Marriage Survivability Following Traumatic Brain Injury

By Jacob W. Gent & Richard H. Adler, Attorneys at Law

The impact of a traumatic injury to a person’s quality of life can be quite significant.  The losses experienced by survivors of serious injury, including traumatic brain injury, can be pervasive and insidious, and often have long-term implications.  In addition to the changes and consequences to the injured person’s physical, financial, cognitive, and/or mental well-being, their relationships with those close to them can also suffer setbacks.

A 2007 study examining marital stability following traumatic brain injury was conducted by the Department of Physical Medicine and Rehabilitation at Virginia Commonwealth University.[1]  The study followed 120 patients who were married at the time of injury and admitted to an outpatient rehabilitation clinic associated with a Level 1 Trauma Center.  The study was designed to replicate a 1997 study by Wood and Yurdakul in the United Kingdom[2] that focused on post-injury relationship stability.

The Wood and Yurdakul study examined the frequency of relationship breakdowns looking at risk factors such as gender, time since injury, injury severity, and duration of relationship.  They followed 131 adults, averaging 8 years post injury, and who were married or living with their partners for at least one year prior to injury.  They found nearly one half of the marriages broke down with separations (34%) more common that divorce (15%).

Participants in the American study consisted of 122 consecutively admitted individuals because of Traumatic Brain Injury (TBI) that were married at the time of the moderate-to-severe TBI and completed a follow-up evaluation between 2.5 and 8 years.[3]   A TBI is defined as damage to brain tissue caused by an external mechanical force and evidenced by loss of consciousness due to head trauma, post-traumatic amnesia, skull fracture, or objective neurological findings.  The study considered injury etiology, Glasgow Coma Scale (GCS) scores on admission, duration of unconsciousness, and duration of post-traumatic amnesia.

The authors of the 2007 study concluded:

  1. “The findings of the present study suggest that marital stability is associated with injury severity.  Longer periods of unconsciousness were associated with a greater likelihood of divorce.”
  2. “… couples in surviving relationships were married nearly three times longer than those in relationships that dissolved.”
  3. “… married survivors were nearly ten years older at the time of the injury than survivors who later separated or divorced.  … Maturity seems to be an advantage in maintaining marriages postinjury.”
  4. “… victims of violence had greater difficulty sustaining marriages than persons injured otherwise.”
  5. The data refuted the clinical speculation that males are more likely to abandon female traumatic brain injury survivors than vice versa.

The Kreutzer study provided insight in identifying marriages at greater risk for dissolution following injury.  The researchers suggested clinicians more closely monitor younger couples, coupled married for shorter periods of time, victims of violence, and situations involving more severe injuries.  The researchers also encourage a multifaceted treatment approach to include prevention, education and psychological support to improve the chances of marital stability following a traumatic brain injury.

[1] J.S. Kreutzer, J.H. Marwitz, N. Hsu, K. Williams and A. Riddick, Marital stability after brain injury: an investigation and analysis. NeuroRahabilitation 22 (2007) 53-59.

[2] R.I. Wood and L.K. Yurdakul, Change in relationship status following traumatic brain injury, Brain Injury 11 (1997), 491.

[3] The time of  follow-up that ranged between   2.5 to 8 years  (and no data on the average years of marriage) in the American study is a significant difference than the UK study where the participants averaged 8 years of marriage post injury.  The authors of the American study recognize this variable as a “limiting” factor in its conclusion:

“This present investigation has a number of limitations that should be considered.  Follow-up information was obtained between 30 to 96 months post injury.  A longer follow-up interval would have provided a more accurate picture of long-term martial stability.”