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