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Traumatic Brain Injury: A Hidden Consequence for Battered Women
Abstract
The inability of substantial numbers of battered women to terminate or extricate themselves from violent relationships is of grave concern to clinical practitioners. Despite professional intervention, many victims of domestic violence return to the batterer and to repetitive battering, demonstrating that, for these women, traditional psychosocial interventions are ineffective. In a sample of 53 battered women, 92% reported having received blows to the head in the course of their battering; 40% reported loss of consciousness. Correlations between frequency of being hit in the head and severity of cognitive symptoms were significant, strongly suggesting that battered women should be routinely screened for traumatic brain injury and postconcussive syndrome. Development of treatment strategies to address the potentially damaging sequelae of head trauma in this population is essential. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... 19 The Center nurse obtained ABI (mTBI and/or HBI) history from all these survivors reporting partner physical abuse to head/neck/face and then screened them for potential mTBI using the HELPS questionnaire. 29 The survivors were also screened for potential strangulation using the Danger Assessment-Revised (DA-R) tool. 30 Survivors included male and female victims of IPV visiting a Justice Center, aged 15 to 90 years, and reporting at least 1 incident of physical abuse by a current or former partner within the past 60 days of the initial visit to the Center. ...
... The original HELPS is a 5-item screening questionnaire to identify possible victims of mTBI needing an indepth neuropsychological assessment. 29,31 Although the psychometric properties of the original HELPS have not been established, it includes parameters outlined in the American Congress of Rehabilitation Medicine guidelines to establish the presence of mTBI. 29,32,33 Previously, the HELPS has successfully identified the presence of mTBI in the IPV population. ...
... 29,31 Although the psychometric properties of the original HELPS have not been established, it includes parameters outlined in the American Congress of Rehabilitation Medicine guidelines to establish the presence of mTBI. 29,32,33 Previously, the HELPS has successfully identified the presence of mTBI in the IPV population. 29,34 It includes questions about history of head injury (Q1), requiring emergency medical services (Q2), alteration in mental status (Q3), presence of mTBI-related symptoms (Q4), and health issues due to mTBI (Q5). ...
Objective:
The recent United States Government Accountability Office report highlights the need for improved data on the prevalence of intimate partner violence (IPV)-related acquired brain injury (ABI) to help direct Health & Human Services public efforts. This article identifies the prevalence and risk factors for IPV-related ABI among survivors of IPV at a Justice Center in New York.
Setting:
Community Justice Center.
Participants:
Forty survivors of IPV, aged 17 to 73 years (median 32, interquartile range: 25.25, 42) were assessed within 60 days of sustaining physical violence.
Design:
Retrospective chart review.
Main measures:
The HELPS and the Danger Assessment-Revised were used at the initial Center visit.
Results:
Of the 40 physical IPV survivors screened, all (100%) reported a prior history of partner-induced ABI within the past 60 days. Thirty-seven (92.5%) survivors also reported sustaining at least 1 potential hypoxic brain injury from strangulation. However, only 16 (40%) survivors screened positive on the HELPS for a history of IPV-related mild traumatic brain injury. Females (95%) and individuals with low income (67.5%) largely comprised our sample. Compared with the County's average, the proportion of African Americans/Blacks and refugees was 227% higher (42.5% vs 13%) and 650% higher (7.5% vs 1.09%), respectively. Refugee status (P = .017) also correlated with number of previous ABIs. On an exploratory binary logistic regression with stepwise selection, only balance difficulties (P = .023) and difficulty concentrating/remembering (P = .009) predicted a positive screen for mild traumatic brain injury.
Conclusions:
Consistent with previous findings, our data indicate a high prevalence of IPV-related ABI among visitors to a New York Justice Center. An overrepresentation of African Americans/Blacks and refugees in our sample relative to the region signified a higher prevalence of IPV in these populations and warrants a provision of more trauma-informed ABI resources to these groups/communities. Intimate partner violence survivors visiting Justice Centers should be screened for motor/neurocognitive symptoms suggestive of mild traumatic brain injury. Further research to identify the prevalence and risk factors of IPV-related ABI statewide and nationwide is urgently needed to improve resource allocation and clinical management.
... There is strong evidence linking trauma in particular to adverse physical health symptoms-particularly among those victims who experience abuse across the lifespan (i.e., both in childhood and adulthood; Kendall-Tackett, 2009;Kendall-Tackett et al., 2003;Van Houdenhove et al., 2009). IPV victims are at an increased risk for a range of physical health issues, such as chronic pain (e.g., Dillon et al., 2013;Vives-Cases et al., 2011), cardiovascular symptoms (e.g., hypertension and chest pains; Breiding et al., 2008;Mason et al., 2012), gastrointestinal symptoms/disorders (e.g., Bonomi et al., 2009), seizures/epilepsy (Coker et al., 2000), back pain/issues (e.g., Coker et al., 2005), brain/head injuries (e.g., Gagnon and DePrince, 2017;Jackson et al., 2002), headaches/migraines (e.g., Coker et al., 2000), and type II diabetes (e.g., Mason et al., 2013). Although some adverse physical health symptoms may be attributed to injuries from the actual IPV itself, there is a clear relationship between trauma, such as PTSD, and physical health problems. ...
... Participant physical health was assessed using a list of nine health problems based on health symptoms included in previous studies examining physical health consequences of IPV (e.g., Breiding et al., 2008;Coker et al., 2000). The list also included the addition of a brain/head injury item given evidence of a high occurrence of head injuries among IPV victims (Gagnon and DePrince, 2017;Jackson et al., 2002). Specifically, participants were asked, "Which of the following health problems have you experienced in the past 12 months? ...
... Notably, all five of these health issues are neurological-related (or adjacent) issues: pain, seizures/epilepsy, back problems, brain/head injury, and headaches/migraines (see Fig. 1). Although each of these health issues has been observed in other IPV samples (e.g., Coker et al., 2000Coker et al., , 2005Dillon et al., 2013;Gagnon and DePrince, 2017;Jackson et al., 2002;Vives-Cases et al., 2011), it is important to note that some of the earliest work examining the link between trauma and physical health focused on chronic pain (e.g., Gross, et al., 1980;Kendall-Tackett, 2009) and that the relationship between trauma and chronic pain has been well-documented in the literature. Chronic pain syndromes, such as fibromyalgia, are particularly likely among those who experience lifelong patterns of re-victimization (Van Houdenhove et al., 2009). ...
Rationale
The negative physical and mental health consequences of intimate partner violence (IPV) have been well-documented, as those who are exposed to trauma experience more physical health issues. Further, an abuser’s direct access to a firearm drastically increases the risk for fatality, which can exacerbate ongoing stress and trauma in an abusive relationship. However, very little research has investigated the intersection of exposure to firearms and adverse health outcomes in the context of IPV. Objective. This study investigates the sensitivity of firearm exposure in IPV contexts by examining if abusive partner firearm ownership—regardless of actual use of a gun in the abuse—is associated with negative health outcomes. Methods. The research team administered questionnaires to IPV victims (N = 215) from six domestic violence shelters across rural and urban locations in a single state. Results. Having an abusive partner who owned a firearm was associated with significantly worse physical health—above and beyond IPV experienced in the relationship. Even so, IPV involving firearms was not significantly associated with physical health beyond partner firearm ownership. The relationship between partner firearm ownership and negative health outcomes was primarily attenuated by sleep disturbances among victims. Conclusions. The results provide initial information about the role that firearms play in adverse victim health beyond injuries (e.g., gunshot wounds) and fatalities.
... Perceived cognitive functioning, although not a direct measure of objective neuropsychological performance, is relevant due to its relationship to quality of daily living and social functioning (Kennedy et al., 2001). Of the studies conducted on female survivors of IPV and self-reported cognitive functioning, findings demonstrate that many women report frequent and severe cognitive problems in the domains of memory, concentration, and attention (Kennedy et al., 2007;Jackson et al., 2002). In terms of variables related to self-reported cognition, greater perceived impairment has been linked to higher levels of psychological abuse (Straight et al., 2003), sexual coercion, depression, and PTSD (Kennedy et al., 2001). ...
... A cross-cultural approach is warranted due to cultural differences in how sequelae are manifested following traumatic events (Jobson & O'Kearney, 2008). Due to the limited generalizability of these studies, it has thus been recommended to replicate with a more diverse sample of female survivors from a variety of settings (Jackson et al., 2002). Further, depression and PTSD are the only variables related to mental health that have been studied in relation to perceived cognitive abilities (Kennedy et al., 2001). ...
... depression, generalized anxiety, and PTSD) and severity of violence were included. We hypothesized that women would report impairment in executive functioning (Kennedy et al., 2007;Jackson et al., 2002), and that the severity of violence (Straight et al., 2003) and mental health variables (Kennedy et al., 2001) would be strongly related to perceived executive functioning. ...
The COVID-19 pandemic has resulted in psychological sequelae in different populations, especially female victims of intimate partner violence (IPV) who are pregnant. Nonetheless, little is known about how IPV events and pregnancy are related to mental health outcomes for pregnant women during the pandemic, when this research took place. 155 pregnant women (82 primigravidas and 73 multigravidas women) were assessed using questionnaires for mental health status and IPV events.
The results showed that primigravida women were less likely to experience intimate partner violence than multigravida women. Further, first time pregnancy was not related to symptoms of psychopathology nor perceived stress, even after controlling for the potential effect of IPV. In contrast, IPV was related to all measures of psychopathology, except for pregnancy-specific stress. The results provide information about the relationship of IPV, pregnancy and psychopathology during the COVID-19
pandemic. However, due to the study design (part of awider study), it is
not yet possible to examine how IPV patterns with respect to pregnancy
may have changed in response to the pandemic. In light of the relationship between IPV and mental health during the pandemic, assessment of IPV appears to be an important component in health assessments of pregnant women.
... Perceived cognitive functioning, although not a direct measure of objective neuropsychological performance, is relevant due to its relationship to quality of daily living and social functioning (Kennedy et al., 2001). Of the studies conducted on female survivors of IPV and self-reported cognitive functioning, findings demonstrate that many women report frequent and severe cognitive problems in the domains of memory, concentration, and attention (Kennedy et al., 2007;Jackson et al., 2002). In terms of variables related to self-reported cognition, greater perceived impairment has been linked to higher levels of psychological abuse (Straight et al., 2003), sexual coercion, depression, and PTSD (Kennedy et al., 2001). ...
... A cross-cultural approach is warranted due to cultural differences in how sequelae are manifested following traumatic events (Jobson & O'Kearney, 2008). Due to the limited generalizability of these studies, it has thus been recommended to replicate with a more diverse sample of female survivors from a variety of settings (Jackson et al., 2002). Further, depression and PTSD are the only variables related to mental health that have been studied in relation to perceived cognitive abilities (Kennedy et al., 2001). ...
... depression, generalized anxiety, and PTSD) and severity of violence were included. We hypothesized that women would report impairment in executive functioning (Kennedy et al., 2007;Jackson et al., 2002), and that the severity of violence (Straight et al., 2003) and mental health variables (Kennedy et al., 2001) would be strongly related to perceived executive functioning. ...
Current literature demonstrates that female survivors of intimate partner violence (IPV) suffer cognitive impairment. Nonetheless, less is known about how women perceive their cognitive functioning and related factors. The main objective was to assess to what degree abuse severity and mental health are related to perceived cognitive functioning in women who have been exposed to IPV. A group of female IPV survivors (n = 82) were assessed with the Quality of Life Outcomes in Neurological Disorders (Neuro-QOL-EF), Composite Abuse Scale Revised (CASR-SF), the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder Scale (GAD-7). Findings revealed self-reported impairment in concentration, information processing, and attention. Associations were found between self-reported executive function (EF) and posttraumatic stress, abuse severity, and depression. Further, a model including abuse severity and posttraumatic stress explained up to 20.8% of the variance in perceived EF. Findings indicate that female survivors report a high prevalence of difficulties in the domain of EF. Self-reported impairment in EF may be indicative of higher levels of posttraumatic stress (PTSD) and depression, meriting further assessment and possibly treatment. This study opens the way for the potential use of perceived cognitive functioning screening tools with female survivors.
