Chronic stress may put TBI caregivers at risk for illness

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Women caring for partners with traumatic brain injury (TBI) experience enough grief and stress to put their own health at risk, according to a small study of U.S. veterans’ wives and girlfriends.

Anger, blame and grief for the loss of the man they once knew were linked to elevated inflammation levels that raise the women’s risk for chronic disease, researchers say, and not being able to turn to their loved one for support only makes things worse.

“You think about your spouse or significant other and that is such a meaningful relationship and usually the person you go to when you are under stress,” said Karen Saban, of the Loyola University Chicago Marcella Niehoff School of Nursing, who led the study. “Here they are going through this very stressful situation but they’ve kind of lost their main person to get support from.”

Saban, who is also a research health scientist at the Edward Hines Jr. Veteran’s Administration Hospital in Hines, Illinois, noted that the women could be finding it particularly difficult to cope because they are relatively young, still working and raising children.

Past research shows a link between grief and physical health problems like high blood pressure and coronary artery disease, Saban and her colleagues write in Biological Research for Nursing. Chronic stress and depression also puts caregivers at increased risk of inflammation-related illnesses, they note.

Since the year 2000, Saban’s team writes, 244,217 veterans have been diagnosed with the TBI, considered moderate or severe in 43,000 of those cases. The injury can cause seizures, lack of coordination, weakness and cognitive problems.

Researchers analyzed data on 40 women recruited for a larger national study on caregivers from a Veterans Administration trauma clinic, social networking sites and by sending letters to veterans’ homes.

The women, caring for a husband or domestic partner who had TBI within the previous 10 years, answered questions about their levels of grief, stress and depression. They also gave saliva samples, which were used to measure tumor necrosis factor, a protein that signals stress and immune responses.

Based on the womens’ responses, Saban’s team found that the caregivers felt 35 percent more anger than is typical among women not caring for TBI victims, and also had 25 percent more tumor necrosis factor than average.

The women caregivers felt the same type of grief experienced by people whose loved ones have died, but it was their levels of anger and blame – which are a part of grief – that were key to the higher levels of inflammation-promoting tumor necrosis factor, according to the results.

“Some anger is probably very normal for caregivers, but I think it’s a difficult emotion to express and, in particular, these caregivers of vets who had a war injury may feel even more guilty,” Saban told Reuters Health. “That feeling may be inducing some of these chemical changes that may set them up for chronic inflammation and possibly chronic disease in the future.”

Rebecca Utz, a sociologist at the University of Utah in Salt Lake City, said the study offered several important reminders about the complexities of grief, loss and the physiological responses they can cause.

“A person does not have to die to experience a loss,” said Utz, who was not involved in the study. “TBI represents a major redefinition of the person’s identity, functioning and relationship to others. This redefinition is the loss that caregivers are experiencing,” she said.

The study demonstrates that caregivers may be at increased risk for mental health issues and inflammation-related illnesses, Utz added.

“Their stress has real physical health outcomes, which may alter or reduce their ability to provide caregiving. This has implications on the longevity and staying-power of caregivers, especially those that are expected to provide long duration of caregiving,” she said.

Utz noted that the study should have better explained the blame and anger that the women felt and how it was associated with grief, mental health problems and inflammatory responses.

Saban said therapy could offer caregivers both social support and coping mechanisms.

“Getting beyond feeling the stress and burden, there are ways that perhaps people can reframe how they’re looking at the situation over time . . . saying, ‘I am really making a difference in this person’s life,’” Saban said.