





























35

Graduate Student Journal of  Psychology 
2018, Vol. 17

Copyright 2018 by the Department of  Counseling and Clinical Psychology 
Teachers College, Columbia University

Effect of  Brain Injury on Post-Deployment Relationship 
Satisfaction in Veteran Couples
Savannah Grier1,2 and Deborah A. Perlick, Ph.D.2

1Department of  Counseling & Clinical Psychology, Teachers College, Columbia University, New York, NY 
2JJ Peters Department of  Veterans Affairs Medical Center and VISN 3 Mental Illness, 

Research, Education and Clinical Center, Bronx, NY and 
Department of  Psychiatry, Icahn School of  Medicine at Mount Sinai, New York, NY

Reintegration of  veterans from the Operation Enduring Freedom-Operation Iraqi Freedom (OEF/OIF) era 
presents numerous challenges for both the veteran and their partner, particularly when the veteran returns 
with physical and psychological injuries. The proposed study aims to explore the factors that affect relation-
ship satisfaction, including depression, emotion dysregulation, and communication patterns in OEF/OIF 
veterans with a history of  mild traumatic brain injury (mTBI) and their partners. Cross-sectional analyses 
were conducted to compare measures of  these factors between 35 veterans and 35 partners from Greater 
New York and Baltimore, MD. Initial analyses of  variance indicated that veterans were more likely to be more 
depressed and emotionally dysregulated, and less likely to engage in positive communication compared to 
partners. Hierarchical regression suggested that veterans were less likely to report relationship satisfaction 
when accounting for depression, emotion dysregulation, and positive interaction patterns. Partners were less 
likely to report relationship satisfaction only when accounting for depression. These cross-sectional analyses 
identify key areas that present challenges to OEF/OIF veterans reentering civilian life with their significant 
other, which could inform mental health services targeting military couples. Limitations and future directions 
are discussed.

Reintegration of  veterans from the Operation 
Enduring Freedom-Operation Iraqi Freedom (OEF/
OIF) era following multiple deployments and extended 
absence presents numerous challenges for both 
the veteran and their spouse or partner (Bowling & 
Sherman, 2008; Cohen et al., 2009). Traumatic brain 
injury (TBI) has been termed the ‘signature injury’ of  
returning OEF/OIF service members, affecting up to 
44% of  soldiers wounded in combat with 80–90% clas-
sified as mild (mTBI) (Hoge et al., 2008). This injury is 
defined by the VA/DOD Clinical Practice Guideline 
for Management of  Concussion/Mild Traumatic Brain 
Injury (Concussion/mTBI Guideline Working Group, 

2009) as an injury or concussion associated with at 
least one of  the following: brief  (< 30 minutes) loss 
of  consciousness, altered state of  consciousness or 
post-traumatic amnesia for < 24 hours following the 
injury. Moreover, veterans come home with a number of  
emotional wounds of  war that can disrupt the harmony 
of  the relationship such as posttraumatic stress disorder 
(PTSD) and depression (Bowling & Sherman, 2008), 
which often occurs in tandem with mTBI (Perlick et al., 
2014). Research suggests that veterans with a history 
of  TBI are 1.5 times more likely to die by suicide than 
veterans without a history of  TBI (Brenner et al., 2011). 
In addition, veteran depression has been linked to role 
uncertainty, poor marital adjustment and disturbed 
family functioning (Dekel & Monson, 2010).

Veterans with a history of  mTBI can also contend 
with impulsivity and emotion dysregulation, which can 
lead to serious ramifications within the couple. Studies 
of  combat veterans have found high rates of  marital 
distress and intimate partner violence reported by 54% 

Override (Hidden running head text):
Grier, Perlick
Effect of Brain Injury

Keywords: veterans, military couples, intimacy, PTSD, TBI
Acknowledgements: This study is supported by VA Merit Award 

1I01RX001106 from the VA Office of  Research & Development 
and the VISN 3 MIRECC.

Please address correspondence regarding this article to: 
savannah.grier@gmail.com



36

GRIER, PERLICK

of  OEF/OIF couples (Dekel, & Monson, 2010). As 
a result of  the veteran’s impaired interpersonal skills, 
both those with TBI and their family members expe-
rience a “shrinking of  support networks” (LoBello 
et al., 2003), reducing the couple’s ability for enjoy-
ment and companionship which might provide a 
buffer against the challenges of  reintegration. Low 
spousal relationship satisfaction has been associated 
with poor socio-emotional skills, particularly empathic 
ability, which is a common sequela of  TBI (Burridge 
et al., 2007). Furthermore, military couples often must 
re-establish relationship routines, reallocate household 
responsibilities, renegotiate parental roles in caregiv-
ing and discipline, while addressing financial strain and 
reconnecting emotionally (Gerwitz et al., 2010). As 
such, studies have found that TBI has a more negative 
impact on spouses than on other caregivers, supported 
by high rates of  marital distress and intimate partner 
violence, reported by 54% of  OEF/OIF couples (Dekel, 
& Monson, 2010).