... Results from a neurological assessment, in combination with a review of Ariana's medical and educational records, provided strong evidence of traumatic brain injury (TBI) likely the result of the violent attacks by her batterer-trafficker partner. For Ariana, this was experienced as difficulty with concentration, frequent confusion, limitations with problem-solving, and poor judgment (Jackson et al. 2002). TBI may also result in cognitive problems that would have likely impacted Ariana's ability to perceive, remember, or understand risky situations (Levin 1999). ...
... Researchers have found that approximately half of women who were prostituted or trafficked reported TBI due to "violent assaults with baseball bats, crowbars, or from having their heads slammed against the wall or against car dashboards" (Farley et al. 2004, p. 59). Similarly, the majority of injuries sustained from physical assaults by intimate partners are to the head, face, and neck (Jackson et al. 2002). The severity of TBI ranges from "mild," i.e., a brief change in mental status or consciousness, to "severe," i.e., an extended period of unconsciousness or amnesia after the injury. ...
... The severity of TBI ranges from "mild," i.e., a brief change in mental status or consciousness, to "severe," i.e., an extended period of unconsciousness or amnesia after the injury. Symptoms of TBI include difficulty with concentration, frequent confusion, difficulties with problem-solving, and poor judgment (for review, see Jackson et al. 2002). TBI has also been associated with certain cognitive problems that diminish the ability to perceive, remember, or understand risky situations (Levin 1999). ...
In this chapter, the links between human trafficking and intimate partner violence (IPV) over the life course are reviewed. Exposure to intimate partner violence during childhood increases risk for victimization in sex trafficking during young adulthood. The lasting impacts of exposure to interpersonal violence during childhood affect one’s ability to trust others or to perceive future relationships as supportive, thereby increasing risk for exploitation in human trafficking. Furthermore, IPV and human trafficking share common dynamics. The element of coercive control facilitated by power imbalance and intermittency of abuse has been documented in offender-victim interactions involving IPV and human trafficking. Human trafficking victims are commonly trafficked by an abusive and exploitive intimate partner, and victims may be arrested and prosecuted for human trafficking offenses due to their forced involvement in criminal activities.
... One study distinguished between single and multiple episodes of violence resulting in TBI, 100% and 75%, respectively, with strangulation in 25% of these cases (Valera & Kucyi, 2017). Population types included shelter populations Jackson et al., 2002;Monohan & O'Leary, 1999;Valera & Berenbaum, 2003;Valera & Kucyi, 2017), emergency department and hospital users ( Corrigan et al., 2003), survivors in contact with law enforcement (Gag- non & DePrince, 2017), women seeking services in non-IPV specific health-care clinics (Anderson, Stockman, Sabri, Campbell, & Campbell, 2015;Campbell et al., 2018), sex workers ( Baumann et al., 2018;Farley et al., 2018), and veterans ( Iverson et al., 2017;Iverson & Pogoda, 2015). Many studies recruited for participants who were undiagnosed but suspected of TBI, some selected only on history of IPV, and others were included based on known TBI diagnosis, which may contribute to the variance of reported rates of prevalence. ...
... The onus of screening, assessment, and triage for IPV largely falls on frontline professionals in health-care and community contexts. As early screening and intervention can lead to improved outcomes, routine screening for TBI when IPV is disclosed or suspected was encouraged by a number of authors (Ackerman & Banks, 2009;Amoroso & Iverson, 2017;Bau- mann et al., 2018;Campbell et al., 2018;Corrigan et al., 2003;Davis, 2014 Pagoda, 2015;Jackson et al., 2002;Monohan & O'Leary, 1999;Murray et al., 2016;Smith & Holmes, 2018;Stern, 2004;St. Ivany, Kools, Sharps,& Bullock, 2018b;Zieman et al., 2017). ...
... Even when neuropsychological testing is completed appropriately, it is possible survivors with IPV-related TBI may present as normal or near normal (Monohan & O'Leary, 1999;Valera & Berenbaum, 2003). Support approaches should include referral for assessment and/or external programs for clients who screen positive or are suspected of TBI (Banks, 2007;Campbell et al., 2018;Iverson & Pogoda, 2015;Jackson et al., 2002). ...
... One study distinguished between single and multiple episodes of violence resulting in TBI, 100% and 75%, respectively, with strangulation in 25% of these cases (Valera & Kucyi, 2017). Population types included shelter populations (Gutman et al., 2004;Jackson et al., 2002;Monohan & O'Leary, 1999;Roberts & Kim, 2005;Valera & Berenbaum, 2003;Valera & Kucyi, 2017), emergency department and hospital users (Corrigan et al., 2003), survivors in contact with law enforcement (Gagnon & DePrince, 2017), women seeking services in non-IPV specific health-care clinics (Anderson, Stockman, Sabri, Campbell, & Campbell, 2015;Campbell et al., 2018), sex workers (Baumann et al., 2018;Farley et al., 2018), and veterans Iverson & Pogoda, 2015). Many studies recruited for participants who were undiagnosed but suspected of TBI, some selected only on history of IPV, and others were included based on known TBI diagnosis, which may contribute to the variance of reported rates of prevalence. ...
... 2-3) Reflecting this gap, many different options were present in the studies reviewed. Four studies used the original HELPS Brain Injury Screening Tool, developed by head trauma specialists for use by individuals without a neurology background (Gagnon & DePrince, 2017;Hux, Schneider, & Bennett, 2009;Jackson et al., 2002;Zieman, Bridwell, & Cardenas, 2017). The OSU-TBI-ID was used by Baumann and colleagues (2018), while colleagues (2017, 2015) used the Modified Veterans Affairs TBI Screening Tool. ...
... Even when neuropsychological testing is completed appropriately, it is possible survivors with IPV-related TBI may present as normal or near normal (Monohan & O'Leary, 1999;Valera & Berenbaum, 2003). Support approaches should include referral for assessment and/or external programs for clients who screen positive or are suspected of TBI (Banks, 2007;Campbell et al., 2018;Iverson & Pogoda, 2015;Jackson et al., 2002). Some authors cited the need for health professionals to support safety planning in an effort to reduce subsequent and repetitive assaults that may have a cumulative effect on the brain (Corrigan et al., 2003;Jackson et al., 2002;Banks, 2007). ...
Objectives:
The objective of this scoping review is to examine the extent, range, and nature of literature targeting health-care professionals on the prevalence and outcome of intimate partner violence (IPV)-related traumatic brain injury (TBI). The purpose is to gain an understanding of prevalence, investigate screening tool use, generate IPV/TBI-specific support recommendations, and identify suggestions for future research.
Method:
The review was guided by Arksey and O'Malley's five stages for conducting a scoping review. A comprehensive search of nine databases revealed 1,739 articles. In total, 42 published research papers that focused specifically on TBI secondary to IPV were included in the study.
Synthesis:
The literature reports inconsistencies in prevalence rates from IPV-related TBI. There are no current standardized screening practices in use, though the literature calls for a specialized tool. Frontline professionals would benefit from education on signs and symptoms of IPV-related TBI. Empirical studies are needed to generate reliable data on prevalence, experience, and needs of brain-injured survivors of TBI.
Conclusions:
Findings from this study demonstrate the need for the development of an IPV-sensitive screening tool, more accurate data on prevalence, an interprofessional approach to care, and raised awareness and education on the diffuse symptoms of IPV-related TBI.
... While an estimated 80% of TBIs as a result of DV are mild (Thurman & Guerrero, 1999), loss of consciousness or even coma are not uncommon sequelae (Monahan & O'Leary, 1999). 30-77% of women suffering a TBI as a result of DV report prolonged residual problems stemming from their brain injury (Corrigan, Wolfe, Mysiw, Jackson, & Bogner, 2003;Jackson, Philp, Nuttall, & Diller, 2002;Valera & Berenbaum, 2003). Despite this, many instances of TBI go unrecognized by health professionals or unreported by the victims themselves (Cassidy et al., 2014). ...
... Although the exact numbers are unknown, repeated head injuries are thought to be frequently experienced in DV. Studies examining repetitive injuries have found that more than 90% of female DV victims experience head injury events at a frequency of 2-5 times per year (Jackson et al., 2002). Alarmingly, 25% of those women reported hits to the head or face more than 20 times in the past 5 years (Jackson et al., 2002). ...
... Studies examining repetitive injuries have found that more than 90% of female DV victims experience head injury events at a frequency of 2-5 times per year (Jackson et al., 2002). Alarmingly, 25% of those women reported hits to the head or face more than 20 times in the past 5 years (Jackson et al., 2002). Another study of battered women found that 72% had experienced repeated injuries (Valera & Berenbaum, 2003), while repeated strangulation injuries are reported in more than 50% of cases (Smith, Mills, & Taliaferro, 2001), with 23% of victims reporting five or more occurrences in their life to date. ...
Traumatic brain injury (TBI) resulting from episodes of domestic violence (DV) is a serious yet greatly underreported issue. Head injuries arising in these circumstances are often concussive or sub-concussive in nature, and are unlikely to be isolated incidents, with victims frequently suffering repetitive TBIs over time. Although men may also be victims of DV, women and children are most at risk of DV via intimate partners and parents, respectively. Due to the complexities of these interpersonal relationships, victims of DV are not always able to receive appropriate clinical diagnoses, care or follow-up after TBI. TBI arising from DV is also likely to occur in a complex milieu of fear, anxiety and depression, the physical and psychological consequences of which may worsen or perpetuate the pathology of TBI. This review examines the complexities of TBI arising from DV from several perspectives, with focus on three pertinent and interrelated topics: 1) pathobiology and complications of single and repetitive TBI, encompassing direct neural consequences, inflammation and hormonal changes; 2) behavioral, cognitive and psychosocial consequences of TBI; and 3) contributing factors to TBI and complications, including strategies to increase clinician recognition of TBI in DV patients, and programs and policies in place in Australia and abroad to decrease rates of offending.
... As a result, this cohort have an increased vulnerability for further victimisation, explosive and aggressive conduct [13], depression, suicidal and self-harming behaviours [14], and a higher probability of sustaining another TBI [12]. Because IPV and NAI are often a behaviour pattern that occurs over time, rather than as a single event, victims of IPV and NAI are prone to multiple episodes of TBI [15] with some studies reporting victims receiving up to at least 10 TBI's in the preceding 12-month period [12]. There are numerous identified reasons [12,16,17] why victims of IPV and NAI do not report these TBI's. ...
... In 2002, when reporting [15] on intimate partner abuse (IPV), it was identified that as many as 92% of IPV victims reported to have received blows to the head and, for 40% of the victims this has resulted in loss of consciousness. In addition, it was also reported [15] that 83% of IPV victims have been hit in the head and shaken, 72% had been strangled and 8% had received blows to the head at least 20 times in the previous year. ...
... In 2002, when reporting [15] on intimate partner abuse (IPV), it was identified that as many as 92% of IPV victims reported to have received blows to the head and, for 40% of the victims this has resulted in loss of consciousness. In addition, it was also reported [15] that 83% of IPV victims have been hit in the head and shaken, 72% had been strangled and 8% had received blows to the head at least 20 times in the previous year. Additional research has identified that the incidence of TBI in IPV victims ranges from 30 to 75% [32]. ...
Aim:
To provide epidemiological data and related costs to the national health insurance scheme for traumatic brain injury (TBI) in New Zealand.
Method:
A retrospective analytical review utilising detailed descriptive minor and moderate-to-severe epidemiological TBI data obtained from the Accident Compensation Corporation (ACC) for 2012-2016. Injuries were analysed by three levels of increasing severity: moderate, moderate-to-serious (MSC) and severe claims categories.
