Mental health

Wendling, Sara Beth, Bell, Allison

Due to traumatic brain injury (TBI) or polytrauma (i.e., multiple traumatic experiences), our Service members sometimes require specialized, long-term care from caregivers who can be family members, friends, or aids. These caregivers are often responsible for assisting Service members with tasks involved in everyday living such as bathing, dressing, transporting, and more. To draw attention to the vital role caregivers play in Service members’ lives, we will highlight issues surrounding the stigma of being a caregiver for Service members, and the difficulties they face, along with resources available to them. Stigma of Caregiving for a Service Member with a TBI Research has found that caregivers of Service members tend to experience a stigma associated with caregiving. A recent study found that about 35% of caregivers reported experiencing stigma by association; that is, simply experiencing stigma by being affiliated with a Service member with a TBI. Stigma and negative attitudes can be shown as discomfort around, and avoidance of, Veterans with TBI and their families. Stigma among caregivers can potentially contribute to: o Caregiver strain o Anxiety o Depression o Feelings of loneliness o Lower self-esteem Stigma also makes it more difficult for Veterans to feel connected to their community. As a caregiver assisting a Veteran with a TBI reintegrate into society, it may be helpful to: o Connect with others o Practice self-care o Use available resources Connecting with Others: One way to cope with the stigma of caregiving for a Veteran with a TBI is to find other caregivers who might be in a similar situation. It is important to create relationships with individuals in similar situations to combat feelings of loneliness. Connecting with others may be beneficial for both the caregiver and Veteran. Caregivers can find support groups in their community where they can spend time with other caregivers who will normalize their experiences. Caregivers who are unable to participate in an in-person peer support group may utilize virtual support groups to connect with other military caregivers. Practicing Self-care: It is important for caregivers to take care of themselves. Creating self-care habits is another great way to ensure caregivers meet their own needs and refuel when needed. Caregivers can practice mental health “checks” to identify daily needs and assess their emotional well-being. Simple habits such as calling a friend or choosing to rest instead of running errands may lower stress. Daily practices such as setting aside time to shower, going on walks, or preparing balanced meals are useful in promoting mental health and well-being. It is also beneficial to share the load of caregiving responsibilities. For example, asking another family member or friend to share caregiving responsibility allows the primary caregiver to take the needed time for themselves to avoid burnout. Using available resources: There are many resources available for military caregivers. Resources range from peer support groups to family counseling and financial assistance. Using the resources and programs available to military caregivers may help to lighten the load and stress of caregiving. Check out the Caregiver Resource Directory for various caregiver resources and ways to get connected. Caregivers are crucial to the support of Service members who have suffered from a TBI or polytrauma, so it is important that they have access to resources and tools to avoid burnout. Military One Source may be one particularly helpful resource, as they are continually updating their resources. By finding connections with others, investing time in self-care, and utilizing available resources, caregivers can routinely check in on themselves to ensure they are managing the stigma of caregiving for a Veteran with TBI, and effectively fulfilling their caregiver role. Reference: Phelan, S. M., Bangerter, L. R., Friedemann-Sanchez, G., Lackore, K. A., Morris, M. A., Van Houtven, C. H., ... & Griffin, J. M. (2018). The impact of stigma on community reintegration of veterans with traumatic brain injury and the well-being of their caregivers. Archives of Physical Medicine and Rehabilitation, 99(11), 2222-2229. Link to source: https://doi.org/10.1016/j.apmr.2018.04.007 Link to TRIP report: https://aub.ie/MilitaryREACHPhelanTRIP

Family Story

https://militaryreach.auburn.edu/ffCaringForAServiceMember.jsp

https://aub.ie/MilitaryREACHPhelanTRIP

Phelan, S. M., Bangerter, L. R., Friedemann-Sanchez, G., Lackore, K. A., Morris, M. A., Van Houtven, C. H., ... & Griffin, J. M. (2018). The impact of stigma on community reintegration of veterans with traumatic brain injury and the well-being of their caregivers. Archives of Physical Medicine and Rehabilitation, 99(11), 2222-2229.

