AUTHOR=Brickell Tracey A. , French Louis M. , Ivins Brian J. , Lippa Sara M. , Wright Megan M. , Baschenis Samantha M. , Sullivan Jamie K. , Hungerford Lars D. , Lange Rael T. 

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

JOURNAL=Frontiers in Neurology

VOLUME=Volume 16 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1475098

DOI=10.3389/fneur.2025.1475098

ISSN=1664-2295

ABSTRACT=ObjectiveTo 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).ParticipantsParticipants 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).ResultsParticipants 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.ConclusionUnHFF 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.