While there is a growing body of  research estab-
lishing the validity and efficacy of  family and couples 
interventions tailored specifically to the OEF/OIF 
cohort, targeting PTSD, depression, and relationship 
functioning post-deployment (Monson et al., 2008; 
Sautter et al., 2011; Schumm et al., 2013; Sherman 
et al., 2009; 2012), there has yet to be an evidence-
based intervention developed to specifically meet the 
needs of  veterans with a history of  mTBI and their 
partners. Rodgers et al. (2007) adapted the multifamily 
group (MFG) model (Macfarlane, 2002) for civilian TBI 
and family members, which was then recently adapted 
by Perlick et al. (2014) in a pilot study for veterans 
with a history of  mTBI and their partners. Perlick et al. 
(2014) found overall increases in caregivers’ feelings of  
empowerment, greater occupational activity and inter-
personal relationships on the part of  the veteran, and 
decreases in veteran anger and depressive symptoms. 
Furthermore, participants noted that the group helped 
to reduce feelings of  isolation by providing a space 
to discuss common struggles and aided in restoring 
relationships through communication and under-
standing (Straits-Tröster et al., 2014). These promising 
results prompted the researchers to develop and test 
a multifamily group treatment for mTBI in military 
couples in a randomized controlled trial. The interven-
tion would address problem-solving challenges due to 

compromised executive functioning, emotion dysregu-
lation, and challenges related to couples communication. 
Although the study’s test groups are still underway, there 
has already been meaningful data collected from the 
enrolled participants that could provide some insight 
to the challenges military couples from the OEF/OIF 
era are facing post-deployment.

The current study aims to explore the relationship 
among depression, emotion regulation, communica-
tion patterns, and relationship satisfaction in OEF/
OIF veterans with a history of  mTBI and their part-
ners. Cross-sectional data collected will be analyzed to 
compare these constructs between veterans and part-
ners and to define the variables that predict relationship 
satisfaction. We hypothesize that veterans will score 
higher on measures of  depression, emotion regula-
tion, and conflict communication patterns compared 
to partners. Moreover, we hypothesize that depres-
sion, emotion regulation, and communication patterns 
will significantly predict relationship satisfaction when 
controlling for each variable. In examining these factors, 
we hope to illuminate the constellation of  constructs 
that better predict relationship satisfaction in OEF/OIF 
veterans with mTBI.

Method

Participants and Procedure
A sample was drawn from an ongoing larger 

randomized controlled trial, which aims to expand upon 
Perlick et al.’s (2014) MFG adaptation for veterans with 
mTBI and their partners. These participants, 35 veterans 
and 35 partners, were recruited via clinician or program 
director referrals from the TBI/Polytrauma clinics, 
OEF/OIF centers, and Caregiver Support Groups 
from the James J. Peters VA Medical Center, VA New 
York Harbor Healthcare System, and VA Maryland 
Healthcare System. Because mTBI often overlaps with 
other conditions, the inclusion criteria were selected to 
ensure veterans met diagnostic criteria for mTBI that 
could only be explained by combat exposure in Iraq 
or Afghanistan. Thus, veterans who had other neuro-
logical conditions that either exacerbated the mTBI (i.e., 
borderline moderate) or better explained the mTBI were 
screened out. The previous MFG adaptation for this 
population found a significant cognitive gap between 
veterans with mTBI versus those with a moderate TBI, 



37

EFFECT OF BRAIN INJURY

which would have disrupted treatment (Perlick et al., 
2014). For this reason, veterans were only included if  
they received a diagnosis for mild TBI. A detailed list of  
inclusion and exclusion criteria can be found in Table 1. 
Couples read and signed separate informed consent 
forms prior to completing the screening and baseline 
assessment. Veterans and partners were assessed sepa-
rately in private offices. Couples were compensated $90 
for completion of  the assessment battery.

