Health outcomes before and during the COVID-19 pandemic in caregivers of service members and Veterans with traumatic brain injury

Abstract: Purpose: To examine change in health-related quality of life (HRQOL) during the COVID-19 pandemic in caregivers of service members/veterans (SMVs) with traumatic brain injury (TBI), by comparing HRQOL during the first year of the pandemic to HRQOL 12 months pre-pandemic. Methods: Caregivers (N = 246) were classified into three COVID-19 Pandemic Impact groups based on impact ratings of the pandemic on HRQOL: No Impact (n = 50), Mild Impact (n = 117), and Moderate-Severe Impact (n = 79). Caregivers completed 19 measures across physical, social, caregiving, and economic HRQOL domains, and a measure of SMV Adjustment. T-scores were used to determine individual symptom trajectories for each measure as follows: Asymptomatic (pre + during < 60 T); Developed (pre < 60 + during ≥ 60 T); Improved (pre ≥ 60 T + during < 60 T); and Persistent (pre + during ≥ 60 T). Results: Using ANOVA, during the pandemic, the Moderate-Severe Impact group reported worse scores on 19 measures (d = 0.41–0.89) compared to the No Impact group and 18 measures (d = 0.31–0.62) compared to the Mild Impact group (d  = 0.31–0.38). The Mild Impact group reported worse scores on two measures compared to the No Impact group (d = 0.42–0.43). Using the entire sample, the majority of HRQOL measures were classified as Asymptomatic (47.2–94.7%), followed by Persistent (2.4–27.2%). Few were classified as Developed (0.4–12.6%) or Improved (2.4–13.8%). Using repeated measures ANOVA, no meaningful effects sizes were found for mean scores on all measures completed pre-pandemic compared to during the pandemic (d ≤ 0.17). Conclusion: The vast majority of caregivers reported stability in HRQOL pre-pandemic compared to during the pandemic. The COVID-19 pandemic was not associated with a high prevalence of decline in caregiver HRQOL.