Understanding Health-related Quality of Life in Caregivers of Civilians and Service Members/Veterans With Traumatic Brain Injury: Establishing the Reliability and Validity of PROMIS Mental Health Measures

Arch Phys Med Rehabil. 2019 Apr;100(4S):S94-S101. doi: 10.1016/j.apmr.2018.05.021. Epub 2018 Jun 19.


Objective: To provide important reliability and validity data to support the use of the Patient-Reported Outcomes Measurement Information System (PROMIS) mental health measures in caregivers of civilians or service members/veterans (SMVs) with traumatic brain injury (TBI).

Design: Patient-reported outcome surveys administered through an electronic data collection platform.

Setting: Three TBI model systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility.

Participants: Caregivers (N=560) of individuals with a documented TBI (344 civilians and 216 military).

Intervention: Not applicable.

Main outcome measures: PROMIS anxiety, depression, and anger item banks.

Results: Internal consistency for all the PROMIS Mental Health item banks was very good (all α>.86) and 3-week test-retest reliability was good to adequate (ranged from .65 to .85). Convergent validity and discriminant validity of the PROMIS measures were also supported. Caregivers of individuals who were low functioning had worse emotional health-related quality of life (HRQOL) (as measured by the 3 PROMIS measures) than caregivers of high-functioning individuals, supporting known groups validity. Finally, levels of distress, as measured by the PROMIS measures, were elevated for those caring for low-functioning individuals in both samples (rates ranged from 26.2% to 43.6% for caregivers of low-functioning individuals).

Conclusions: Results support the reliability and validity of the PROMIS anxiety, depression, and anger item banks in caregivers of civilians and SMVs with TBI. Ultimately, these measures can be used to provide a standardized assessment of HRQOL because it relates to mental health in these caregivers.

Keywords: Anger; Anxiety; Caregiver; Depression; Emotion; Patient reported outcome measures; Psychometrics; Rehabilitation; Traumatic brain injury.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Validation Study

MeSH terms

  • Adult
  • Anger
  • Anxiety / diagnosis
  • Brain Injuries, Traumatic / psychology*
  • Brain Injuries, Traumatic / rehabilitation
  • Caregivers / psychology*
  • Depression / diagnosis
  • Female
  • Humans
  • Male
  • Middle Aged
  • Military Personnel / psychology
  • Patient Reported Outcome Measures
  • Psychometrics
  • Quality of Life / psychology*
  • Reproducibility of Results
  • Stress, Psychological / diagnosis*
  • Surveys and Questionnaires / standards*
  • Veterans / psychology