Perceived care partner burden at 1-year post-injury and associations with emotional awareness, functioning, and empathy after TBI: A TBI model systems study

Daniel W. Klyce, Kritzianel Merced, Alexander Erickson, Dawn M. Neumann, Flora M. Hammond, Angelle M. Sander, Jennifer A. Bogner, Tamara Bushnik, Joyce S. Chung, Jacob A. Finn

Research output: Contribution to journalArticlepeer-review


BACKGROUND: People with traumatic brain injury (TBI) can lack awareness of their own emotions and often have problems with emotion dysregulation, affective disorders, and empathy deficits. These impairments are known to impact psychosocial behaviors and may contribute to the burden experienced by care partners of individuals with TBI. OBJECTIVE: To examine the associations of emotional awareness, emotional functioning, and empathy among participants with TBI with care partner burden. METHOD: This multisite, cross-sectional, observational study used data from 90 dyads (participants with TBI and their care partner) 1-year post-injury. Participants with TBI completed the Difficulty with Emotional Regulation Scale (DERS; Awareness, Clarity, Goals, Impulse, Nonacceptance, and Strategies subscales); PTSD Checklist-Civilian Version; NIH Toolbox Anger-Affect, Hostility and Aggression Subdomains; PHQ-9; GAD-7; and the Interpersonal Reactivity Index (empathic concern and perspective taking subscales). Care partners completed the Zarit Burden Inventory (ZBI) and provided demographic information. RESULTS: Care partners were predominately female (77%), and most were either a spouse/partner (55.2%) or parent (34.4%). In an unadjusted model that included assessments of emotional awareness, emotional functioning, and empathy of the participant with TBI, the DERS-Awareness and NIH-Hostility subscales accounted for a significant amount of variance associated with care partner burden. These findings persisted after adjusting for care partner age, relationship, education, and the functional status of the participant with TBI (β=0.493 and β=0.328, respectively). CONCLUSION: These findings suggest that high levels of hostility and low emotional self-awareness can significantly affect the burden felt by TBI care partners.

Original languageEnglish (US)
Pages (from-to)59-69
Number of pages11
Issue number1
StatePublished - 2023

Bibliographical note

Funding Information:
This research was supported by grants from the US Department of Health and Human Services (HHS), Administration for Community Living’s (ACL) National Institute for Disability, Independent Living, and Rehabilitation Research (NIDILRR), 90DPTB0002 (Indiana University), 90DPTB0001 (The Ohio State University), 90DPTB0016 (TIRR Memorial Herman), and 90DPTB0010 (New York University Langone Health). The contents of this article do not necessarily represent the policy of the NIDILRR, ACL, or HHS, and you should not assume endorsement by the federal government. Other contributions to this manuscript are the result of work supported with resources and the use of facilities at the Central Virginia VA Health Care System (Richmond, VA), Minneapolis VA Health Care System (Minneapolis, MN), and VA Palo Alto Health Care System (Palo Alto, CA). The views, opinions, and/or findings contained in this article are those of the authors and should not be construed as an official US Department of Veterans Affairs or other federal agency position, policy, or decision unless so designated by other official documentation.

Publisher Copyright:
© 2023-IOS Press. All rights reserved.


  • alexithymia
  • caregiving
  • emotional awareness
  • Traumatic brain injury

PubMed: MeSH publication types

  • Observational Study
  • Journal Article


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