Materials
Depression. The Center for Epidemiologic Studies 

Depression scale (CES-D; Radloff, 1977) is a 20-item self-
report measure of  depressive symptoms. Participants 
indicated the extent to which items applied to them-
selves within the past weeks on a scale of  0 (rarely or 
none of  the time) to 3 (most or all of  the time). Sample 
items include “I had crying spells,” “I felt sad,” and “I felt 
hopeful about the future.” Radloff  (1977) found high 
internal consistency (Cronbach’s α = .90).

Table 1

Inclusion criteria for veterans

• Deployment-related mTBI, confirmed by the VA TBI Identification Clinical Interview (Vanderploeg et al., 2012) 
and in accordance with the VA/DOD Clinical Practice Guideline for Management of Concussion/Mild Traumatic 
Brain Injury: injury or concussion associated with at least one of the following: brief (< 30 minutes) loss of 
consciousness or altered state of consciousness or post-traumatic amnesia for < 24 hours following the injury

• OEF/OIF era

• No pre-existing neurologic condition(s) (head trauma unrelated to deployment, seizures, strokes, neurosurgery, 
other neurologic impairments based on medical record or self-report)

• No severe cognitive deficits, as defined by a Montreal Cognitive Assessment (MoCA; Nasreddine, 2005) score 
≥ 19. The 30-item MoCA screens for impairment in specific areas of cognitive functioning deemed necessary 
for participation in a 90-minute, structured group including attention and concentration, executive functions, 
language and conceptual thinking. We have specified a MoCA cut-off at the lower end of the range for mild 
cognitive dysfunction (≥ 19), in order to exclude Veterans with severe memory and/or other cognitive deficits, 
while admitting those with more mild deficits, as these represent our target population, i.e., Veterans with a 
history of mTBI

Inclusion criteria for veterans and partners

• Currently married or cohabitating with a partner for 6+ months
• 18 years old or older
• No current alcohol or drug abuse or dependence defined by a Short Michigan Alcoholism Screening Test (SMAST; 

Selzer, 1975) ≥ 3, based on the recommended cut-off for TBI survivors (Gentilello et al., 1995) or a Drug Abuse 
Screening Test-10 (DAST-10; Skinner, 1982) ≥ 3l

• No life diagnosis of a psychotic disorder or active psychosis (schizophrenia, schizoaffective or bipolar disorder) 
or active psychosis based on the Structured Clinical Interview for DSM-IV-TR (SCID-L; First et al., 2007)

• Absence of “severe” inter-partner violence as defined by the revised 20-item Conflict Tactics Scale Short Form 
(CTS2S) (Straus & Douglas, 2004)

• No suicide attempt (actual, aborted, or interrupted) within the past six months indicated on the Columbia Suicide 
Severity Rating scale (C-SSRS)

• Absence of medical condition or life event (e.g., ongoing or pending legal action in another state) that would 
compromise participation

• No participation in another psychosocial intervention trial or couples’ treatment six months prior to or during 
study or follow-up.



38

GRIER, PERLICK

Emotion dysregulation. The Difficulties in 
Emotional Regulation (DERS; Gratz & Roemer, 2004) 
is a 41-item self-report measure that assesses emotion 
dysregulation across the following dimensions of  
emotion regulation: (a) awareness and understanding of  
emotions; (b) acceptance of  emotions; (c) the ability to 
engage in goal-directed behavior and refrain from impul-
sive behavior, when experiencing negative emotions; 
and (d) access to emotion regulation strategies perceived 
as effective. Participants were asked to rate the extent of  
which items apply to themselves, with responses ranging 
from 1 (almost never) to 5 (almost always). Cronbach’s 
alpha was .93 (Gratz & Roemer, 2004).

Communication. The Communication Patterns 
Questionnaire (CPQ; Christensen & Sullaway, 1984), is a 
35-item self-report measure of  conflict communication 
that addresses partners’ behavior during three stages of  
an argument: (a) when some problem in the relation-
ship arises; (b) during a discussion of  a relationship 
problem; and (c) after a discussion of  a relationship 
problem. The participants’ scores are factored into three 
subscales: demand/withdraw, high conflict, and positive 
interaction. Christensen (1988) found a relatively high 
agreement between partners’ independent reports for 
these three subscales (r’s above .70). In addition, he 
found that positive interaction and demand/withdraw 
communication subscales were significantly related to 
marital adjustment in the expected direction.

