Unhealthy family functioning is associated with health-related quality of life among military spouse caregivers.

Abstract

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.

Health empowerment and health‐related quality of life in older individuals with disabilities and their spouse carers: A cross‐sectional study

“…This suggests that not only does one individual's stress affect their spouse's HRQOL, but also when one individual's resources are enhanced, it can positively impact the HRQOL of their spouse (Lyons et al, 1998). However, earlier research often focused on the relationship between stress and the HRQOL of one of the spouses (Brickell et al, 2022; Dong et al, 2021). Very few studies have examined the personal resources that could improve the HRQOL from a dyadic perspective.…”

Longitudinal health-related quality of life in military caregivers no longer providing care.

“…In previous research, intimate partner caregivers often described experiencing a change in the dynamic of their relationship with the SMV, navigating both care provider and intimate partner roles (Bui et al, 2018; Carlozzi et al, 2018). Elsewhere, less emotional support and companionship, greater social isolation, more psychological distress, and less satisfaction with life were found for intimate partner caregivers who reported lower relationship satisfaction and higher levels of unhealthy family functioning (Brickell, French, Sullivan, et al, 2022; Brickell, French, Varbedian, et al, 2022). Research has also found that when intimate partners make internal attributions, such as a lack of love, for the SMV’s emotional withdrawal and negative affect symptoms associated with PTSD and other mental health conditions, it can lead to intimate partner psychological distress, problems with emotional communication and intimacy, and relationship distress (Campbell & Renshaw, 2018, 2019).…”

Living with a traumatized partner: Dyadic approach to well-being of war-affected married couples.

“…However, mental health problems can significantly change roles, rules, and closeness in family system and thus change family balance (Gerlock et al, 2014). Even the simplest tasks or family routines, like driving children to school or going grocery shopping, can be affected if an individual avoids these activities because they may trigger traumatic reminders (Brickell et al, 2022; Gerlock et al, 2014). This calls for behavioral accommodation, which has been detected among PTSD couples (Monson et al, 2009).…”

“…However, many factors, such as physical or mental illness, can influence and change the family balance. Studies show significant associations between the severity of PTSD, anxiety, and depression symptoms and high levels of family and dyadic stress, low communication quality, and more conflicts (Brickell et al, 2022; Monson et al, 2009; Renshaw et al, 2011), which negatively affect family cohesion and adaptability. Although many war veterans successfully navigate the transition to civilian life, some experience functional impairment in work, home, or interpersonal relationships, even if they do not meet the full criteria for PTSD (Brickell et al, 2022; Rona et al, 2009).…”