Individuals who have experienced traumatic brain injury (TBI) or polytrauma (i.e., multiple traumatic injuries) are likely to require long-term assistance in activities of daily living. This study focuses on the experiences of caregivers (n = 564) who care for a veteran with a history of polytrauma, including a TBI. This study examined the associations between caregivers’ experiences of stigma, feelings of caregiver strain, and well-being outcomes of themselves and their veteran. More specifically, caregivers reported on perceived stigma (i.e., against themselves, their veteran care recipient, and their family), strain experienced from caregiving, their own mental health (i.e., depression, anxiety, loneliness, and self-esteem), and the veteran’s community reintegration (i.e., reentry into their community and engagement with their community following injury). Results suggest that all forms of stigma negatively affected caregiver well-being and veterans’ community reintegration.

https://doi.org/10.1016/j.apmr.2018.04.007

Mental health
Physical health
Trauma
Veterans

Multiple branches

Active Duty
Veteran

Other
Parent of a service member or veteran
Spouse of service member or veteran

Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
Aged (65 yrs & older)

Cross-Sectional Study
Quantitative Study

Phelan, Sean M., Bangerter, Lauren R., Friedemann-Sanchez, Greta, Lackore, Kandace A., Morris, Megan A., Van Houtven, Courtney H., Carlson, Kathleen F., van Ryn, Michelle, Harden, Kristin J., Griffin, Joan M.

Objective: To assess the association between perceived stigma and discrimination and caregiver strain, caregiver well-being, and patient community reintegration. Design: A cross-sectional survey study of 564 informal caregivers of U.S. military service veterans of wars in Iraq and Afghanistan who experienced traumatic brain injuries or polytrauma (TBI/PT). Setting: Care settings of community-dwelling former inpatients of U.S. Department of Veterans Affairs Polytrauma Rehabilitation Centers. Participants Caregivers of former inpatients (N=564), identified through next-of-kin records and subsequent nominations. Interventions: Not applicable. Main Outcome Measures: Caregiver strain, depression, anxiety, loneliness, and self-esteem; as well as care recipient community reintegration, a key aspect of TBI/PT rehabilitation. Results: Family stigma was associated with strain, depression, anxiety, loneliness, lower self-esteem, and less community reintegration. Caregiver stigma-by-association was associated with strain, depression, anxiety, loneliness, and lower self-esteem. Care recipient stigma was associated with caregiver strain, depression, anxiety, loneliness, lower self-esteem, and less community reintegration. Conclusions: Perceived stigma may be a substantial source of stress for caregivers of U.S. military veterans with TBI/PT, and may contribute to poor outcomes for the health of caregivers and for the community reintegration of the veterans for whom they provide care.

W.B. Saunders

Article
REACH Publication

Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery, College of Medicine, Rochester, Division of Health Care Policy and Research, Mayo Clinic, SMP
Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery, Mayo Clinic, College of Medicine, Rochester, LRB
Hubert H. Humphrey School of Public Affairs, University of Minnesota, GFS
Division of Health Care Policy and Research, Mayo Clinic, Rochester, KAL
Adult and Child Consortium for Health Outcomes Research and Delivery Science, Anschutz Medical Campus, University of Colorado Aurora, MAM
Durham Veterans Affairs Health Care System, Department of Population Health Sciences, School of Medicine, Duke University, CHV
Veterans Affairs Portland Health Care System, Oregon Health & Science University, KFC
Division of Health Care Policy and Research, Mayo Clinic, Oregon Health & Science University, MV
Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery, College of Medicine, Rochester, Division of Health Care Policy and Research, Mayo Clinic, KJH
Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery, College of Medicine, Rochester, Division of Health Care Policy and Research, Mayo Clinic, JMG