Results:
Over the January 2012 to December 2016 period there were 97,955 claims for TBI costing ACC $1,450,643,667 [equivalent to £$743,417,120]. Falls accounted for nearly half (41.7%, 8262), and over a quarter (39.9%; $67,626,000 [£34,662,176]) of the moderate claims for TBI. Motor vehicle accidents recorded the highest percentage (36.5%), total costs ($610,978,229 [£313,170,000]) and highest mean cost per-moderate claim per-year ($47,372 ± $2401 [£24,282 ± £1231]) for MSC TBI claims. This was similar for severe claims where motor vehicles accidents accounted for 56% of the total serious claims, 65.1% of the costs with a mean cost per-serious claim of $64,913 ± 4331 [£32,759 ± £2186] per-year.
Conclusion:
There were 97,955 TBI injury claims lodged over the duration of the study with 36% (n = 35,304) classified as MSC. The incidence of total TBI in New Zealand was 432 per 100,000 population, and 155 per 100,000 for MSC TBI claims. Despite the growing number of studies reporting on the effects of sports-related TBI, there is a paucity of studies reporting on the longitudinal effects of TBI in falls, assaults and motor vehicle accidents. Further research is warranted into the assessment and management of intimate partner violence and child abuse victims for TBI's.
... To-date, IPV-related brain injuries have been vastly understudied, yet the rates of partner-inflicted head trauma and probable brain injury among IPV-EW are estimated to be extremely high. For example, studies suggest that anywhere from 30% to 92% of participants report at least one episode of abuse with either exposure to head or neck trauma and/or probable brain injury (Jackson et al., 2002;Valera and Berenbaum, 2003;St Ivany and Schminkey, 2016;Valera and Kucyi, 2017;Esopenko et al., 2021;Campbell et al., 2022). Another recent scoping review found that the prevalence of head trauma is between 19% and 100% across studies, with the large range being due to varied definitions of head trauma and brain injury as well as varied participant inclusion characteristics (e.g., inclusion of only participants with injuries to the head; Haag et al., 2022). ...
... IPV-related TBI can occur due to being punched, kicked, thrown, hit with an object, or shaken, all of which can result in focal and/ or diffuse axonal injury (Sheridan and Nash, 2007;Valera et al., 2019). NFS, suffocation, and other forms of impeded breathing occurring as a result of IPV can cause hypoxic-ischemic brain injuries from a lack of, or decrease in, oxygen to the brain (Jackson et al., 2002;Valera and Berenbaum, 2003;Kwako et al., 2011;Haag et al., 2022;Valera et al., 2022). With so many avenues for brain trauma, it is probably unsurprising that estimates suggest that approximately 23 million people are living with IPV-related brain injury in the United States alone (St Ivany and Schminkey, 2016). ...
Exposure to intimate partner violence (IPV), including physical, sexual, and psychological violence, aggression, and/or stalking, impacts overall health and can have lasting mental and physical health consequences. Substance misuse is common among individuals exposed to IPV, and IPV-exposed women (IPV-EW) are at-risk for transitioning from substance misuse to substance use disorder (SUD) and demonstrate greater SUD symptom severity; this too can have lasting mental and physical health consequences. Moreover, brain injury is highly prevalent in IPV-EW and is also associated with risk of substance misuse and SUD. Substance misuse, mental health diagnoses, and brain injury, which are highly comorbid, can increase risk of revictimization. Determining the interaction between these factors on the health outcomes and quality of life of IPV-EW remains a critical need. This narrative review uses a multidisciplinary perspective to foster further discussion and research in this area by examining how substance use patterns can cloud identification of and treatment for brain injury and IPV. We draw on past research and the knowledge of our multidisciplinary team of researchers to provide recommendations to facilitate access to resources and treatment strategies and highlight intervention strategies capable of addressing the varied and complex needs of IPV-EW.
... For example, in one study using a survey in a community health center, women who suffered "probable BI" due to IPV were more likely than those without "probable BI" to report symptoms such as headaches, memory loss, and fainting problems among others. 4 Other studies [5][6][7] have examined reports (via interview questions or surveys) of head trauma, or alterations in consciousness (AICs), in relation to cognitive, behavioral, and psychological outcomes. However, to our knowledge, there is only one published study that used neuropsychological tasks to assess the relationship between IPV-related BIs with cognitive and psychological outcomes. ...
... Furthermore, cognitive and psychological difficulties resulting from IPV-related BIs may cause job loss or instability, additional abuse due to increased financial dependence, and possibly an increased risk of permanent brain damage. 6,45 These are all issues that have tremendous relevance for the livelihood of Latina women and underscore the critical need for raising awareness and increasing research on this topic. ...
Objective:
The aim of this study was to assess the prevalence of brain injury (BI) and its relationship to cognitive and psychological outcomes in women survivors of intimate partner violence (IPV) in Colombia, South America.
Setting:
Women's shelters and organizations in Barranquilla, Colombia.
Participants:
Seventy women from the city of Barranquilla, Colombia, who experienced any form of IPV.
Design:
Cross-sectional, retrospective.
Main measures:
Participants were administered the computerized EMBRACED neuropsychological battery to assess learning, working and long-term memory, cognitive flexibility, and processing speed. Participants also completed measures of psychological symptoms. Partner violence severity was assessed with a semistructured interview for survivors of domestic violence. Presence and severity of IPV-related BI were assessed using the Brain Injury Severity Assessment (BISA).
Results:
Thirty-one percent of women sustained at least one BI during an abusive relationship, and 10% sustained repetitive BIs. Furthermore, BI was negatively associated with measures of long-term and working memory, cognitive flexibility, as well as a trending (P = .05) positive association with depression. With the exception of the relationship between BI and cognitive flexibility, which was substantially reduced and no longer significant, all of these relationships were nearly identical in strength when controlling for abuse severity, socioeconomic status, and educational level.
Conclusion:
These data are the first to specifically examine IPV-related BI in relation to cognitive and psychological functioning in a sample of Colombian women. These data add cross-cultural knowledge to the limited work in this area that has largely focused on women in North America.
... The areas of memory, attention, and concentration are especially compromised in that women show greater distractibility problems, significant difficulties in concentration and in remembering everyday events, as well as in contained and sustained attention as a consequence of having been exposed to violence. Other areas that affect the visuoconstructive ability and executive functions, as well as fluency speed and motor processing, are also impacted, affecting decision-making and response inhibition [37,[47][48][49][50][51]. ...
... This shows that there is a neuropsychological impact in the visuospatial area (visual perception and spatial orientation), language area (receptive speech and expressive speech), memory area (short-term memory and logical thinking), intellectual area (thematic drawings and conceptual activity), and in the attention test (attentional control). These results are in line with other studies that show how women victims of abuse show cognitive problems related to physical and psychological abuse, as well as the chronic stress produced by it [49,53]. ...
Female victims of abuse, as well as suffering from psychopathological disorders such as depression, can have neuropsychological sequelae affecting memory and attention, with serious consequences, both physical and psychological, in their daily lives. Therefore, the objective of this study is to analyse these sequelae that affect attention and memory, as well as the possible association of these sequelae to depression. A total of 68 women, victims of gender-based violence, between the ages of 15 and 62 participated in this study. The Luria DNA Battery (Neuropsychological Diagnosis of Adults) by Manga and Ramos (2000); and the Beck Depression Inventory (2011) were applied. It is shown that female victims of gender-based violence present poor short-term memory, attentional control, and score low on the Luria-DNA battery. Of these women, 60% suffer from some relevant type of depression. Through HJ-Biplot analysis, a direct relationship was found between memory and attentional control with the total score of the Luria battery. However, an inverse relationship was found between short-term memory and depression. In addition, three well-differentiated clusters of female victims of gender-based violence were identified. It is concluded that a lower rate of depression is observed in female victims of abuse when they have a more intact short-term memory.
... Other studies, though not epidemiologic in nature, have included these other indicators and have suggested much higher rates (eg, 35%-74%) of IPVrelated BIs. [51][52][53][54] The earliest studies to address this issue were in the late 1990s/early 2000s. [52][53][54] These studies provided initial estimates of IPV-related BIs as well as psychological and cognitive correlates. ...
... [51][52][53][54] The earliest studies to address this issue were in the late 1990s/early 2000s. [52][53][54] These studies provided initial estimates of IPV-related BIs as well as psychological and cognitive correlates. First, Monahan and OʼLeary 54 found that 35% of women residing in a shelter experienced a head injury from their partner, with 44% of these women reporting LOC; these women were also more likely to endorse somatic, cognitive, and emotional symptoms than women without a history of head injury. ...
In this report, we identify existing issues and challenges related to research on traumatic brain injury (TBI) in females and provide future directions for research. In 2017, the National Institutes of Health, in partnership with the Center for Neuroscience and Regenerative Medicine and the Defense and Veterans Brain Injury Center, hosted a workshop that focused on the unique challenges facing researchers, clinicians, patients, and other stakeholders regarding TBI in women. The goal of this "Understanding TBI in Women" workshop was to bring together researchers and clinicians to identify knowledge gaps, best practices, and target populations in research on females and/or sex differences within the field of TBI. The workshop, and the current literature, clearly highlighted that females have been underrepresented in TBI studies and clinical trials and have often been excluded (or ovariectomized) in preclinical studies. Such an absence in research on females has led to an incomplete, and perhaps inaccurate, understanding of TBI in females. The presentations and discussions centered on the existing knowledge regarding sex differences in TBI research and how these differences could be incorporated in preclinical and clinical efforts going forward. Now, a little over 2 years later, we summarize the issues and state of the science that emerged from the "Understanding TBI in Women" workshop while incorporating updates where they exist. Overall, despite some progress, there remains an abundance of research focused on males and relatively little explicitly on females.
... A systematic review of injury patterns in IPV, compared to simple assault, showed higher rates of head, neck, and face injuries, a lower rate of extremity injuries, and a similar rate of abdominal and trunk injuries (Wu, Huff, & Bhandari, 2010). Almost all (92%) battered women report receiving a blow to the head (Jackson, Philp, Nuttall, & Diller, 2002), and 30% to 74% of women experiencing IPV report history of at least one TBI (Kwako et al., 2011;Valera & Berenbaum, 2003). ...
... A repeat head injury rate of 88% with loss of consciousness in 81% of participants was reported in a survey of IPV victims with known TBI by Zieman et al. (2017). Jackson et al. (2002) reported correlation between severity of cognitive symptoms and frequency of blows to the head in a sample of battered women. Like our study, these studies link IPV to TBI using subjective reporting, descriptive measures, and known diagnosis in patients with a history of TBI. ...
Intimate partner violence (IPV) causes harm to an estimated 42 million victims each year. Routine forensic examination excludes specific evaluation of traumatic brain injury (TBI), thereby missing an opportunity to diagnose and offer treatment. This quality assurance/quality improvement project was designed to determine whether TBI signs and symptoms are detected in IPV patients using existing forensic nurse examination protocols. TBI signs and symptoms were cataloged from medical records to infer the incidence of TBI and inform an expansion of the nursing exam. Retrospective review of 19 cases collected over 31 days in June and July 2017 identified a predominance of young (average age 32.3), female (89.5%) patients with obstetric history (76.5% with one or more pregnancy), presenting with symptoms including lightheadedness/dizziness (84.2%), headache (78.9%), difficulty breathing (78.9%), and throat pain (68.4%). Subjective mechanism of injury included strangulation (100%), blow to the head with the perpetrator’s hand (52.6%), and fall to the ground (36.8%). TBI was not diagnosed during the exam, but recorded signs and symptoms indicated patterns consistent with brain injury. As a result of these findings, our team proposes an expansion of the exam to include near point of convergence, balance, and hand-eye coordination testing to ensure detection of TBI signs in IPV victims. By detecting TBI signs early, community efforts can guide patients towards recovery, appropriate treatment options and successful return to society.
