Marital Stability Over 10 Years Following Traumatic Brain Injury

Marital Stability During the Year After Traumatic Brain Injury in an Ecuadorian Sample: A Repeated-Measures Study

Background: Traumatic brain injury (TBI) is a major cause of death and disability worldwide and often leads to long-lasting emotional, physical, and cognitive changes and results in reduced functioning across multiple domains. These changes often lead to strain in marital relationships as the uninjured spouse grapples with adapting to the changes in their partner. Aims: The purpose of this study was to examine the probability of marital stability after TBI at 6 and 12 months following injury (i.e., probability trajectory across those two time points), as well as predictors of that probability trajectory. Methods: The study design was repeated-measures and observational. Patient recruitment and follow-up took place from January 2018 to March 2020 in Quito, Ecuador. Ninety-seven TBI survivors were recruited while hospitalized in the neurosurgery unit of Hospital Eugenio Espejo, a tertiary care center. Patients were assessed at 6 and 12 months after their injury. Hierarchical linear modeling (HLM) was used to examine baseline predictors of linear marital probability trajectories across 6 and 12 months after injury. A final set of HLMs included each of the previously significant predictors from the first model, time, and the interaction terms between time and the previously significant predictor. Results: The first HLM found that marital probability remained stable between 6 and 12 months after TBI. Individuals who were employed at baseline had higher marital probability trajectories than those who had been unemployed. Older individuals had higher marital probability trajectories than younger individuals, and women had higher marital probability trajectories than men. Conclusions: This is the first study to examine marital probability trajectories for an Ecuadorian adult population with TBI, and the data are of great value to understanding post-TBI outcomes in the region. These results can inform interventions and support systems to bolster marital resilience in the aftermath of TBI. Further research is warranted to explore the nuances of these relationships and to validate these findings in diverse populations.

Traumatic brain injury and long-term associations with work, divorce and academic achievement

OBJECTIVE

Traumatic brain injuries (TBI), irrespective of severity, may have long-term social implications. This study explores the relationships between TBI severity and outcomes related to work stability, divorce, and academic achievement.

METHODS

Using a Danish nationwide sample of persons with and without TBI, we employed case-control and longitudinal cohort designs. The case-control design utilized individuals aged 18 to 60 years and examined work stability. Each case, employed at time of TBI, was compared with 10 matched controls. The cohort design utilized individuals alive from 1980 to 2016 with and without TBI and assessed the likelihood of 1) divorce and 2) higher-level education. TBI exposures included concussion, skull fractures, or confirmed TBI.

RESULTS

TBI cases exhibited higher odds ratios (OR) for work instability at all follow-ups compared to controls. Increased TBI severity was associated with a higher risk of work instability at 2-year follow-up (concussion: OR = 1.83; skull fracture: OR = 2.22; confirmed TBI: OR = 4.55), and with a higher risk of not working at 10-year follow-up (confirmed TBI: OR = 2.82; concussion: OR = 1.63). The divorce incidence rate ratio (IRR) was elevated in individuals with TBI (males: IRR = 1.52; females: IRR = 1.48) compared to those without TBI. Individuals with childhood TBI had reduced chances of attaining high school degree or higher (males: IRR = 0.79; females: IRR = 0.85) compared to those without TBI.

CONCLUSION

TBI is associated with an increased long-term risk of social consequences, including work instability, divorce, and diminished chances of higher education, even in cases with concussion.

Traumatic brain injury as a chronic disease: insights from the United States Traumatic Brain Injury Model Systems Research Program

Traumatic brain injury (TBI) is a global health priority, associated with substantial burden. Historically conceptualised as an injury event with finite recovery, TBI is now recognised as a chronic condition that can affect multiple domains of health and function, some of which might deteriorate over time. Many people who have had a TBI remain moderately to severely disabled at 5 years, are rehospitalised up to 10 years post-injury, and have a reduced lifespan relative to the general population. Understanding TBI as a chronic disease process can be highly informative for optimising care, which has traditionally focused on acute care. Chronic brain injury care models must be informed by a holistic understanding of long-term outcomes and the factors that can affect how care needs evolve over time. The United States Traumatic Brain Injury Model Systems of Care follows up individuals with moderate-to-severe TBI for over 30 years, allowing characterisation of the chronic (2-30 years or more post injury) functional, cognitive, behavioural, and social sequelae experienced by individuals who have had a moderate-to-severe TBI and the implications for their health and quality of life. Older age, social determinants of health, and lower acute functional status are associated with post-recovery deterioration, while younger age and greater functional independence are associated with risky health behaviours, including substance misuse and re-injury. Systematically collected data on long-term outcomes across multiple domains of health and function are needed worldwide to inform the development of models for chronic disease management, including the proactive surveillance of commonly experienced health and functional challenges.

Behavioral couples therapy for brain injury: single case methodology with bi-phasic design

OBJECTIVES

To explore the outcomes of Behavioral Couples Therapy (BCT) for couples with brain injury.

BACKGROUND

Brain injury can result in communication, emotional and behavioral disturbances, leading to higher levels of depression, anxiety and relationship distress. Currently, no study has explored the outcomes of BCT in couples impacted by brain injury.

METHOD

Four heterosexual couples living with brain injury were seen at a specialist outpatient service, and attended an average of 13 (range 8-25) BCT sessions. Participants with brain injury and their partners completed weekly measures of depression, anxiety, and couple satisfaction throughout baseline, assessment, intervention, and follow-up phases. Data were visually analyzed, and effects examined using reliable change analysis, and between-phase comparison conducted using Tau-U.

RESULTS

Tau-U analysis demonstrated that both the patient and partner groups experienced significant overall improvement in relationship satisfaction and anxiety. Partners also reported significant reduction in depression scores overall. Reliable change analysis indicated improvement for some individual patients and partners, with effects maintained at follow-up in some cases.

CONCLUSIONS

The results offer promising results regarding the use of BCT for brain injury in increasing relationship satisfaction and reducing psychological distress. Further investigation is warranted.