J Head Trauma Rehabil Vol. 27, No. 1, pp. 3–13 Copyright c  2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Invisible Side of War: Families Caring for US Service Members With Traumatic Brain Injuries and Polytrauma Joan M. Griffin, PhD; Greta Friedemann-S ´ anchez, PhD; Agnes C. Jensen, BS; Brent C. Taylor, PhD; Amy Gravely, MA; Barbara Clothier, MA, MS; Alisha Baines Simon, MS; Ann Bangerter, BA; Treven Pickett, PsyD; Christina Thors, PhD; Sherry Ceperich, PhD; John Poole, PhD; Michelle van Ryn, PhD Objectives: To (1) identify informal caregivers to injured US service members following acute rehabilitation for polytraumatic injuries, principally traumatic brain injury (TBI), and (2) describe the prevalence and variation of care recipient and caregiver experiences. Design: Cross-sectional survey of caregivers. Participants: Caregivers (N = 564) of service members with TBI who received inpatient rehabilitation care in a Veterans Affairs’ Polytrauma Rehabilitation Center between 2001 and 2009. Main Outcome Measures: Questions about caregiver and patient characteristics, type, and quantity of care currently being provided. Results: Caregiving responsibilities fall primarily on women (79%), typically a parent (62%) or spouse (32%). After a median 4 years since injury, 22% of patients still required assistance with activities of daily living and instrumental activities of daily living. An additional 48% required assistance with only instrumental activities of daily living. Nearly 25% of caregivers reported more than 40 h/wk of care and another 20% reported 5 to 40 h/wk of care. Of caregivers providing assistance with activities of daily living, 49% provided care ≥80 h/wk. Nearly 60% of caregivers were solely responsible for the caregiving. Most caregivers also reported providing other help, including managing emotions and navigating health and legal systems. Conclusions: Caregivers who provide assistance with either activities of daily living or instrumental activities of daily living may need additional resources to meet the long-term needs of their injured family member. Keywords: polytrauma, caregiving, families, traumatic brain injury, veterans Author Affiliations: Center for Chronic Disease Outcomes Research, Department of Veterans Affairs Health Care System, Minneapolis, Minnesota (Drs Griffin and Taylor and Mss Jensen, Gravely, Clothier, Simon, and Bangerter); Department of Medicine, University of Minnesota Medical School, Minneapolis (Drs Griffin and Taylor); Humphrey School of Public Affairs, University of Minnesota, Minneapolis (Dr Friedemann-S ´ anchez); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (Dr Taylor); Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia (Drs Pickett and Ceperich); Departments of Psychiatry and PM&R, Virginia Commonwealth University School of Medicine, and Department of Psychology, Virginia Commonwealth University, Richmond (Dr Pickett); James A. Haley Veterans’ Hospital, Tampa, Florida (Dr Thors); Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Dr Poole); and Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis (Dr van Ryn). This research was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development and a grant from the Health Services Research and Development (HSR&D) service (SDR-07- 044). The findings and conclusions presented in this manuscript are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or HSR&D. The sponsor was not involved in any aspect of the study’s design and conduct; data collection, management, analysis, or interpretation of data; or the preparation, review, or approval of the manuscript. T RAUMATIC BRAIN INJURY (TBI) is now con- sidered the signature injury of wars in Iraq (Opera- tion Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]). 1 At least 22% of US Army soldiers returning from these wars are estimated to have The authors certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on them or on any organization with which they are associated. They certify that all financial and material support for this research work is clearly identified in the title page of the manuscript. The manuscript submitted does not contain information about medical devices. The authors thank the family caregivers who participated in this study. Data used in this article have been presented at AcademyHealth, June 2010, and North American Brain Injury Society, October 2010. The authors declare no conflicts of interest. Corresponding Author: Joan M. Griffin, PhD, Center for Chronic Disease Outcomes Research, One Veterans Dr, Mailstop 110, Minneapolis VA Med- ical Center, Minneapolis, MN 55417 (joan.griffin2@va.gov). DOI: 10.1097/HTR.0b013e3182274260 Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. 3