Does severity of neurobehavioral effects of traumatic brain injury affect caregiver perceptions of discrimination?

Background: Individuals with traumatic brain injury (TBI) often experience neurobehavioral problems that appear socially inappropriate, leading to discriminatory treatment. Many people with TBI receive assistance from family caregivers, who may also experience discrimination due to their association with the injured veteran. This research aims to explore whether neurobehavioral effects of TBI increase caregivers' perceptions of discrimination toward their injured care recipient and toward themselves.

Methods: Family caregivers of 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 perceived discrimination as well as six common neurobehavioral effects of TBI: difficulty communicating, problems with emotional adjustment, poor interpersonal skills, impulsivity, inattentiveness, and unawareness of behavior problems.

Results: Forty-eight percent of family caregivers reported experiencing discrimination and 68% reported that their injured relative experienced discrimination at least sometimes. In bivariate regression models, all six types of neurobehavioral problems were associated with more frequent caregiver perception of discrimination towards the injured veteran (all p-values < .001). Likewise, all six problems were associated with more frequent caregiver experiences of discrimination towards themselves (all p-values < .05).

Discussion: Our data suggest that noticeable neurobehavioral effects of TBI may lead to increased exposure to discrimination for both TBI patients and their family caregivers. Discrimination may cause stress and lead to avoidance of social situations. It is not clear whether intervention to affect public perception of individuals with TBI or improve coping strategies will reduce these experiences.