Relationship Satisfaction. The Dyadic Adjustment 
Scale (DAS; Spanier, 1976) is a 32-item measure of  
relationship quality in married or unmarried cohabit-
ing couples. Participants are asked to rate 30 questions 
relating to various aspects of  intimacy and relationship 
satisfaction on a Likert scale and 2 questions with “yes/
no” responses (e.g., “Has either of  the following been 
problems in the relationship in the past month?”). The 
entire scale’s Cronbach’s α was .96 (Spanier, 1976).

Data Analysis
To test the first hypothesis, one-way analyses of  vari-

ance (ANOVA) were conducted to compare scores on 
CES-D, DERS, CPQ, and DAS between veterans and 
partners to examine differences in depression, emotion 
dysregulation, communication patterns, and relationship 
satisfaction, respectively. Hierarchical regression models 
were run to determine statistical predictive significance 
of  the above measures in the veteran sample and partner 

sample to test whether depression, emotion regulation, 
and communication patterns predicted relationship 
satisfaction. Predictors that were statistically significant 
at an alpha level of  .05 were retained for further analysis. 
Three multivariate linear regression models were used 
to analyze the predictive power of  these variables sepa-
rately and together, when controlling for each other. As 
a result, the models could delineate whether all predic-
tors better explained variance in relationship satisfaction, 
as hypothesized, or if  there were any significant predic-
tors independent of  the others.

Results

Table 2 presents demographic characteristics of  the 
veteran and partner sample. Data from 70 participants 
(i.e., 35 couples) were used in the current investigation.

Findings suggest that veterans scored significantly 
higher on measures of  depression (F(1, 63) = 18.86, 
p < .01) and emotion dysregulation (F(1, 63) = 25.85, 
p < .01) and lower on positive interaction patterns 
(F(1, 63) = 7.44, p < .05) compared to partners. These 
results partially support the first hypothesis, which states 
that veterans would score higher on measures of  depres-
sion and emotion dysregulation. While veterans scored 
significantly higher on each subscale of  emotion dysreg-
ulation (see Table 3), no significant findings emerged 
from the high conflict CPQ subscale. Furthermore, no 
significant differences were found in veterans’ and part-
ners’ scores of  relationship satisfaction. Medium to large 
effect sizes were observed. Overall, these initial results 
suggest that there are significant differences in depres-
sion, emotional regulation, and positive communication 
patterns when comparing veterans to their partners.

To test our second hypothesis, an incremental test 
was run to determine the potential predictive power of  
each measure and the subscales within the DERS and 
CPQ, specifically. Results suggested that the following 
measures reached statistical significance: the DERS non-
acceptance of  emotional responses (NONACCEPT) 
subscale, the CPQ positive interaction subscale, the 
CES-D, and the DAS. As such, only these variables 
were used in subsequent multivariate regression analyses.

The findings of  these final regression runs partially 
supported our second hypothesis in that all three 
constructs were significant predictors of  relation-
ship satisfaction in veterans but not partners. Table 4 



39

EFFECT OF BRAIN INJURY

summarizes the findings of  three regression models 
run to test whether accounting for the above covariates 
predicts relationship satisfaction. For veterans, all three 
regression equations reached statistical significance 
suggesting that variance in relationship satisfaction is 
better explained when accounting for greater depres-
sion (β = -.65, t(24) = -4.80, p < .01), greater emotional 
non-acceptance (β = .45, t(24) = 3.47, p < .01), and 
fewer positive interaction patterns (β = .57, t(24) = 5.15, 
p < .01). However, the depression-only regression 

equation was the only model to reach significance for 
partners (β = -.55, t(23) = -3.14, p < .01), suggesting 
that depression predicts relationship satisfaction while 
non-acceptance of  emotional responses and positive 
interaction patterns do not play a considerable role.

Discussion

The current study assessed common factors affect-
ing veterans with a history of  mTBI and their partners, 

Table 2
Participant Demographics

Veterans (N = 35) n (%) Partners (N = 35) n (%)

Age (x̅ ± s.d.) 35.60 (8.545) Age (x̅ ± s.d.) 34.41 (9.74)

Gender
Male 33 (94)

Gender
Female 32 (91)

Race
Black
White
Multiracial
Native American

16 (46)
17 (48)
1 (3)
1 (3)

Race
Black 
White 
Asian 
Multiracial 
East Indian 
Unknown

13 (37)
17 (49)
1 (3)
2 (6)
1 (3)
1 (3)

Ethnicity
Hispanic 
Non-Hispanic 
Missing

12 (35) 
22 (63) 
1 (3)

Ethnicity
Hispanic 
Non-Hispanic

8 (24) 
26 (76)