... 2 Whereas there are distinct bodies of literature examining both IPV and TBI, only a few studies directly address the correlation between them; a scoping review conducted by the authors (in press) identified 20 English language original research studies expressly considering the intersection. 15 Existing studies have identified a relationship between IPV/TBI and a range of biopsychosocial challenges faced by survivors, 3,7,[16][17][18] and explored various health care contexts, [19][20][21][22][23] as well as survivor categories such as veterans, 24 ethnic groups, 25 and marginalized women. 26 Yet, although the identified studies focused on prevalence rates, identification and screening, and recommendations for health care professionals, none of them address the state of TBI knowledge among frontline workers, an area highlighted as being of key importance. ...
... 26 Yet, although the identified studies focused on prevalence rates, identification and screening, and recommendations for health care professionals, none of them address the state of TBI knowledge among frontline workers, an area highlighted as being of key importance. 7 Further investigation has been recognized as a priority both by researchers 3,[14][15][16]18,27 and in mainstream media. [28][29][30][31] To address this gap, we conducted a pilot project surveying the IPV support community in Toronto, Canada to better understand the degree of existing TBI-specific knowledge and relevant services available, identify ways to improve survivor health and wellbeing, and bridge the divide between research and practice by developing a national knowledge-topractice network to support brain injured women survivors of IPV. ...
Background:
Traumatic brain injury (TBI) as a result of intimate partner violence (IPV) is a significant health concern; yet, little is known about the intersection between the two. Existing research is scarce, limiting the ability of health care providers to develop effective supports. This pilot project surveyed the IPV support community in Toronto, Canada to understand the degree of existing TBI-specific knowledge and relevant services available among these service providers and to seek to bridge the divide between research and practice by developing a national knowledge-to-practice network to support brain-injured women survivors of IPV.
Materials and Methods:
In phase 1, 68 agencies providing IPV support services were invited to complete an anonymous online survey. In phase 2, 22 stakeholders attended a workshop held to disseminate existing knowledge, develop a national knowledge-to-practice network, and determine next steps in research and practice.
Results:
The results highlighted a general lack of TBI awareness and understanding among IPV service providers. In addition, participants stated that frontline workers and women survivors of IPV alike do not recognize signs or symptoms of TBI. Recommendations addressing research gaps, professional and public education, and service development were identified and are discussed herein.
Conclusions:
The identified lack of TBI knowledge among IPV service providers highlights the immediate need to increase education among management and frontline workers. Further investigation identifying best practices for knowledge transfer are suggested. The development of a national strategy addressing education, research, and funding is critical for successful uptake and integration of TBI-sensitive services within the IPV sector.
... Recently, the alarming incidence and effects of IPV-related BI in women have gained increased media focus and public concern. Although accurate and generalizable prevalence rates of IPV-related BI have yet to be fully established, existing studies estimate the occurrence of IPV-related BI (including potential HIBI as a result of nonfatal strangulation [NFS]) to be as high as 92% (Jackson et al. 2002;Campbell et al. 2022), with a recent review demonstrating, that anywhere from 19 to 100% of participants across studies with varying definitions of BI and inclusion criteria report head, face, and neck trauma as a result of IPV exposure (Haag et al. 2022). Furthermore, according to the CDC, approximately 14% of women with IPV exposure experience at least one instance of a loss of consciousness (LOC) from sustaining either impacts to their heads or NFS, suffocation, or other forms of impeded breathing (Breiding et al. 2014). ...
A large proportion of women exposed to intimate partner violence (IPV) experience brain injury (BI), and although IPV has been associated with numerous individual, social, and cultural factors, no single factor has consistently predicted either the use of, or experience of, violence within intimate relationships. The experience of IPV and IPV-related BI is often associated with significant mental health concerns, particularly post-traumatic stress disorder (PTSD), and common cognitive sequelae generally include deficits in attention, working memory, executive functioning, processing speed, response inhibition, and memory. Furthermore, there is evidence that the myriad of cognitive and psychological problems associated with BI may also increase the risk of future IPV perpetration. Accurate characterization of lifetime exposure to both IPV and IPV-related BI are needed to fully understand the effects of trauma on well-being. To comprehensively characterize and quantify cumulative lifetime exposure to head trauma and predict long-term prognosis, a holistic approach to screening and assessment of IPV-related BI that incorporates well-validated, all-cause BI tools, supplemented with structured recall cues and measures of childhood and other lifetime trauma exposures, are necessary.
... There has been an increased and long-overdue focus in the IPV literature on the high prevalence of head trauma (e.g., being punched, shaken violently) and nonfatal strangulation (NFS), which often results in focal and diffuse or anoxic/hypoxic brain injury, respectively (Valera & Berenbaum, 2003;Valera & Kucyi, 2017). In fact, recent reviews examining IPV related head trauma in Veterans and the general population demonstrated that a high proportion of respondents in these samples (up to 92% [Jackson et al., 2002]) reported probable traumatic brain injury or exposure to NFS (Haag et al., 2022;Campbell et al., 2022). In the current study, brain injury exposure was not assessed as an outcome of interpersonal trauma as the researchers were not anticipating the prevalence of IPV in this sample. ...
Military sexual trauma (MST) has deleterious long-term psychological consequences. Among female U.S. military members, MST is associated with increased risk for future interpersonal victimization, such as experiencing intimate partner violence (IPV). Few studies have investigated the implications of the cumulative effects of IPV and MST on psychological functioning. This study examined rates of co-exposure to MST, IPV, and their cumulative impact on psychological symptoms. Data were collected from 308 female Veterans (FVets; age: M = 42, SD = 10.4) enrolled in an inpatient trauma-focused treatment program in a Veterans Administration (VA) hospital. Data were collected at program admission on symptoms of posttraumatic stress disorder (PTSD), depression, and current suicidal ideation. Lifetime trauma exposure was assessed using semi-structured interviews that identified adverse childhood events (ACEs) and combat theater deployment as well as MST and IPV. Group differences on psychological symptoms were examined among those exposed to MST, IPV, MST + IPV, and compared to FVets with ACEs or combat exposure, but no other adulthood interpersonal trauma (NAIT). Half of the sample (51%) reported experiencing both MST and IPV, approximately 29% reported MST, 10% reported IPV, and 10% reported NAIT. FVets in the MST + IPV group had worse PTSD and depression symptoms than either the MST or IPV groups. The NAIT group had the lowest scores on these measures. There were no group differences in current suicidal ideation; however, 53.5% reported at least one previous suicide attempt. FVets in this sample reported significant lifetime exposure to MST and IPV, with the majority having experienced MST + IPV. Exposure to MST + IPV was associated with greater PTSD and depression symptom severity, yet an overwhelming proportion reported current and past suicidal ideation regardless of trauma exposure history. These results demonstrate the importance of assessing for lifetime interpersonal trauma history when developing and providing mental and medical health interventions for FVets.
... Perhaps the most visible and immediate health consequence of IPV is the physical injury sustained by the victim during the incident, including bruises, welts, sprains, and even fractures. [11][12][13][14] In addition to injury, IPV has other physical health consequences. This type of violence has been associated with various forms of functional disorders, including gastrointestinal disorders, chronic pain syndromes, asthma, memory loss, disabilities, and dizziness. ...
... While there are no epidemiological studies on the rates of TBI among IPV victims, one literature review on TBI from IPV found rates between 35-92% [29]. Jackson et al.'s study of women attending domestic violence support groups found that 92% reported a blow to the head or face and 44% reported loss of consciousness (LOC) [30]. Valera and Berenbaum found 74% of a shelter sample of women exposed to IPV sustained TBI and 50% had a history of multiple TBI [31]. ...
Traumatic brain injury (TBI) is found at substantially higher rates among incarcerated individuals compared to the general adult population. Individuals with TBI report a higher likelihood to experience a range of deleterious outcomes including substance abuse, depression, post-traumatic stress disorder, aggressive behavior, and violence. Thus, a history of TBI is likely to lead to the types of behaviors that will significantly increase the odds of an individual returning to incarceration post-release, as supported by recent research with a cohort of state prisoners. TBI has largely gone unaddressed by prison reentry programs that are integral to rehabilitating individuals returning to the community. Relatively little is known, however, about the effects of TBI on the receipt of services post-release. Additionally, few studies have examined sex differences in the prevalence of TBI in reentry populations. This chapter uses data from a multi-state prisoner reentry program randomized control trial to examine whether individuals with TBI are significantly different than their peers without TBI with respect to a variety of demographic and psychological metrics and in expressions of needs for and participation in services and programming during the transition from incarceration to the community.
... One used a question on the Miller Abuse Physical Symptoms Scale and found that 7% of all IPV survivors sampled experienced LOC following a head injury [39]. Two used the HELPS screening tool and estimated the prevalence of LOC following a blow to the head by a partner to be between 40 and 57.9% [33,40]. One used self-reports on interviews with survivors and estimated that 30% of IPV survivors sampled experienced LOC following a head injury [35], and 1 used medical records to estimate that 35% of IPV survivors sampled experienced LOC following a "head injury" [41]. ...
Purpose of review The goal of this review is to address prevalence rates in four groups: (i) brain injury (BI) among intimate partner violence (IPV) survivors, (ii) BI among IPV perpetrators, (iii) IPV victimization among people with BI, and (iv) IPV perpetration among people with BI. PubMed and Web of Science databases were searched for peer-reviewed research articles that quantitatively examined IPV in relation to BI.
Recent findings Thirty-two articles were included in the final review. Eighteen articles assessed the prevalence of BI among IPV survivors, 5 assessed the prevalence of fatal BI among samples of IPV homicide victims, 7 assessed the prevalence of BI among IPV perpetrators, 2 assessed the prevalence of IPV victimization among people with BI, and 0 assessed the prevalence of IPV perpetration among people with BI. Prevalence estimates varied considerably based on how BI was “defined,” the type of BI assessed, types of IPV included in the sample, and the measurement tool used, as well as whether the goal was to address TBI (28.1 to 100%) or strangulation-related inferred BI (27–56%). Estimates of BI among perpetrators of IPV range from 5 to 75%; and estimates of IPV victimization among people with BI range from 42.5 to 89%.
Summary Reliance on small convenience samples is problematic when trying to determine the true extent of IPV-related BI. Epidemiological research is needed to improve the accuracy of the estimated prevalence of BI caused by IPV as well as IPV experiences among individuals with BI.
... Domestic violence against women during COVID-19 has affected women in various ways including experiences of chronic pain, sleep disturbances, changes in everyday life routine, depression symptoms, post-traumatic stress disorder, other types of abuse, brain injuries, sexual diseases, substance abuse and many other psychological symptoms, such as avoidance, anxiety, hyperarousal, low mood, re-experiencing trauma. [72,[89][90][91][92][93][94]. It is clear that the multitude of effects domestic violence has on its victims is exacerbated during periods of crisis. ...
Domestic violence against women is defined as harmful behavior that occurs within a home and it involves aggressive and violent conduct towards women. Since the outbreak of the COVID-19 pandemic, and following the restrictions imposed to combat the pandemic (lockdowns, staying at home, isolation), domestic violence against women has increased worldwide. The current entry presents existing knowledge and discusses issues important for public awareness.
... In summary, although the current literature on TBI among IPV survivors [12][13][14][15][16][17][18][19][20] has shed light on the physical, cognitive, and psychosocial consequences of IPV and TBI, this information has not yet translated into changes to TBI rehabilitation practices. Rehabilitation programs aim to provide a comprehensive system of care beginning with the diagnosis, but to date IPV has not been formally addressed alongside TBI in multidisciplinary, community-based interventions. ...
Background:
Traumatic brain injury (TBI) is a serious and often undiagnosed consequence of intimate partner violence (IPV). Data on prevalence of TBI among IPV survivors are emerging, but prevalence of IPV among patients presenting to TBI clinics is unknown. Identification of IPV is important to ensure patients with TBI receive appropriate intervention and referrals.
Objective:
To determine the proportion of women 18 years and older presenting to an acquired brain injury (ABI) clinic with confirmed or suspected concussion who reported experiencing IPV in the last 12 months or their lifetime.
