now and over time, (b) caring for activities of daily living/instrumental activities of daily living, (c) experiencing an impact of caregiving on employment, income, and out of pocket expenses, (d) parenting more than 1 child, (e) having less time to devote to one's self now and over time, (f) having caregiver needs, and/or (g) assisting a SMV who had incurred a mild TBI; was experiencing greater functional disability; had a posttraumatic stress disorder (PTSD) diagnosis; received mental health and rehabilitation treatment; and/or used an assistive device (all p Ͻ .05; odds ratios [ORs] ϭ 1.13 to 14.57; ds ϭ .02 to 1.30). Conclusions/Implications: Providing care for a SMV after a TBI can impose a heavy burden, particularly for caregivers who provide support to SMVs with comorbid mental health problems, such as PTSD.
The purpose of this study was to examine the (a) prevalence of unmet caregiver needs across eight health care and social service needs and the (b) impact of unmet needs on caregiver health and appraisal outcomes. Research Method/Design: Participants were 264 caregivers (95.8% female; 85.2% spouse/partner) providing help to service members and veterans who sustained a mild to severe or penetrating traumatic brain injury. Caregivers were recruited from Walter Reed National Military Medical Center (Maryland) and via community outreach to participate in the congressionally mandated 15-year Longitudinal Traumatic Brain Injury Study (Sec721 NDAA FY2007) supported by the Defense and Veterans Brain Injury Center. Caregivers completed the Caregiver Appraisal Scale, SF-36v2 Health Survey, and caregiver questionnaire. Participants were divided into 3 health care and social service needs groups: no unmet needs, 1-3 unmet needs, and 4 -8 unmet needs. Results: Six of the 8 needs were each endorsed by a majority of caregivers (59.1%-70.1%). Each need was reported as unmet by 29.5% to 52.7% of caregivers. A significant linear relation was found between number of needs and poorer outcomes (i.e., 4 -8 needs Ͻ 1-3 needs Ͻ 0 needs). The cumulative number of unmet needs was significantly related to worse outcomes in most areas, while most individual needs were not significantly related to outcomes. One exception was the caregiver's unmet need for medical health, which was significantly related to increased bodily pain. Conclusions/Implications: Continued support from programs and expansion in the breadth and scope of health care and social services for caregivers is required, including identifying the issues that hinder caregivers accessing the services they need.
Purpose/Objective: To (a) examine the factor structure of the original 47-item Caregiver Appraisal Scale (CAS) in caregivers of service members/veterans (SMVs) following traumatic brain injury (TBI) and (b) assess whether the CAS yields a similar factor structure in this population compared to caregivers of civilian adults following TBI. Research Method/Design: Participants were 287 caregivers (female ϭ 96.2%; spouse ϭ 87.8%; mean age ϭ 38.6 years) of SMVs who sustained a mild, moderate, severe, or penetrating TBI, recruited from Walter Reed National Military Medical Center and via caregiver community outreach. Caregivers completed the CAS, Caregiver Questionnaire, and Mayo-Portland Adaptability Inventory-4 upon enrollment in the study. Results: Principal component analysis (PCA) revealed four factors that explained 43.2% of the variance in CAS scores: Perceived Burden, Caregiving Relationship Satisfaction, Caregiving Ideology, and Caregiving Mastery. Thirty-seven of the 47 CAS items loaded significantly onto only one of the four factors (Ն.40). A secondary PCA was performed on these 37 items, resulting in a four-factor solution very similar to that of the 47-item solution, which explained 46.8% of the variance in the 37-item measure. All but one item loaded significantly on a factor corresponding to a conceptually similar construct. Conclusions/Implications: Military and civilian caregivers have overlapping and differing concerns. The findings support a 37-item four-factor model of This article was published Online First March 21, 2019.
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