A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

Traumatic brain injury (TBI) is a challenging condition that, according to the Centers for Disease Control and Prevention (CDC), is a leading cause of death and disability. TBI results from an impact of external force to the brain, usually caused by a direct blow to the head, jolt of the head, or a penetrating object. A TBI can be classified as mild, moderate, or severe. TBI can lead to significant changes in one’s personality, cognitive abilities, social roles, and employment status. These changes can be challenging to relationships, including marriage. Previous research has shown that marriage stability plays a pivotal role for people with TBI to successfully live well post-injury. However, little research has focused specifically on marital stability and marriage status change after a TBI.

Previous studies were limited to very small sample sizes or only looked at marriage status for a relatively small number of years after the injury (i.e., < 10 years). Since marital stability appears to play a prominent role in the wellness of people recovering from and living with a TBI, it seems important to investigate marital stability over a longer period of time. In a recent NIDILRR-funded study, a group of researchers investigated marital stability, rate of change in marital status, and predictors of marital stability over 10 years after initial TBI. The researchers wanted to know what personal characteristics might predict marital stability. They also wanted to know whether the cause of injury or severity of TBI would increase the likelihood of staying married or ending a marriage.

Researchers from TBI Model System (TBIMS) Centers in Colorado, Indiana, and Ohio looked at data for 1,423 participants enrolled in the TBIMS National Database. The TBIMS National Database collects data on individuals admitted for inpatient acute TBI rehabilitation at TBIMS centers across the US. It includes data on preinjury, injury, acute care, rehabilitation, and outcomes at 1, 2, and 5 years post-injury and every 5 years thereafter, with information on persons with TBI up to 30 years post-injury at present. To be included in this study, participants had to be at least 16 years old at the time of their injury and have had a moderate to severe TBI. The participants also had to be married at the time of their injury, eligible for 10-year follow-up at any point between June 25, 1998 and June 19, 2019, and had their marital status information collected at time of injury and at 10-year follow-up. For marital stability, researchers examined marital status at injury, then at 1, 2, 5, and 10 years post-injury. Participants were considered “married” if they remained married to the same partner at each time point. They were considered “not married” if separated or divorced at any of the time points. For predictors of marital stability, researchers looked at demographic data, such as age at injury, gender, race/ethnicity, education level, employment status, and any history of substance abuse at the time of injury. They also looked at TBI-related factors such as the cause of the injury (vehicular, violence, fall, or other), the severity of the TBI, and cognitive and functional independence at the time of rehabilitation discharge.

The results were as follows:

• The majority of participants (66%) stayed married to the same partner after 10 years.
• Of those whose marital status changed from married to not married, 68% of the change occurred between years 1-5 and 32% occurred between years 5-10.
• Greatest marital loss occurred between time of injury and year 1 post-injury.
• The average rate of marital loss was smaller at each time point after year 1.
• Chances of remaining married were higher for female and older participants.
• Participants without a substance abuse history were more likely to remain married compared to those who had a history of substance abuse.

The authors noted the results may offer a broader insight into predictors for marital stability for people with TBI, building on the limited prior research in this area. They suggested that these results may help dispel myths about highly increased risk of divorce after TBI, offering a message of hope for TBI survivors and their partners. In this study, two-thirds of marriage breakdowns occurred in the first five years after injury, which suggests that proactive relationship interventions may help address marital challenges. The authors also suggested that the results may provide insight into addressing potential substance abuse issues that may lead to marital instability following a TBI. They acknowledged that other factors not included in this study may contribute to marriage stability, such as spirituality, relationship factors like communication and intimacy, and the presence of children in the relationship. Future research may be necessary to further investigate marital adjustment and satisfaction for those who remain married. The authors also suggested that future research examining people with TBI in committed non-marriage relationships may be beneficial. But they noted that this study may offer promising insight into potential interventions that may facilitate improved long-term marriage stability for people with TBI.

To Learn More

The Model Systems Knowledge Translation Center offered a suite of resources for Relationships After TBI, including video interviews with couples living with TBI and factsheets on how TBI can impact intimate relationships.

Brainline.org, a service of WETA, offers extensive resources for TBI, including a section on Family Relationships. Former NIDILRR-funded researcher Jeffrey Kreutzer, PhD, discussed the topic of couples therapy after TBI in a video interview with Brainline.

For health professionals interested in the Therapeutic Couples’ Intervention, visit https://tbi.vcu.edu/interventions/tci/.

To Learn More About this Study

Hammond, F.M., Sevigny, M., Backhaus, S., Neumann, D., Corrigan, J.D., Charles, S., & Gazett, H. (2021) Marital stability over 10 years following traumatic brain injury. Journal of Head Trauma Rehabilitation, 36(4), E199-E202. This article is available from the NARIC collection under Accession Number J86970.