Methods:
Single-center cross-sectional cohort study. Proportion of IPV-related TBI or head, neck, or facial) injuries were determined using a modified HELPS Brain Injury Screening Tool and the Neurobehavioral Symptom Inventory.
Results:
Of the 97 women approached, 50 were enrolled in the study. The average age was 46.1 years and 32 women (64.0%) reported a relationship history with a violent partner; 12-month prevalence of IPV was 26.5% and lifetime prevalence was 44.0%. Within their lifetime, all (44.0%) who reported an IPV history reported emotional abuse, 24.0% reported physical abuse, and 18.0% sexual abuse. HELPS responses indicated a high potential of lifetime IPV-related TBI for 29.2%, most commonly from being hit in the face or head (20.8%).
Conclusion:
Implementation of IPV screening in community-based ABI clinics is a pivotal step toward understanding the potential scope of TBI and addressing the wide range of somatic, cognitive, and affective symptoms experienced by IPV survivors. IPV screening also will lead to timely referral and follow-up and increase patient safety after discharge from rehabilitation.
... These injuries could have a dangerous effect on DV victims. Impairments in memory, judgement, and decision-making could make victims more likely to return to perpetrators, leaving them vulnerable to further abuse [17,18]. When police are called to DV incidents, they have a unique opportunity to identify health issues and promote healthcare access. ...
Domestic violence (DV) victims face significant barriers to accessing healthcare. This is particularly concerning in cases of brain injury (BI), which is difficult to diagnose and risks severe long-term consequences for DV victims. Police may be able to identify head injury (HI) and signpost victims to healthcare. This research investigated potential barriers to police supporting victim health needs by exploring police attitudes towards DV and considering how police interpret and respond to stories of HI in DV victims. Individual interviews were conducted with 12 police officers from forces in South and Central England. This included the use of a clinical vignette. Thematic analysis highlighted three global themes: ‘seesaw of emotions’, ‘police vulnerability’, and ‘head injury is fearful’. Police officers’ vulnerability to external blame was the predominant influence in their responses to HI.
... The wide array of problems confronting those with TBI includes headache, fatigue, impaired memory, reduced attention, depression, aggression, anxiety, sleep disturbances, and sexual dysfunction (Barth et al., 1983). Several reports indicated that TBI can have lifelong impacts including changes in personality and behavior (Banks, 2007;Jackson et al., 2002). ...
... The wide array of problems confronting those with TBI includes headache, fatigue, impaired memory, reduced attention, depression, aggression, anxiety, sleep disturbances, and sexual dysfunction (Barth et al., 1983). Several reports indicated that TBI can have lifelong impacts including changes in personality and behavior (Banks, 2007;Jackson et al., 2002). ...
It has been shown that intelligence as a general mental ability is related to structure and function of the brain regions. However, specificity of this regional dependencies to the intelligence scores in the typical and atypical developed individuals needs to be well understood. In this study, we hypothesized that neural correlates of IQ should not have a fixed pattern rather it must follow a dynamic pattern to compensate the functional deficits caused by a neurodevelopmental disorder. Therefore, EEG correlates of normal IQ in various subtypes of attention deficit hyperactive disorder (ADHD) were compared to a group of healthy controls. Sixty-three ADHD subjects comprising of combined, inattentive, and hyperactive individuals diagnosed by a psychiatrist using structural clinical interview for DSM-V, and 46 healthy controls with similar normal IQ scores were recruited in this study. The subjects’ EEG data were then recorded during an eye-closed resting condition. The subjects’ intelligence level was measured by the Raven’s standard progressive matrices. Then, association between IQ and power of EEG signal were computed in the conventional frequency bands. Subsequently, topographical representations of these associations were compared between the groups. Our results demonstrated that association between IQ score and EEG power is not the same in various ADHD subtypes, and healthy controls. This finding suggests a compensatory mechanism in ADHD individuals for changing the regional oscillatory pattern to maintain the IQ within a normal range.
... For example, as a victim may lose their ability to function independently, they may become more dependent on the perpetrator, making it more difficult for them to leave. They may also lose the ability to keep their employment, or effectively care for children (Hunnicutt, 2017;Jackson et al., 2002). Adding to these complexities, co-morbid mental health issues may both precede or follow the ABI and the family violence (Hunnicutt et al., 2017). ...
Family violence (FV) harms communities worldwide so FV prevention strategies and effective responses are urgently needed. This article reports on FV apparent in a study which explored the experiences of people with both ABI and justice system encounters in Victoria, Australia. One hundred interviews and one focus group consulted people with ABI, their families and carers, and various stakeholder groups in the Victorian justice system in Australia. Qualitative content analysis determined dominant themes and sub-themes and the less common themes. Inductive interpretive content analysis identified themes commonly found in previous published research and themes that appeared unique to, or unanticipated in, our data, such as the FV theme upon which this article focuses. Our findings reveal that FV has adversely affected many people with ABI who came into contact with Victoria’s justice system. Further, as ABI and FV often co-occur with substance abuse, mental health problems, socio-economic and many other significant disadvantages, for some FV perpetrators with an ABI, their ABI symptoms and characteristic co-morbidities may be a mitigating factor in their offending. The connection between ABI and family violence emerged as a troubling research theme. Indeed, the impact of FV on too many of our participants with an ABI compels us to call for further related research and secondary prevention programs targeted at FV victims, and offenders, living with ABI. An intersectional understanding of family violence and TBI/ABI in social ecological contexts is required to better understand brain injury at both individual and population levels.
... En bidragande orsak till den något ojämna fördelningen kan vara att det finns ett mörkertal i gruppen lätt hjärnskadade där alla inte www.sbu.se/304 uppsöker sjukvård, till exempel vid skador inom idrott eller när det gäller kvinnor som råkat ut för misshandel [33]. Världshälsoorganisationen (WHO) har med anledning av mörkertalet uppskattat det verkliga antalet personer som får en hjärnskada med påverkan på hjärnan till över 600 per 100 000 invånare och år [34]. ...
SBU har sammanställt både kvantitativ och kvalitativ forskning på området rehabilitering för vuxna efter en traumatisk hjärnskada, från det tidiga till det sena skedet. Granskningen har gjorts ur ett medicinskt, ekonomiskt, etiskt, socialt och samhälleligt perspektiv.
Projektet initierades av SBU utifrån projektförslag från personer inom den svenska hälso- och sjukvården.
Slutsatser
Rehabilitering vid lätt traumatisk hjärnskada med restsymtom:
Specialiserad hjärnskadeinriktad rehabilitering med fokus på problemlösningsterapi (eng.: problem solving), eller kognitiv beteendeterapi (KBT), minskar restsymtom, förbättrar psykisk funktion, minskar depression samt ökar aktivitetsnivå, delaktighet och livskvalitet, jämfört med sedvanlig vård (resultaten har låg tillförlitlighet). En enkel beräkning ger en kostnad på omkring 500 000 kronor per kvalitetsjusterat levnadsår för sådan rehabilitering. Denna kostnad är troligtvis överskattad eftersom beräkningen inte tar hänsyn till eventuella besparingar genom rehabiliteringen.
Specialiserad interdisciplinär hjärnskadeinriktad rehabilitering ger minskade restsymtom jämfört med sedvanlig vård (resultatet har låg tillförlitlighet). För att kunna bedöma övriga effekter och kostnadseffektivitet behövs mer forskning.
Rehabilitering vid medelsvår till svår traumatisk hjärnskada:
Eftersom det finns få välgjorda studier går det inte att bedöma effekterna av arbetslivsinriktad rehabilitering, rehabilitering med hjälp av samordnare, särskilda boendeformer eller specialiserad hjärnskaderehabilitering i slutenvård i tidigt skede respektive öppenvård i ett senare skede
Upplevelser och erfarenheter av rehabilitering hos personer med traumatisk hjärnskada:
De kvalitativa studierna visade att personer med traumatisk hjärnskada under lång tid måste kämpa på egen hand med att ställa om sitt vardagsliv och att närstående var ett viktigt stöd i rehabiliteringsprocessen. De upplevde att tillgängligheten till hjärnskaderehabilitering var bristfällig och att de insatser som gavs varken var individanpassade eller samordnade. De upplevde vidare att ett professionellt och respektfullt bemötande från de yrkesverksamma och individuellt anpassad information främjade rehabiliteringen.
Kunskapsläget:
Det råder generell brist på välgjorda vetenskapliga studier av rehabilitering för personer med traumatisk hjärnskada där man har en jämförelsegrupp. För att få en bättre kunskap om rehabiliteringens effekter är det önskvärt att framtida studier standardiseras vad gäller design, behandlingsintensitet, utfallsmått och mätmetoder. Det behövs studier som tar hänsyn till effekter och kostnader av olika interventioner över en längre tidshorisont än ett år. Det är också önskvärt med studier från svenska förhållanden som undersöker effekter och personers erfarenheter av att ha fått hjärnskaderehabilitering.
... Assaults by intimate partners happen, by definition, in a chronically traumatizing and invalidating environment. This controlling environment is characterized by emotional abuse and betrayal, coercion, isolation, and lack of independence or ability to access resources (39,40). The psychiatric and psychological effects of the traumatic assaults and abuse interact with the physical and neurological effects of the head injury and amplify the overall clinical presentation of IPV survivors (16). ...
The number of women in the United States that experience blows to the head during assaults by intimate partners is substantial. The number of head blows that result in a traumatic brain injury (TBI) is virtually unknown, but estimates far exceed numbers of TBI in parallel populations (e.g., blast exposure, accidents, sports) combined. Research on the impact of TBI on post-traumatic stress disorder (PTSD) in survivors of intimate partner violence (IPV) is sparse. This methodology paper describes the comprehensive, multi-method approach used by a multi-disciplinary team of investigators from several different fields of expertise to assess the interaction of psychiatric, cognitive, psychological, and physical conditions that result from IPV. Using state-of-the-art instruments, a comprehensive assessment of lifetime trauma exposure, lifetime history of TBI, psychiatric history, and a full assessment of current cognitive, neuropsychological and biomedical function was conducted with 51 female survivors of IPV who screened positive for PTSD. This multi-method assessment included clinician-administered diagnostic interviews modified to specifically assess the sequelae of IPV, standardized self-report surveys, neuropsychological tests, structural, diffusion, and functional neuroimaging and blood-based biomarkers. The specific details and full report of the results of the full study are beyond the scope of this methodology paper. Descriptive characteristics of the complex clinical presentation observed in this unique sample are described. The sample reported high rates of trauma exposure across the lifespan and 80% met full criteria for current PTSD. Women also reported high rates of lifetime subconcussive head injury (88.2%) and TBI (52.9%) from various etiologies (35.3% secondary to IPV). Descriptive findings from the methodological protocol described here have begun to reveal information that will advance our understanding of the impact of subconcussive head injury and TBI on recovery from mental injury among IPV survivors.
... Av andelen drabbade personer som söker sjukvård, är männen överrepresenterade (58 % i slutenvård respektive 52 % i öppenvård 2017) [29]. En bidragande orsak till den något ojämna fördelningen kan vara att det finns ett mörkertal i gruppen lätt hjärnskadade där alla inte uppsöker sjukvård, till exempel vid skador inom idrott eller när det gäller kvinnor som råkat ut för misshandel [33]. Världshälsoorganisationen (WHO) har med anledning av mörkertalet uppskattat det verkliga antalet personer som får en hjärnskada med påverkan på hjärnan till över 600 per 100 000 invånare och år [34]. ...
The aim of the project was to assess rehabilitation interventions for adults with traumatic brain injury from medical, social, ethical and health economic perspectives.