Education
Completed college and/or beyond
Completed 12th grade or GED
Missing

6 (17)
26 (74)
3 (9)

Education
Completed college and/or beyond
Completed 12th grade or GED
Completed 8th grade

17 (49)
17 (48)
1 (3)

Employment Status
Full time
Unemployed
Retired
Student
Missing

12 (34)
11 (31)
3 (9)
7 (20)
2 (6)

Employment Status
Full time
Part time
Unemployed
Retired
Student

12 (34)
5 (14)
11 (31)
1 (3)
6 (17)

Couples (N = 35)

Marital Status
Married
Cohabiting
Engaged

22 (62)
11 (31)
2 (7)



40

GRIER, PERLICK

hypothesizing that depression, emotion dysregulation, 
and communication patterns were key predictors of  
relationship satisfaction. Initial analyses suggested veter-
ans were significantly more depressed, more emotionally 
dysregulated, and less likely to engage in positive inter-
action patterns compared to partners. Hierarchical 
regression models then determined the specific 
constructs that significantly predicted relationship satis-
faction. Finally, multivariate linear regression modeling 
showed that veterans who were more depressed, less 
likely to accept their emotional responses, and less likely 
to engage in positive interaction patterns reported less 
relationship satisfaction. For partners, depression was 
the only factor that significantly predicted relationship 
satisfaction, with greater depression leading to lower 
relationship satisfaction.

These results potentially inform future studies 
examining relationship difficulties post-deployment. 
Among spouses, research has shown that caregiver 
burden generally increases over time after TBI and is 
sustained 7 years post-injury (Blais & Boisvert, 2005). 
In line with the results, relationship satisfaction and 
positive communication patterns could be important 
factors leading to decreases in caregiver burden, which 
are changes targeted in future analysis upon completion 
of  the current study. Interviews with partners of  veter-
ans with mTBI have also demonstrated the therapeutic 
qualities of  better communication and understanding 
within the relationship, particularly when emotions run 
high (Straits-Tröster et al., 2014). This study demon-
strated that veterans who have sustained a mTBI 
struggle with emotion regulation difficulties post-injury 

Table 3
Characteristics of veterans on emotion regulation, depression, and communication vs. partners

Veteran (N = 35) Partner (N = 35)

Measure M(SD) M(SD) Cohen’s d r

Depressiona 23.65 (14.12)** 11.06 (8.1) 1.09 .48**

Emotion Dysregulationb

Non-Acceptance 15.65 (7.29)** 11.24 (5.06) .70 .33**
Goal-Directed Behavior 17.9 (5.53)** 10.64 (4.62) 1.42 .58** 
Impulse 15.12 (6.96)** 9.45 (3.64) 1.02 .45**
Awareness 17.35 (5.18)* 14.34 (6.24) .52 .25*
Strategies 20.56 (8.06)** 12.94 (4.56) 1.16 .5**
Clarity 12.56 (4.94)** 8.64 (2.70) .98 .44**
Total 99.15 (28.66)** 67.09 (20.41) 1.29 .54**

Communication Patternsc

High Conflict 14.88 (5.60) 12.87 (6.93) .32 .16
Demand/Withdraw 18.81 (5.63) 17.10 (6.58) .28 .14
Positive Interaction 17.97 (5.40)* 21.30 (4.69) -.66 -.31*

Relationship Satisfactiond 103.20 (20.86) 110.90 (17.22) -.40 -0.20
a Measured by Center for Epidemiological Studies Depression scale; higher scores indicate higher levels of 
self-reported depressive symptoms.
b Measured by Difficulties in Emotion Regulation scale; higher scores indicate greater self-reported emotion dysregulation.
c Measured by the Communication Patterns Questionnaire; higher scores indicate greater self-reported use of pattern.
d Measured by the Dyadic Adjustment Scale; higher scores indicate greater self-reported relationship satisfaction.

*p ≤ .05. **p ≤ .01.



41

EFFECT OF BRAIN INJURY

compared to their romantic partners, which could help 
explain caregiver burden in terms of  how partners must 
navigate explosive tempers, emotional numbing, and 
isolation. In sum, this study provides preliminary data 
on the predictive value of  specific factors related to 
problem areas for military couples, which can then lead 
to more causal explorations of  the types of  treatment 
that effectively target and treat these post-deployment 
challenges related to reintegration and reestablishing 
intimate relationships.

