Quality of Life for Individuals with Traumatic Brain Injury: The Influence of Attachment Security and Partner Support

By Hess, Ryan A.; Perrone-McGovern, Kristin M. | The Journal of Rehabilitation, October-December 2016 | Go to article overview

Quality of Life for Individuals with Traumatic Brain Injury: The Influence of Attachment Security and Partner Support


Hess, Ryan A., Perrone-McGovern, Kristin M., The Journal of Rehabilitation


Each year over 1.7 million Americans sustain a traumatic brain injury (TBI), and TBIs are responsible for over 53,000 deaths each year in the United States alone (Faul, Xu, Wald, Coronado, & Dellinger, 2010). Through medical expenses, rehabilitation, and lost productivity, TBIs cost the United States approximately $60 billion annually (Finkelstein, Corso, & Miller, 2006). Symptoms of TBI vary depending on injury location and severity (Arlinghaus, Shoaib, & Price, 2005). Changes in functioning after acquiring a TBI typically occur in three categories, including: cognitive, emotional, and physical (Halstead & Walter, 2010). Cognitive changes may include attention deficits, memory difficulties, and slowed processing speed (Bush, McBride, Curtiss, & Vanderploeg, 2005). Emotional changes frequently manifest as irritability, psychiatric-related barriers, and personality changes (Rao & Lykestos, 2000). Changes in physical functioning are characterized by sensory-motor difficulties, sleep disturbances, headaches, fatigue, and sensitivity to light and noise (Lezak & O'Brien, 1988). Persons with TBI may experience changes in one, two, or all three types of functioning. Duration of changes also depends on location and severity of injury but it is generally accepted that neurologic recovery stabilizes after 12 months (Brooks, McKinlay, Symington, Beattie, & Campsie, 1987; Kaplan, 1993; Katz, Polyak, Coughlan, Nichols, & Roche, 2009).

The purpose of the present study was to explore the new challenges that an individual with an acquired disability faces. Specifically, the present authors were interested in examining the influence of health-related quality of life (HRQOL), attachment security, partner support, and relationship satisfaction. Therefore, the present study focused on individuals that have acquired a TBI and who were involved in a romantic relationship for at least six months. The present study sought to elucidate significant variables that contribute to relationship functioning for persons with TBI. As will be demonstrated by the following literature review, attachment security, partner support, and relationship satisfaction have been found to predict HRQOL. The present authors expected these findings to be similar for couples in a romantic relationship when one of the individuals has a TBI.

TBI and Health-Related Quality of Life

Health-related quality of life (HRQOL) has been defined as an individual's perception of his/her physical health and emotional well-being which includes health risks, social functioning, and functional status (Center for Disease Control and Prevention, 2000). The severity of TBI is strongly correlated with HRQOL. Persons who sustained a severe TBI were found to have lower appraisals of HRQOL than were individuals who sustained a moderate or mild TBI (Destaillats, Mazaux, & Belio, 2009). While protective equipment and modern medicine have saved the lives of many accident victims who have sustained head injuries, many of these individuals are now living with cognitive, emotional, and physical deficits as a result of their experience (Diedler, Hanson, & O'Riley, 2009). Individuals with TBI can experience changes in relational functioning, educational functioning, and vocational functioning (Snell & Halter, 2010). For the purpose of the current study, the present authors examined the role of relational functioning (specifically attachment security, partner support, and romantic relationship satisfaction) in HRQOL for individuals who have sustained a TBI.

TBI and Romantic Relationships

Role changes are some of the most common experienced effects for partners of persons with TBI (Gan & Schuller, 2002). Partners often have additional responsibilities thrust upon them such as being a financial provider, caretaker, and provider of transportation. With these new roles can come confusion, sadness, anger, and resentment (Kreutzer, Marwitz, Hsu, Williams, & Riddick, 2007). …

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