Publication year
2014
Citation Title
Chasing the care: Soldiers experience following combat-related mild traumatic brain injury.
Journal Name
Military Medicine
Journal Volume
179
Issue Number
8
Page Numbers
849-855
DOI
10.7205/MILMED-D-13-00526
Summary
Mild traumatic brain injury (mTBI) is often an invisible and hard-to-diagnosis disorder that can have large impacts on Service members’ functioning. Service members who had sustained a deployment-related mTBI and their spouses answered questions regarding the military health care system and care that they received. Soldiers consistently reported a need to “chase the care” or repeatedly request or demand the care they needed, as well as several other problems with advocating for and receiving mTBI treatment.
Key Findings
Soldiers and spouses consistently reported that they had to be very persistent to receive the care Service members needs for mTBI.
Service members reported the following challenges to receiving adequate mTBI care: proving the injury existed (56%), conflicts with providers (67%), lack of provider empathy for non-visible injuries (44%), the need to repeatedly request or demand appropriate care and refferals in order to receive them (78%), fragmented and unorganized care (100%), and difficulty navigating the military health care system (89%).
All 9 Service members reported not knowing they had sustained an mTBI and had misattributed their symptoms to other conditions, often resulting in delayed treatment seeking and care.
Although all Service members and spouses agreed that responsibility for care should be shared between Service members, spouses, and providers, most spouses (78%) felt unwelcome or excluded from treatment and did not know how to help their Service member.
Implications for Program Leaders
Provide education to Service members and their families about common symptoms of mTBI, including brief, widespread pre-deployment education
Offer support groups for Service members and families impacted by mTBI
Educate Service members and their spouses about how to navigate the military healthcare system, advocate for healthcare needs, and collaborate with doctors to ensure proper treatment
Implications for Policy Makers
Encourage the development of a task force to examine potential issues in access to care for Service members who have experienced brain injuries
Recommend collecting data regarding healthcare provision for Service members diagnosed with mTBI that can be used to assess problems with healthcare infrastructure and ways to ameliorate those problems
Continue to support education and programs for Service members who have experienced brain injuries
Methods
Married Active Duty Soldiers with deployment-related mTBIs and their spouses were recruited using flyers and posters from a traumatic brain injury clinic at one southeastern U.S. Army hospital.
Participants and their spouses participated in semi-structured interviews about challenges experienced in receiving care for mTBI.
Transcribed interviews were coded and core categories of content were identified and quantified.
Participants
Participants included nine Soldiers, who were 89% male and had an average age of 32.89 years, and their spouses.
Soldiers identified as White (56%), Latino (22%), Black (11%), and another race (11%); spouses identified as White (78%), Black (11%), and Latino (11%).
Soldiers included three officers, four non-comissioned officers, and two enlisted members.
Soldiers had been deployed between 1-6 times, and the average time since injury was 12 months.
Limitations
Some interviews were conducted separately for the Soldiers and the spouses while others were conducted conjointly, which may have affected responses.
Sampling methods varied across participants, and some participants were hand-picked by researchers for specific characteristics, potentially resulting in problems with researcher bias and selection bias.
The very small sample size (n = 9) limits generalizability.
Avenues for Future Research
Explore the effects of mTBI on the marital relationship
Evaluate a program using a health advocate who would help Soldiers navigate the military health system
Investigate the impact of brain injury on parenting and children
Focus
Army
Target Population
Population Focus
Military Branch
Military Component
Abstract
Objective: One of the most common, yet most difficult to detect injuries sustained by U.S. soldiers in Iraq and Afghanistan is mild traumatic brain injury (mTBI). Left untreated, mTBI can negatively impact soldiers' postdeployment adjustment. This research describes the rehabilitation experiences of soldiers with a history of mTBI and their spouses. Method: Nine soldiers with mTBI and their spouses participated in the study. A total of 27 interviews were conducted exploring couples' post-mTBI rehabilitation experiences. Participants consisted of active duty soldiers with mTBI who had returned from deployment within 2 years, and their civilian spouses. Strauss and Corbin's grounded theory methodology was used to collect and analyze the data. Findings: The majority of the soldiers and spouses who participated (16/18) indicated that uncertain prognosis and symptom management were the greatest challenges of post-mTBI. Other challenges, such as delayed diagnosis, limited access to mental health care, and difficulty navigating an unfamiliar military health care system was also reported. Conclusions: Because of mTBI's lack of visible manifestation, soldiers may confuse their mTBI symptoms with those of other deployment-related injuries and this leads to a delay in treatment. Future research should explore the standardization of post-mTBI rehabilitation programs and the effectiveness of soldier education to promote early detection and treatment.
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