Available at: https://www.ncbi.nlm.nih.gov/pubmed/33439586
In Swedish: https://www.sbu.se/304
... It is made given that survivors of IPV may experience violent episodes at regular intervals over a period of months or years. 23,24 It remains unknown whether chronic and repetitive exposure to IPV, and, by extension, potential BI, puts women at risk for long-term cognitive impairment or neurodegeneration. It has been demonstrated spousal abuse increases the odds of an Alzheimer's diagnosis in women 25 and there is at least one case report of a woman who had experienced IPV with progressive dementia and morphological brain changes consistent with 'dementia pugilistica', the historical precursor to chronic traumatic encephelopathy (CTE). ...
Intimate partner violence (IPV) affects at least 1 in 3 women worldwide and up to 92% report symptoms consistent with brain injury (BI). Although a handful of studies have examined different aspects of brain structure and function in this population, none has characterized potential deficits in cognitive-motor function. This knowledge gap was addressed in the current study by having participants who had experienced IPV complete the bimanual Object Hit & Avoid (OHA) task on a Kinarm End-Point Lab. BI load, as assessed by the Brain Injury Severity Assessment (BISA) tool as well as measures of comorbidities (PTSD, anxiety, depression, substance use, history of abuse) were also collected. Results demonstrated BI load accounted for a significant amount of variability in the number of targets hit and average hand speed. PTSD, anxiety, and depression also contributed significantly to the variability in these measures as well as to the number and proportion of distractor hits, and the object processing rate. Taken together, these findings suggest IPV-related BI, as well as comorbid PTSD, anxiety, and depression, disrupt the processing required to quickly and accurately hit targets while avoiding distractors. This pattern of results reflects the complex interaction between the physical injuries induced by the episodes of IPV and the resulting impacts these experiences have on mental health. Keywords: intimate partner violence, brain injury, strangulation, cognitive-motor function
... The etiology of this cognitive impairment is likely multifactorial, and may reflect the effects of mood disorders, chronic stress responses, and prolonged self-protective hypervigilance, as well as the cumulative effects of repetitive exposure to brain trauma. Studies evaluating self-report of cognitive functioning have found increased endorsement of memory problems and attention problems in victims of IPV with an additional history of head trauma (Campbell et al. 2017;Jackson et al. 2002;Monahan and O'Leary, 1999;Smirl et al. 2019). In a study of the effects of brain injury on cognitive functioning in individuals who experienced IPV, significant correlations between brain injury and aspects of verbal learning and memory were observed even when controlling for abuse severity, anxious arousal, and post-traumatic stress disorder (PTSD) symptom severity (Valera and Berenbaum 2003). ...
Intimate partner violence includes psychological aggression, physical violence, sexual violence, and stalking from a current or former intimate partner. Past research suggests that exposure to intimate partner violence can impact cognitive and psychological functioning, as well as neurological outcomes. These seem to be compounded in those who suffer a brain injury as a result of trauma to the head, neck or body due to physical and/or sexual violence. However, our understanding of the neurobehavioral and neurobiological effects of head trauma in this population is limited due to factors including difficulty in accessing/recruiting participants, heterogeneity of samples, and premorbid and comorbid factors that impact outcomes. Thus, the goal of the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Consortium Intimate Partner Violence Working Group is to develop a global collaboration that includes researchers, clinicians, and other key community stakeholders. Participation in the working group can include collecting harmonized data, providing data for meta- and mega-analysis across sites, or stakeholder insight on key clinical research questions, promoting safety, participant recruitment and referral to support services. Further, to facilitate the mega-analysis of data across sites within the working group, we provide suggestions for behavioral surveys, cognitive tests, neuroimaging parameters, and genetics that could be used by investigators in the early stages of study design. We anticipate that the harmonization of measures across sites within the working group prior to data collection could increase the statistical power in characterizing how intimate partner violence-related head trauma impacts long-term physical, cognitive, and psychological health.
... Traumatic brain injury is common in victims of IPV (61)(62)(63). In a study involving 53 adult female victims of IPV, 92% of the women reported sustaining hits to the head or face, and in 40% of these cases, the victim reported a loss of consciousness after an assault (64). Traumatic brain injury in survivors of IPV often manifests with a postconcussive syndrome, a cluster of symptoms that include disturbed sleep, anxiety or depression, dizziness or vertigo, headache, and posttraumatic stress disorder (61)(62)(63). ...
Intimate partner violence (IPV) is the physical, sexual, or emo-tional violence between current or former partners. It is a major public health issue that affects nearly one out of four women. Nonetheless, IPV is greatly underdiagnosed. Imaging has played a significant role in identifying cases of nonaccidental trauma in children, and similarly, it has the potential to enable the identification of injuries resulting from IPV. Radiologists have early access to the radiologic history of such victims and may be the first to diagnose IPV on the basis of the distribution and imaging appearance of the patient’s currrent and past injuries. Radiologists must be familiar with the imaging findings that are suggestive of injuries resulting from IPV. Special attention should be given to cases in which there are multiple visits for injury care; coexistent fractures at different stages of healing, which may help differentiate injuries related to IPV from those caused by a stranger; and injuries in defensive locations and target areas such as the face and upper ex-tremities. The authors provide an overview of current methods for diagnosing IPV and define the role of the radiologist in cases of IPV. They also describe a successful diagnostic imaging–based ap-proach for helping to identify IPV, with a specific focus on the associated imaging findings and mechanisms of injuries. In addition, current needs and future perspectives for improving the diagnosis of this hidden epidemic are identified. This information is intend-ed to raise awareness among radiologists, with the ultimate goal of improving the diagnosis of IPV and thus reducing the devastating effects on victims’ lives.
... According to Campbell (56), intimate partner violence is associated with PTSD, depression, chronic pain, sexually transmitted diseases, etc. Woods (57) reported that PTSD symptoms could be observed in both abused and post-abused women. Jackson et al. (58) established a link between traumatic brain injury and woman battering. They reported that the frequency of being hit in the head was significantly correlated with severe cognitive symptoms. ...
Purpose: Quarantine is necessary to reduce the community spread of the Coronavirus disease, but it also has serious psychological and socially disruptive consequences. This is known as the quarantine paradox that also includes a surge in the cases of gender-based violence. However, there exists a clear gap of rigorous literature exploring the issue. Hence, the current paper attempts to understand gender-based violence as an aspect of the COVID-19 lockdown. It reviews the pattern of rise in gender violence cases and the resultant psychological and social issues and attempts to create awareness by initiating a discourse urging for change in the response towards the victims of gender-based violence. The paper further attempts to suggest measures to mitigate the issues arising out of gender violence during quarantine. Method: The current paper reviews the literature on the rise of gender-based violence in the times of current and past pandemics. The paper also reviews the published reports in scientific as well as mass media literatures focusing on the rise of gender-based violence during the imposed lockdown, its consequences, and the measures taken by the governments to tackle the issue. Results: The present review reveals that similar to the previous pandemics and epidemics, there has been an alarming rise in the incidents of gender-based violence during the COVID-19 pandemic. The present review further reveals various other risk factors that have been found attributive to the surge of gender-based violence such as economic insecurity and alcohol consumption. The results of the review indicate that despite its global prevalence, gender-based violence has been one of the most neglected outcomes of pandemics. Moreover, the legislatures and services available for such victims are often inadequate and, thus, worsening their situation. Conclusion: Pandemic situations have been found to be associated with advancements in the medical field. However, a part and parcel of this situation is the age-old practice of quarantine that has several negative outcomes. This also includes a surge in gender-based violence that raises serious concerns about the safety of women. As the legislatures provided and measures taken by the governments are falling short in dealing with the issue, a number of non-government organizations are stepping up to provide necessary services to these victims.
... M. Valera & Berenbaum, 2003). Another study of women in a domestic violence shelter reported that 92% of the women experienced a blow to the head or face, and 40% experienced at least one TBI that resulted in a loss of consciousness (Jackson et al., 2002). ...
The study examined rates of possible brain injury among survivors of intimate partner violence. Of the 171 women screened, 91% indicated they had been hit in the head or strangled, and 31% reported it happened more than six times in their life. Only 35% of women who were hit in the head or strangled received medical treatment, and 64% reported losing consciousness or experienced a period of being dazed and confused. Organizations serving intimate partner violence survivors should routinely screen survivors for brain injury so they can obtain timely referrals for neurorehabilitation services to improve their quality of life.
... Cognitive impairments in individuals with a history of IPV may be compounded in those who experience head trauma as a result of abuse (Valera & Berenbaum, 2003). Studies evaluating self-report of cognitive functioning have found increased endorsement of memory problems and attention problems in victims of IPV with an additional history of head trauma (Campbell et al., 2017;Jackson, Philp, Nuttall, & Diller, 2002;Monahan & O'Leary, 1999). In a study of the effects of brain injury on cognitive functioning in individuals who experienced IPV, significant correlations between brain injury and aspects of verbal learning and memory were observed even when controlling for abuse severity, anxious arousal, and Post-traumatic Stress 8 Disorder (PTSD) symptom severity (Stein et al., 2002;Twamley et al., 2009;Valera & Berenbaum, 2003). ...
Intimate partner violence includes psychological aggression, physical violence, sexual violence, and stalking from a current or former intimate partner. Experiencing intimate partner violence is associated with impaired neurocognitive and psychosocial functioning, mental illness, as well as structural brain alterations. These impairments seem to be compounded by exposure to physical trauma to the head. Importantly, up to 90% of women exposed to intimate partner violence also experience some form of head trauma or even repetitive head trauma. However, research on this topic is sparse, and the neurobehavioral and neurobiological effects of head trauma in this population have not been systematically investigated. A key aim of the EnhancingNeuroimaging and Genetics through Meta-Analysis Consortium Intimate Partner Violence Working Group is to provide recommendations for the harmonization of measures collected to facilitate the meta-analysis of neuropsychological, neuroimaging, and genetic data across studies. Here, we review the current literature on the impact of intimate partner violence-related head trauma in men and women. We further provide recommendations for studies examining the effects of intimate partner violence-related head trauma on neuronal, cognitive, and psychological functioning, as well as the influence of genetic variation. We anticipate that the harmonization of measures across studies will increase the statistical power in characterizing how IPV-related head trauma impacts long-term physical and psychological health, as well as in determining the influence of common comorbidities and genetic variation.
... Cognitive impairments in individuals with a history of IPV may be compounded in those who experience head trauma as a result of abuse (Valera & Berenbaum, 2003). Studies evaluating self-report of cognitive functioning have found increased endorsement of memory problems and attention problems in victims of IPV with an additional history of head trauma (Campbell et al., 2017;Jackson, Philp, Nuttall, & Diller, 2002;Monahan & O'Leary, 1999). In a study of the effects of brain injury on cognitive functioning in individuals who experienced IPV, significant correlations between brain injury and aspects of verbal learning and memory were observed even when controlling for abuse severity, anxious arousal, and Post-traumatic Stress 8 Disorder (PTSD) symptom severity (Stein et al., 2002;Twamley et al., 2009;Valera & Berenbaum, 2003). ...
Intimate partner violence includes psychological aggression, physical violence, sexual violence, and stalking from a current or former intimate partner. Experiencing intimate partner violence is associated with impaired neurocognitive and psychosocial functioning, mental illness, as well as structural brain alterations. These impairments seem to be compounded by exposure to physical trauma to the head. Importantly, up to 90% of women exposed to intimate partner violence also experience some form of head trauma or even repetitive head trauma. However, research on this topic is sparse, and the neurobehavioral and neurobiological effects of head trauma in this population have not been systematically investigated. A key aim of the Enhancing Neuroimaging and Genetics through Meta-Analysis Consortium Intimate Partner Violence Working Group is to provide recommendations for the harmonization of measures collected to facilitate the meta-analysis of neuropsychological, neuroimaging, and genetic data across studies. Here, we review the current literature on the impact of intimate partner violence-related head trauma in men and women. We further provide recommendations for studies examining the effects of intimate partner violence-related head trauma on neuronal, cognitive, and psychological functioning, as well as the influence of genetic variation. We anticipate that the harmonization of measures across studies will increase the statistical power in characterizing how IPV-related head trauma impacts long-term physical and psychological health, as well as in determining the influence of common comorbidities and genetic variation.
