Traumatic brain injury and relationship distress during military deployment and reunion

• Published date: 01 February 2024
• Author: Leanne K. Knobloch,Bryan Abendschein
• Date: 01 February 2024
• DOI: http://doi.org/10.1111/fare.12849

RESEARCH

Traumatic brain injury and relationship distress

during military deployment and reunion

Leanne K. Knobloch

1

|Bryan Abendschein

2

1

Department of Communication, University of

Illinois, Urbana, IL

2

School of Communication, Western Michigan

University, Kalamazoo, MI

Correspondence

Leanne K. Knobloch, Department of

Communication, University of Illinois, 3001

Lincoln Hall, 702 South Wright Street,

Urbana, IL 61801, USA.

Email: knobl@illinois.edu

Abstract

Objective: This study seeks to advance the literature by dis-

entangling the effects of deployment-acquired traumatic

brain injury (TBI) from comorbid postconcussive symp-

toms and PTSD symptoms on relationship distress.

Background: Because TBI poses challenges to military

marriages, understanding the predictors of relationship

distress after TBI is important for helping service members

cope with the effects of the injury.

Method: Survey data from the U.S. Army STARRS Pre–

Post Deployment Study, collected from 2,585 married ser-

vice members before and after a combat deployment to

Afghanistan, evaluated predictors of relationship distress

9 months after homecoming.

Results: Deployment-acquired TBI corresponded with

more relationship distress controlling for predeployment

brain health, but its predictive power was eclipsed by con-

current postconcussive symptoms and concurrent PTSD

symptoms. Concurrent PTSD symptoms accounted for

twice as much variance in relationship distress than con-

current postconcussive symptoms.

Conclusion: Targeting and treating comorbid conditions

may be essential for supporting military marriages

after TBI.

Implications: Military command, policymakers, and medi-

cal professionals may find value in broadening support

services for TBI to include resources addressing post-

concussive symptoms, PTSD symptoms, and relationship

distress.

Author Note: This paper is based on public use data from the Army Study to Assess Risk and Resilience in Servicemembers (STARRS).

The data are available from the Inter-university Consortium for Political and Social Research (ICPSR) at the University of Michigan

(http://doi.org/10.3886/ICPSR35197.v7). The contents of the paper are solely the responsibility of the authors and do not necessarily

represent the views of the STARRS investigators, funders, Department of the Army, or Department of Defense.

Received: 24 June 2022Revised: 20 December 2022Accepted: 30 December 2022

DOI: 10.1111/fare.12849

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use,

distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

© 2023 The Authors. Family Relations published by Wiley Periodicals LLC on behalf of National Council on Family Relations.

424 Family Relations. 2024;73:424–440.

wileyonlinelibrary.com/journal/fare

KEYWORDS

marital dissatisfaction, military deployment, postconcussive symptoms,

PTSD symptoms, relationship distress, traumatic brain injury

Traumatic brain injury (TBI), which refers to a blow or jolt to the head that damages brain func-

tioning, is a signature wound of post-9/11 military service (U.S. Department of Defense

[DoD], 2021). During the period from 2000 to 2021, more than 453,000 U.S. military personnel

were diagnosed with TBI for the first time; this number does not include service members diag-

nosed with a repeat injury (Traumatic Brain Injury Center of Excellence, 2022). TBI among ser-

vice members and veterans is a potentially debilitating and chronic condition tied to a variety

of negative outcomes (Helmick et al., 2015; Schulz-Heik et al., 2016; Swan et al., 2018). For

example, TBI among military personnel is associated with poorer physical health (Swan

et al., 2018), more substance abuse (Brady et al., 2019), higher unemployment (Pogoda

et al., 2016), and increased risk of dementia (Barnes et al., 2018). TBI among service members

and veterans also corresponds to poorer mental health, including anxiety disorders, mood disor-

ders, and cognitive disorders (Chin & Zeber, 2020). In sum, TBI is of considerable concern to

both military medicine and family science (Helmick et al., 2015; Voris & Steinkopf, 2019).

TBI affects not just people’s physical and mental health, but it affects the well-being of mili-

tary marriages (Brickell et al., 2022; Hyatt et al., 2014). TBI presents challenges for military

couples such as communication problems, emotional distress, and caregiving burden (Brickell

et al., 2018; Delgado et al., 2018; Hyatt et al., 2014; Voris & Steinkopf, 2019). Accordingly,

TBI can be detrimental to marital satisfaction and relationship quality among military couples

(e.g., Brickell et al., 2022; Freytes et al., 2017). Because support from partners is pivotal for

helping military personnel cope with the aftermath of TBI (e.g., Freytes et al., 2017; Godwin

et al., 2015; Malec et al., 2017), the predictors of relationship distress are important to under-

stand among service members with TBI.

Despite a growing literature examining the negative effects of TBI on military marriage,

questions remain about whether the injury itself is the driving factor or if comorbid conditions

are accountable. Although most TBIs are mild, comorbid conditions such as postconcussive

symptoms (i.e., physical health issues such as dizziness, fatigue, sensitivity to noise and light,

headaches; Stein et al., 2016) and posttraumatic stress symptoms (i.e., mental health issues such

as disturbing memories, avoidance, numbing, hyperarousal; Lange, French, et al., 2020) among

military personnel can complicate recovery. Disentangling whether TBI or a comorbid condi-

tion is the central predictor of relationship distress among service members has key ramifica-

tions for both policy and practice (e.g., Brickell et al., 2020; Lange, French, et al., 2020). We

pursue this topic by analyzing prospective longitudinal data from the U.S. Army Study to

Assess Risk and Resilience in Servicemembers (Army STARRS; Ursano et al., 2020), which

surveyed three brigade combat teams of U.S. Army soldiers before and after they deployed to

Afghanistan.

Relationship distress and TBI

Research on civilian and military populations, which tends to focus on mild TBI as the most

commonly experienced injury, documents considerable marital difficulties associated with TBI.

With respect to civilians, approximately 50% of married couples report clinically significant

levels of marital dissatisfaction after TBI (Kreutzer et al., 2016), and approximately 30% of

individuals with TBI report having problems with personal relationships 10years after the

injury (Ponsford et al., 2014). Married couples coping with brain injury report trouble adjusting

to personality changes (Buckland et al., 2021), irritability and volatility within the relationship

TRAUMATIC BRAIN INJURY425