Couples’ experiences after a traumatic brain injury: a mixed-method synthesis and qualitative study

Background: Traumatic brain injuries (TBIs) can result in a number of consequences for those who has sustained the injuries, as well as having an impact on their wider system. Estimates of divorce and relationship dissolution among couples following TBI can be as high as 54% and partners are reported to experience high levels of stress. The majority of studies have explored couples’ relationships following TBI from the perspective of either the person with TBI or the partner, as opposed to exploring this dyadically and, therefore, limiting the holistic understanding to this topic. Aim: The two aims of this thesis are as follows: firstly, the mixed-method synthesis review aimed to explore the current dyad evidence-base around couples’ experiences and relationships following TBI; and secondly, the qualitative study aimed to explore the impact of TBI on couples’ experiences and relationships. Method: The systematic review’s search strategy consisted of a computerised search across five databases and manual searches for further references in other relevant literature reviews and reference lists. The quality of the qualitative and quantitative studies were analyses separately. Metaethnography was employed to synthesize the finding from the qualitative studies. In the qualitative empirical study, five dyad-couples participated in the semi-structured interviews. The individuals with TBI and their partners were interviewed independently. The data collected was analysed using a combined deductive-inductive framework analysis approach, which supported comparisons between and within couples. Results: The systematic review yielded eight eligible studies, three quantitative and five qualitative studies. Review of the quantitative studies suggested couples reported poor relationship quality and partners reported more dyadic dissatisfaction and overall poorer relationship adjustment than the people with TBI. Analysis of the qualitative studies suggested there were significant variations in the way couples’ experience and respond to TBI. This included individual responses from the people with TBI, their partners or collectively as a couple, which influenced their relationship dynamics and also how they coped. The findings also drew attention to other contextual factors that influenced couples’ attributions and perceptions toward the TBI-related changes. Deductive and inductive analysis of the interviews in the qualitative empirical study identified three overarching themes: ‘You begin to realise that, actually, life may not be the same ever [again]…’; perceived influences on relationship endurance following TBI; and contextual and other factors. These explored the impact of TBI on couples’ relationships and the processes that interacted with or influenced their perceived relationship endurance. Conclusion: Although limited by a small number of eligible studies in the systematic review and small sample size in the qualitative empirical study, this thesis emphasized the importance of dyadic research for gaining a holistic understanding of couples’ experiences and relationships following TBI. This allows the complex interplay between the TBI, the person who has suffered the TBI, their partner and their relationship to be better understood. The interconnectedness between the individuals and how the difficulties are experienced raises possible issues for healthcare services around their views and approaches to the individual with TBI, their partner and the couple’s relationship during the recovery and rehabilitation journey