ORIGINAL RESEARCH article
Front. Neurol.
Sec. Cognitive and Behavioral Neurology
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1475098
This article is part of the Research TopicInnovations in the assessment and treatment of TBI and co-occurring conditions in military connected populationsView all 12 articles
RUNNING HEAD: Family Functioning and TBI Outcome Unhealthy Family Functioning is Strongly Associated with Warfighter Brain Health Following Traumatic Brain Injury in United States Service Members and Veterans
Provisionally accepted
Tracey A Brickell1*
Louis M French1
Sara M Lippa1
Megan M Wright1Samantha M Baschenis1Jamie K Sullivan1
Lars D Hungerford2
Rael T Lange1- 1Walter Reed National Military Medical Center, Bethesda, United States
- 2Naval Medical Center San Diego, San Diego, California, United States
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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<.001, η_p^2=.07) and STBI (p=.001, η_p^2=.10) groups, but not in the NIC group (p=.107, η_p^2=.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=.074 to .841). The MTBI and STBI UnHFF groups had a significant and meaningfully higher number of clinically elevated HRQOL scores when compared to controls (p<.001 to p=.018; η_p^2=.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.
Keywords: family functioning dysfunction conflict, military service member veteran warfighter, Traumatic Brain Injury, Brain health, neurobehavioral, posttraumatic stress
Received: 02 Aug 2024; Accepted: 30 Jul 2025.
Copyright: © 2025 Brickell, French, Lippa, Wright, Baschenis, Sullivan, Hungerford and Lange. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Tracey A Brickell, Walter Reed National Military Medical Center, Bethesda, United States
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