Unhealthy family functioning is strongly associated with warfighter brain health following traumatic brain injury in United States service members and veterans

Objective To examine the relationship between family functioning and health-related quality of life (HRQOL) outcomes following traumatic brain injury (TBI) in service members and veterans (SMVs). Participants Participants were 359 United States SMVs classified into three groups: non-injured controls (NIC, n = 62); uncomplicated mild TBI (MTBI; n = 189); and complicated mild, moderate, severe, and penetrating TBI (STBI; n = 108). Participants completed 10 HRQOL measures from the TBI-QOL and Neuro-QOL, and the Family Assessment Device-General Functioning subscale (FAD-GF) 2-or-more years post-injury. Using the FAD-GF, the NIC, MTBI, and STBI participants were divided into six subgroups: Group 1 = NIC Healthy Family Functioning (HFF) ( n = 34); Group 2 = NIC Unhealthy Family Functioning (UnHFF) ( n = 28); Group 3 = MTBI HFF ( n = 88); Group 4 = MTBI UnHFF ( n = 101); Group 5 = STBI HFF ( n = 58); and Group 6 = STBI UnHFF ( n = 50). Results Participants with UnHFF had a significant and meaningfully higher number of clinically elevated HRQOL scores compared to those with HFF in the MTBI ( p < 0.001, ηp2 =0.07) and STBI ( p = 0.001, ηp2 =0.10) groups, but not in the NIC group ( p = 0.107, ηp2 =0.04). There were no differences in the total number of clinically elevated HRQOL scores when comparing the MTBI and STBI HFF groups to controls ( p = 0.074 to 0.841). The MTBI and STBI UnHFF groups had a significant and meaningfully higher number of clinically elevated HRQOL scores when compared to controls ( p < 0.001 to p = 0.018; ηp2 =0.07 to.14). The MTBI UnHFF group was 10 to 28 times more likely to have poor HRQOL outcome compared to controls. The STBI UnHFF group was 6 to 17 times more likely to have poor HRQOL outcome compared to controls. Conclusion UnHFF was strongly associated with poor long-term HRQOL. HFF was strongly associated with good long-term HRQOL outcome. Assessment and management of family distress may facilitate better TBI recovery and readiness in warfighters.