Limitations
The following study has several limitations that 

affect the generalizability of  the results. A major limi-
tation arises from the homogeneity of  gender in the 
veteran sample and the partner sample, which are nearly 
exclusively male and female, respectively. Studies suggest 
that women are almost twice as likely to suffer from 
depression compared to men of  the same age (Pratt & 
Brody, 2008). As such, it remains unclear whether the 

results relating to depression in partners is a function 
of  their relationship to the veteran or to the majority 
of  partners identifying as women. In the larger social 
context, men are also often expected to limit their range 
of  emotions, while women are expected to be highly 
emotional and communicative of  their feelings (Plant 
et al., 2000). Thus, the near-exclusive male status of  
the veteran cohort cannot be ruled out as a possible 
explanation for the differences in emotional acceptance 
and positive interaction patterns compared to partners. 
As the larger study continues and sample size increases, 
efforts to disperse gender differences among the veteran 
and partner samples will hopefully dilute any biases that 
are likely to confound the results related to depression, 
emotional acceptance, and communication patterns.

In addition, the study did not account for the possi-
ble confound of  comorbidity. Specifically, veterans who 
have sustained a mTBI not only tend to suffer from 
depression and/or PTSD, but also from cognitive and 
neurologic challenges. The neuropsychiatric sequelae 

Table 4
Summary of hierarchical regression analysis for variables predicting relationship satisfaction

Veteran (N = 35) Model 1 Model 2 Model 3

Variable B SE B β B SE B β B SE B β

Depression -.92 .23 -.61 -1.3 .27 -.86** -.98 .20 -.64**
Non-acceptance of 
emotions 1.19 .51 .42* 1.24 .36 .44*

Positive interactions 2.21 .43 .57**
R2 .369 .479 .748
F for change in R2 15.81** 5.49* 26.68**

Partners (N = 35) Model 1 Model 2 Model 3

Variable B SE B β B SE B β B SE B β

Depression -1.2 .40 -.55** -1.33 .44 -.59** -1.20 .55 -.53
Non-acceptance of 
emotions .40 .76 .10 .45 .79 .12

Positive interactions .37 .88 .10
R2 .30 .309 .315
F for change in R2 9.88** .27 .17

*p < .05. **p < .01.



42

GRIER, PERLICK

of  mTBI may include cognitive dysfunctions (problems 
in memory, attention, executive functions, affect recog-
nition, empathy, self-awareness) as well as comorbid 
mood, posttraumatic stress and other neurobehavioral 
disorders (Halbauer et al., 2009; Cicerone et al., 2006; 
Wehman et al., 2009; Huckans et al., 2010). As such, 
the interaction between the neuropsychiatric sequelae 
and mood or anxiety disorders could be the defining 
characteristic that leads to greater emotion dysregula-
tion, which then leads to lower relationship satisfaction. 
The present study does not allow for us to discount the 
possibility that mTBI is exclusively responsible for the 
factors explored in the current study. While exclusion 
criteria filtered those veterans with more severe cognitive 
impairments, the study did not completely rule out the 
possible effects of  the aforementioned comorbidities 
in the relationship among emotional and interpersonal 
factors that predict relationship satisfaction.

Finally, the study only compares veterans post-injury 
with their civilian partners, which does not account for 
the veterans’ overall character and disposition before 
the injury occurred. In addition, many of  the partners 
did not know the veteran pre-injury and thus could 
not provide reliable data as to the nature of  the rela-
tionship before the veteran sustained the mTBI. The 
current study’s findings would have been strengthened 
with an additional cohort of  veterans without mTBI 
and their partners to control for related factors that 
may better explain the variance in relational difficul-
ties, such as preexisting mood disorders or turbulent 
personal history. Thus, this study cannot rule out the 
possible influence of  extraneous variables based on the 
findings of  the current sample.

Conclusion

This preliminary study of  the factors that contrib-
ute to relationship satisfaction identified several 
key areas that can present challenges to OEF/OIF 
veterans reentering civilian life with their significant 
other. Combat-related TBI is accompanied by vari-
ous sequelae that affect the quality of  relationships, 
such as depression, difficulties in emotion regula-
tion and maladaptive communication patterns, which 
can compromise relationship satisfaction. However, 
in knowing the detrimental factors the study also 
identified possible protective factors that could help 

sustain relationship satisfaction and wellbeing, such 
as the potential for improvement through encouraging 
acceptance of  the veteran’s emotional responses and 
engaging in positive communication patterns. Moving 
forward, this study provides the framework for future 
expansions of  the data as sample size increases and 
post-intervention data becomes available, which would 
elucidate the longitudinal effects of  multifamily group 
for OEF/OIF veteran couples.

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