Publication year
2015
Citation Title
Association between long-term cognitive decline in Vietnam veterans with TBI and caregiver attachment style.
Journal Name
Journal of Head Trauma Rehabilitation
Journal Volume
30
Issue Number
1
Page Numbers
E26-E33
DOI
10.1097/HTR.0000000000000046
Summary
Traumatic brain injury (TBI) is a major concern among military members, and it is important to understand how to best care for military members affected by a TBI. Forty male Vietnam Veterans with TBI and their caregivers participated in a study to examine the relationship between cognitive decline and caregiver attachment style (secure, preoccupied, fearful, or dismissing). Veterans whose caregivers were more fearfully attached experienced more cognitive decline than those whose caregivers were more securely attached.
Key Findings
Veterans with a TBI and a caregiver high in fearful attachment experienced greater cognitive decline than those with a caregiver low in fearful attachment.
Other caregiver attachment styles (e.g., secure, preoccupied, dismissing) were not related to levels of cognitive decline.
Additional variables studied in caregivers (e.g., caregiver depression, level of conscientiousness) were not related to Veterans’ cognitive decline.
Implications for Program Leaders
Offer classes for caregivers about how to create stimulating environments for Service Members with a TBI as a means of minimizing cognitive decline
Create support groups for caregivers, affording them opportunities to exchange social support
Maintain regular communication with spouses of Service members with a TBI, including via social media, to provide continuing education and support as needed
Implications for Policy Makers
Recommend integrating caregiver education of attachment styles as part of the support process for Service members managing a TBI
Continue to support programs that allow for systemic holistic support of Service members who suffer from TBI
Encourage the training of professionals who work with Service members with a TBI and their families on how to create an environment that is sufficiently stimulating
Methods
Participating Vietnam Veterans were pulled from a large longitudinal study, the Vietnam Head Injury Study.
Caregivers were given the Relationship Questionnaire to determine attachment style; the Armed Forces Qualification test, delivered preinjury and again in phase four (2008-2012), was used to establish a measure of cognitive decline.
Veterans were split into two comparable groups (high vs. low fearfully attached caregiver), and cognitive decline was compared between groups.
Participants
This study included 40 male Veteran and female caregiver dyads recruited from the Vietnam Head Injury study, which began in 1967.
All caregivers knew the Veterans before the TBI or within five years post-injury.
Caregivers had an average age of 62 years and were primarily female spouses (90%).
Veterans' average age was 63 years, and most did not experience loss of consciousness as part of their TBI.
Limitations
Caregivers self-reported attachment style, which may have introduced bias for reporting in a socially desirable way.
Without a control group, the direction of effects cannot be inferred.
The sample was small and fairly homogeneous, limiting the generalizability.
Avenues for Future Research
Investigate the relationship between attachment style and cognitive decline in a more diverse sample
Examine caregiver attachment style and its impact on specific environmental conditions that can act as protective barriers against cognitive decline in Veterans with a TBI
Replicate the study with a recent sample of Veterans who have served in OEF/OIF/OND
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
Objective: To examine whether a caregiver’s attachment style is associated with patient cognitive trajectory after traumatic brain injury (TBI). Setting: National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland. Participants: Forty Vietnam War veterans with TBI and their caregivers. Main Outcome Measure: Cognitive performance, measured by the Armed Forces Qualification Test percentile score, completed at 2 time points: preinjury and 40 years postinjury. Design: On the basis of caregivers’ attachment style (secure, fearful, preoccupied, dismissing), participants with TBI were grouped into a high or low group. To examine the association between cognitive trajectory of participants with TBI and caregivers’ attachment style, we ran four 2 × 2 analysis of covariance on cognitive performances. Results: After controlling for other factors, cognitive decline was more pronounced in participants with TBI with a high fearful caregiver than among those with a low fearful caregiver. Other attachment styles were not associated with decline. Conclusion and Implication: Caregiver fearful attachment style is associated with a significant decline in cognitive status after TBI. We interpret this result in the context of the neural plasticity and cognitive reserve literatures. Finally, we discuss its impact on patient demand for healthcare services and potential interventions.
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