... An abundance of evidence indicates that mTBI can have lifelong impacts, including changes in personality and behavior (Banks, 2007;Brewer et al., 2002;Jackson, Philp, Nuttall, & Diller, 2002). In addition to these impacts, research suggests that women face worse TBI related outcomes than men following a head injury (Farace & Alves, 2000). ...
Traumatic Brain Injury (TBI) is an injury to the brain caused by an acute injury to the head, neck, or face, such as a blunt force trauma. Survivors of Intimate Partner Violence (IPV) are at high risk for TBI, given how frequently they are repeatedly struck in the head. An abundance of evidence indicates that even “mild” TBI can have lifelong impacts, including personality and behavioral changes. TBI often goes undiagnosed in survivors as most do not seek medical treatment for their injuries. Given the lack of diagnoses, these symptoms may often be overlooked or misunderstood. One emerging method for treating the symptoms of TBI is neurofeedback (NF). NF is a type of biofeedback that uses operant conditioning to regulate activity in various regions of the brain. NF can lead to better cognitive performance and emotional self-regulation. Given the potentially high rate of TBI in IPV, it is worth exploring if NF can reduce the symptoms that negatively impact survivors. The current study explores the use of NF to treat IPV survivors who experienced head injury and, as such, probable TBI (N = 32). Survivors participated in a quantitative EEG (qEEG) to locate problem areas of the brain and participated in assessments, before and after treatment, to examine constructs such as depression and Post-Traumatic Stress Disorder (PTSD). Results show significant differences in both the qEEG data and written assessments following the completion of NF. These results suggest NF could mitigate symptoms of probable TBI in IPV survivors.
... Particularly concerning is that injuries to the head, neck, and face area often happen several times throughout the course of a DV survivor's abuse, increasing a survivor's risk of sustaining a brain injury (Murray, Lundgren, Olson, & Hunnicutt, 2016). A survey of 53 women accessing domestic violence services (Jackson, Philp, Nuttall, & Diller, 2002) found that 92% of women reported having been hit in the head or face, while 88% reported having been hit in the head in the past 5 years with a mode of 2-5 times. Twenty-five percent reported sustaining hits to the head more than 20 times in the past 5 years. ...
Domestic violence (DV) survivors are susceptible to traumatic and anoxic-hypoxic brain injury, collectively referred to as brain injury (BI). This study characterized: 1) provider perception of the impact of BI on DV survivors’ experiences with advocacy services and 2) survivors’ reported exposures that can lead to BI. Data were collected at five advocacy organizations in 2017: 11 focus groups were conducted with service providers (n = 45 staff & 17 administrators) and interview administered surveys were completed with survivors (n = 49). Our findings indicate a discrepancy between providers’ perception of the potential impact of BI on survivors’ presentation and ability to access services, and survivors’ pervasive exposure to incidents that can cause BI. Over 81% of survivors reported having been hit in the head or been made to have their head hit another object at least once, and over 83% of survivors reported ever having been strangled. Raising organizational capacity to serve DV survivors with BI is necessary. Intervention suggestions are provided.
... Research regarding HNF injuries among women subjected to IPV has found the prefrontal cortex to be one of the cerebral areas most affected by physical abuse (Stein et al. 2002). Damage to this area may explain diminished cognitive functioning found among female victims in the domains of memory, attention, and executive functioning ( Jackson et al. 2002;Monahan and O'Leary 1999;Rincón and Fernández 2015;Stein et al. 2002;Twamley et al. 2009). Thus, researching the nature of these injuries is critical to understanding the psychological and neuropsychological consequences of IPV, and even a victim's susceptibility to remaining in the violent relationship (Southwick et al. 2005;Valera and Barenbaum 2003). ...
This cross-sectional study describes knowledge, perceived competence, and behaviors relative to intimate partner violence (IPV)-related brain injury (BI) among staff in residential domestic violence shelter programs across a New England state. A 23-item questionnaire was administered to registrants of an online IPV-related BI training series. Within this sample, knowledge about IPV-related BI was high, but relative to providing screening, accommodations, and specialized referrals to survivors with BI, perceived competence was low, and behaviors were infrequent. IPV shelter agencies should facilitate IPV-related BI training programs for staff and prioritize developing and implementing BI screening, accommodation, and referral policies and procedures.
Primary objective:
Despite a high prevalence of intimate partner violence (IPV) and its lasting impacts on individuals, particularly women, very little is known about how IPV may impact the brain. IPV is known to frequently result in traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). In this overview of literature, we examined literature related to neuroimaging in women with IPV experiences between the years 2010-2021.
Research design:
Literature overview.
Methods and procedures:
A total of 17 studies were included in the review, which is organized into each imaging modality, including magnetic resonance imaging (structural, diffusion, and functional MRI), Electroencephalography (EEG), proton magnetic resonance spectroscopy (pMRS), and multimodal imaging.
Main outcomes and results:
Research has identified changes in brain regions associated with cognition, emotion, and memory. Howeverto date, it is difficult to disentangle the unique contributions of TBI and PTSD effects of IPV on the brain. Furthermore, experimental design elements differ considerably among studies.
Conclusions:
The aim is to provide an overview of existing literature to determine commonalities across studies and to identify remaining knowledge gaps and recommendations for implementing future imaging studies with individuals who experience IPV.
Objective: A high prevalence of depression exists in specific sub-samples of survivors of brain injury (BI) sustained from intimate partner violence (IPV). However, the experience of depression by survivors of IPV-related BI from general civilian populations remains unclear. This study documents the symptom profile of
depression reported by individuals who screened positive for sustaining an IPV-related BI.
Methods: 36 individuals who screened positive for possible IPV-related BI completed the Beck Depression
Inventory-2nd Edition (BDI-II). Subscales characterizing the nature of the symptoms were created. Frequency and descriptive statistics were calculated for item responses on the BDI-II. Participants were also assigned to high or low symptom severity groups to examine between-group differences.
Results: Participants endorsed experiencing somatic symptoms more severely than self-evaluative and
affective symptoms. Additionally, self-evaluative and cognitive symptoms correlated with total BDI-II scores for the high symptom severity group but not for the low symptom severity group.
Conclusions: The findings highlight somatic symptoms of depression, in particular as a common experience
among survivors of IPV-related BI. Further, self-evaluative and cognitive symptoms may be more sensitive in detecting depression after IPV-related BI. These results may aid in the development of guidelines to better diagnose and treat depression in IPV-related BI.
Background: Gender-based violence (GBV) is a critical public health concern, demanding for global coordinated efforts. While nursing students form part of a healthcare team with significant roles in identifying and responding to abused victims, studies assessing their readiness to combat GBV are limited in Namibia.
Aim: To assess undergraduate nursing students’ perceptions and to determine the relationship of the study variables to readiness to combat GBV during the coronavirus disease 2019 (COVID-19) pandemic in Namibia.
Setting: This study was conducted at a university satellite campus in Namibia.
Methods: A cross-sectional survey was used to collect data from 105 third and fourth-year undergraduate nursing students using ADKAR model. Data were analysed using Statistical Package for the Social Sciences, version 27.0, for descriptive statistics and logistic regression in determining relationships between study variables.
Results: The study results show a mean readiness of 1.65 ± 0.19. Most respondents perceived themselves ready (73.3%), whereas 26.7% were not. Readiness was common with reinforcement (89.5%) and awareness (84.8%), knowledge (81.9%) and desire (76.2%) subscales. Predictors of readiness in this study were gender and age (R2 = 0.40; R2 = 0.37; p ≤ 0.05).
Conclusion: The results of this study highlight that age and gender were significant predictors for readiness among the undergraduate students in Namibia. The results highlight the importance of GBV education in a nursing curriculum. A qualitative design is recommended for future studies.
Contribution: The results of this study will support global efforts in strengthening the health system response on GBV incidences.
The high incidence of concussions/mild traumatic brain injury and the significant number of people with persisting concussion symptoms as well as the concern for delayed, neurodegenerative effects of concussions makes them a major public health concern. There is much to learn on concussions with respect to pathophysiology as well as vulnerability and resiliency factors. The heterogeneity in outcome after a concussion warrants a more personalized approach to better understand the biological and psychosocial factors that may affect outcome. In this chapter we address biological sex and gender as they impact different aspects of concussion including incidence, risk factors and outcome. As well, this chapter will provide a more fulsome overview of intimate partner violence, an often-overlooked cause of concussion in women. Applying the sex and gender lens to concussion/mild traumatic brain injury is imperative for discovery of its pathophysiology and moving closer to treatments.
This chapter outlines examples of sex and gender considerations with respect to concussion, a topic that has historically received minimal attention. Definitions of sex (biological characteristics) and gender (social constructs) are provided. Epidemiological studies have shown that there are differential patterns of injury across the lifespan by sex with increasing concussion rates among girls/women. Although the literature is mixed, a compelling number of studies are showing that girls/women may have more severe and prolonged symptoms.This chapter also presents examples of research across different contexts such as among high-risk workers and older adults, sports, and vulnerable population. Areas of brain injury that have not received much attention, such as intimate partner violence which disproportionally affects women, are also addressed.Sex differences in concussion rates and outcomes in various contexts are explained in relation to biological and gender or socio-cultural factors. Examples of biological differences include research on reproductive health (e.g., menstrual cycles, contraception) and structural differences in the brain, while gender or socio-cultural differences cover symptom reporting and gender based violence.Finally, this chapter provides some new developments, including resources to assist researchers and clinicians to facilitate sex and gender considerations in research and clinical practice. This research is still in its infancy stage but has shown much growth and recognition recently.KeywordsSex and genderVulnerable populationsSocio-cultural factorsBiological factorsSportsEpidemiologyMild traumatic brain injuryConcussion
Intimate partner violence (IPV) is a serious public health problem with long lasting consequences to those who are suffering from it. Its prevalence is concerning in all kinds of relationships, including heterosexual and non-heterosexual relationships. The current article provides a theoretical overview of the basis of IPV, including possible risk factors for IPV perpetration, types of perpetrators, predictors of recidivism, and the effect of IPV on victims. The most relevant measures for screening and assessing current IPV and future recidivism, as well as the different kinds of available treatments, are discussed.
Intimate partner violence (IPV) affects at least 1 in 3 women worldwide and up to 92% report symptoms consistent with brain injury (BI). Although a handful of studies have examined different aspects of brain structure and function in this population, none has characterized potential deficits in cognitive-motor function. This knowledge gap was addressed in the current study by having participants who had experienced IPV complete the bimanual Object Hit & Avoid (OHA) task on a Kinarm End-Point Lab. BI load, post-traumatic stress disorder (PTSD), anxiety, depression, substance use, and history of abuse were also assessed. A stepwise multiple regression was undertaken to explore the relationship between BI load and task performance while accounting for comorbid psychopathologies. Results demonstrated BI load accounted for a significant amount of variability in the number of targets hit and average hand speed. PTSD, anxiety, and depression also contributed significantly to the variability in these measures as well as to the number and proportion of distractor hits, and the object processing rate. Taken together, these findings suggest IPV-related BI, as well as comorbid PTSD, anxiety, and depression, disrupt the processing required to quickly and accurately hit targets while avoiding distractors. This pattern of results reflects the complex interaction between the physical injuries induced by the episodes of IPV and the resulting impacts these experiences have on mental health.
While much of the focus on brain injury has centered on athletes and military veterans, victims of domestic violence (DV) comprise an under-represented cohort. Epidemiological studies show that a majority of domestic violence cases have a history of trauma to the head or neck resulting in both TBI and oral maxillofacial damage. However, distinctive oral injuries that are sustained simultaneously with brain trauma as a result of DV have yet to be fully elucidated. If a correlation can be made between specific oral injuries and TBI, then dentition may serve as a reliable biomarker for TBI. Specific dental biomarkers of injury would improve identification, diagnosis, and prognosis of TBI regardless of patient declamation. Dentists have the opportunity and obligation to add significantly to the body of knowledge regarding the frequency, presentation, profile, and characteristics of head and neck injuries of TBI in victims of DV. In so doing, the effort will fill the knowledge gaps and clarify misinformation in the lay, clinical, and scientific communities regarding the impact of TBI in DV events. The dental field can become a leader in branding the procedures, protocols, and clinical practices in the recognition and intervention against TBI in the DV population.
