How does stigma affect the mental health of family caregivers of veterans with traumatic brain injury?

Background. Families of individuals with stigmatized conditions can also experience illness-related stigmatization. Because individuals with traumatic brain injury (TBI) often have neurobehavioral problems that appear socially inappropriate, family caregivers may experience discrimination and stigma-by-association. This research aims to determine whether family caregivers of persons with TBI: 1) perceive discrimination toward their family member; 2) perceive discrimination toward themselves; 3) feel shame about their family member; and 4) experience depression, anxiety, and social isolation resulting from these perceptions.

Methods: Family caregivers of injured veterans who had been discharged from inpatient TBI rehabilitation for at least 3 months were eligible for this pilot study. Forty individuals completed a mailed survey with validated measures of stigma and discrimination.

Results: Forty-eight percent of family caregivers reported that they experienced discrimination and 68% reported that their injured relative experienced discrimination at least sometimes. In bivariate regression models, perceived discrimination of the veteran and family shame were significantly (p<.05) associated with greater social isolation. Perceptions of family discrimination were associated with depression, anxiety, and social isolation after controlling for other potential reasons for discrimination (age, sex, race, income).

Discussion: Our data suggest that family caregivers of individuals with TBI suffer discrimination and consequent mental health effects. They may be inclined to social isolation to avoid stigmatizing situations for themselves and the family member they provide care for. It is not clear how well such individuals are served by mental health professionals or whether counseling approaches may be enhanced by focusing on family context in these situations.