Although intimate partner violence (IPV) related (TBI) is increasingly recognized as an important area of concern, there is no existing research that seeks to identify correlates of IPV related TBI. Given the profound consequences of TBI, it is important to identify individual and social-ecological conditions that are associated with probable TBI among persons with a history of physical violence in their intimate partnerships. In this paper, we are concerned specifically with physical abuse that occurs in violent intimate relationships. The sample included 130 participants who were formerly abused by an intimate partner. This study was part of a larger research project that utilized a web-based survey to learn about the socio-ecological conditions surrounding IPV-related TBI. The HELPS screening tool was employed to calculate risk for TBI. Approximately half of the survey respondents (n= 64) were determined to have likely experienced IPV-related TBI. This finding is consistent with existing literature showing that TBIs are highly prevalent among individuals who have experienced IPV. Logistic regression analysis was used to explore the correlates of IPV-related TBI. The results show that punishment for the abuser, time since the relationship ended, and seeking help for the health consequences of IPV were significantly associated with probable TBI. Results, limitations, future directions and implications are discussed.
We examined the effects of intimate violence on the physical and psychological health of women over time. Changes in levels of physical and psychological abuse, injuries, physical health symptoms, anxiety, and depression were assessed three times: immediately after exit from a domestic violence program and at 81/2- and 141/2-month follow-ups. Analyses showed a significant decline in abuse, physical health symptoms, anxiety, and depression over time. Longitudinal structural equation modeling demonstrated that ongoing abuse was significantly related to increased physical and psychological health problems from one time period to the next, even when prior levels of physical and psychological health were controlled. Within each time interval, the effects of abuse on physical symptoms appeared to be mediated through anxiety and depression; although this relationship was replicated at several time points, the mediation was not verified across time, probably because measurement intervals were too long to reflect the underlying causal sequence. Although injuries were the direct result of abuse, injuries showed no significant effect on physical symptoms, anxiety, or depression. Implications for intervention and future research are discussed.
Patients with head injuries frequently complain of a decreased ability to endure intense light and sound stimuli. The few psychophysical studies that have objectively studied this type of hyperaesthesia have not assessed to what extent patients recover from this hyperaesthesia after mild head injury (MHI). A computerised rating technique was used to assess tolerance to intense sound (95 dB) and light (1500 lux) stimuli in patients with an uncomplicated MHI. Patients were tested 10 days and five weeks after the injury. Although most patients substantially recovered from both visual and acoustic hyperaesthesia, 25% of the patients were still not able to endure intense stimuli by five weeks. Analysis of data obtained with two behavioural rating scales (one with post-concussive/cognitive complaints and a second with emotional/vegetative complaints) indicated that visual hyperaesthesia was specifically related to the post-concussive/cognitive complaints scale.
We assessed the incidence of sexual violence, physical violence, physical health symptoms, gynecological symptoms, and risk behaviors for contracting an STD or HIV infection in women who had used a shelter for women with abusive partners. In addition, we investigated the relationships between sexual violence and the frequency of physical health symptoms, including specific gynecological symptoms. Results indicated that one fourth of the women interviewed had experienced sexual violence and nearly two thirds of the women had experienced physical violence in the past 6 months. The incidence of physical health symptoms, gynecological symptoms, and risk behaviors for exposure to STDs and HIV infection are presented. The correlations among sexual violence, physical violence, and experiences of physical health symptoms are also reported. This study is particularly valuable because previous research has not documented the relationship between sexual violence and physical health symptoms.
Despite the high prevalence and potentially serious outcomes associated with concussion in athletes, there is little systematic research examining risk factors and short- and long-term outcomes.
To assess the relationship between concussion history and learning disability (LD) and the association of these variables with neuropsychological performance and to evaluate postconcussion recovery in a sample of college football players.
A total of 393 athletes from 4 university football programs across the United States received preseason baseline evaluations between May 1997 and February 1999. Subjects who had subsequent football-related acute concussions (n = 16) underwent neuropsychological comparison with matched control athletes from within the sample (n = 10).
Clinical interview, 8 neuropsychological measures, and concussion symptom scale ratings at baseline and after concussion.
Of the 393 players, 129 (34%) had experienced 1 previous concussion and 79 (20%) had experienced 2 or more concussions. Multivariate analysis of variance yielded significant main effects for both LD (P<.001) and concussion history (P=.009), resulting in lowered baseline neuropsychological performance. A significant interaction was found between LD and history of multiple concussions and LD on 2 neuropsychological measures (Trail-Making Test, Form B [P=.007] and Symbol Digit Modalities Test [P=.009]), indicating poorer performance for the group with LD and multiple concussions compared with other groups. A discriminant function analysis using neuropsychological testing of athletes 24 hours after acute in-season concussion compared with controls resulted in an overall 89.5% correct classification rate.
Our study suggests that neuropsychological assessment is a useful indicator of cognitive functioning in athletes and that both history of multiple concussions and LD are associated with reduced cognitive performance. These variables may be detrimentally synergistic and should receive further study.
The potential seriousness of mild traumatic brain injury (MTBI) is increasingly recognized; however, information on the frequency of MTBI among high school athletes is limited.
To identify the type, frequency, and severity of MTBI in selected high school sports activities.
Observational cohort study.
Two hundred forty-six certified athletic trainers recorded injury and exposure data for high school varsity athletes participating in boys' football, wrestling, baseball and field hockey, girls' volleyball and softball, boys' and girls' basketball, and boys' and girls' soccer at 235 US high schools during 1 or more of the 1995-1997 academic years.
Rates of reported MTBI, defined as a head-injured player who was removed from participation and evaluated by an athletic trainer or physician prior to returning to participation. National incidence figures for MTBI also were estimated.
Of 23566 reported injuries in the 10 sports during the 3-year study period, 1219 (5.5%) were MTBIs. Of the MTBIs, football accounted for 773 (63.4%) of cases; wrestling, 128 (10.5%); girls' soccer, 76 (6.2%); boys' soccer, 69 (5.7%); girls' basketball, 63 (5.2%); boys' basketball, 51 (4.2%); softball, 25 (2.1%); baseball, 15 (1.2%); field hockey, 13 (1.1%); and volleyball, 6 (0.5%). The injury rates per 100 player-seasons were 3.66 for football, 1.58 for wrestling, 1.14 for girls' soccer, 1.04 for girls' basketball, 0.92 for boys' soccer, 0.75 for boys' basketball, 0.46 for softball, 0.46 for field hockey, 0.23 for baseball, and 0.14 for volleyball. The median time lost from participation for all MTBIs was 3 days. There were 6 cases of subdural hematoma and intracranial injury reported in football. Based on these data, an estimated 62816 cases of MTBI occur annually among high school varsity athletes participating in these sports, with football accounting for about 63% of cases.
Rates of MTBI vary among sports and none of the 10 popular high school sports we studied is without the occurrence of an MTBI. Continued involvement of high school sports sponsors, researchers, medical professionals, coaches, and sports participants is essential to help minimize the risk of MTBI.
Domestic violence is the most common cause of nonfatal injury to women in the United States. To identify risk factors for such injuries, we examined the socioeconomic and behavioral characteristics of women who were victims of domestic violence and the men who injured them.
We conducted a case-control study at eight large, university-affiliated emergency departments. The 256 intentionally injured women had acute injuries resulting from a physical assault by a male partner. The 659 controls were women treated for other conditions in the emergency department. Information was collected with a standardized questionnaire; no information was obtained directly from the male partners.
The 256 intentionally injured women had a total of 434 contusions and abrasions, 89 lacerations, and 41 fractures and dislocations. In a multivariate analysis, the characteristics of the partners that were most closely associated with an increased risk of inflicting injury as a result of domestic violence were alcohol abuse (adjusted relative risk, 3.6; 95 percent confidence interval, 2.2 to 5.9); drug use (adjusted relative risk, 3.5; 95 percent confidence interval, 2.0 to 6.4); intermittent employment (adjusted relative risk, 3.1; 95 percent confidence interval, 1.1 to 8.8); recent unemployment (adjusted relative risk, 2.7; 95 percent confidence interval, 1.2 to 6.5); having less than a high-school-graduate's education (adjusted relative risk, 2.5; 95 percent confidence interval, 1.4 to 4.4); and being a former husband, estranged husband, or former boyfriend (adjusted relative risk, 3.5; 95 percent confidence interval, 1.5 to 8.3).
Women at greatest risk for injury from domestic violence include those with male partners who abuse alcohol or use drugs, are unemployed or intermittently employed, have less than a high-school-graduate's education, and are former husbands, estranged husbands, or former boyfriends of the women.
Data regarding the development of a structured interview measuring alterations that may accompany extreme stress are presented. A list of 27 criteria often seen in response to extreme trauma and not addressed by DSM-IV criteria for posttraumatic stress disorder (PTSD) were generated based on a systematic review of the literature and a survey of 50 experts. A structured interview for disorders of extreme stress (SIDES) measuring the presence of these criteria was administered to 520 subjects as part of the DSM-IV PTSD field trials. Inter-rater reliability as measured by Kappa coefficients for lifetime Disorders of Extreme Stress was .81. Internal consistency using coefficient alpha ranged from .53 to .96. Results indicate that the SIDES is a useful tool for investigation of response to extremes stress.
Because violence usually happens in private, researchers and clinicians have had difficulty studying and diagnosing abusive relationships. The most popular and widely used measure of intimate violence in couples and families is the Conflict Tactics Scale, a self-report measure where respondents are asked to indicate whether they or their partner have engaged in certain behaviors over a specific time, such as the past year. The Conflict Tactics Scale is beneficial because it requires little time to complete, is easy to administer, and is a reliable measure. There is also a version for measuring maltreatment in parent–child relationships, the Conflict Tactics Scale Parent Child.
Context Soccer players incur concussions during matches and training sessions,
as well as numerous subconcussive blows to the head from impacts with the
soccer ball (headers). The combination of soccer-related
concussions and the number of headers may be a risk for chronic traumatic
brain injury (CTBI).Objective To determine whether amateur soccer players have evidence of CTBI.Design, Setting, and Participants Cross-sectional study of 33 amateur soccer players and 27 amateur athletes
involved in swimming and track (controls) in the Netherlands who underwent
interviews and neuropsychological testing.Main Outcome Measures Performance of soccer players vs controls on 16 neuropsychological tests
having 27 outcomes.Results Compared with control athletes, amateur soccer players exhibited impaired
performance on tests of planning (39% vs 13%; P=.001)
and memory (27% vs 7%; P=.004). Among soccer players,
9 (27%) had incurred 1 soccer-related concussion and 7 (23%) had had 2 to
5 concussions during their career. The number of concussions incurred in soccer
was inversely related to the neuropsychological performance on 6 of the neuropsychological
tests.Conclusions Our results indicate that participation in amateur soccer in general
and concussion specifically is associated with impaired performance in memory
and planning functions. Due to the worldwide popularity of soccer, these observations
may have important public health implications.
This article compares the rate of physical abuse of children and spouses from a 1975 study with the rates from a 1985 replication. Both studies used nationally representative samples (2,143 families in 1975 and 3,520 in 1985), and both found an extremely high incidence of severe physical violence against children ("child abuse") and a high incidence of violence against spouses. However, the 1985 rates, although high, were substantially lower than in 1975: the child abuse rate was 47% lower, and the wife abuse rate was 27% lower. Possible reasons for the lower rates in 1985 are examined and evaluated, including: (a) differences in the methods of the studies, (b) increased reluctance to report, (c) reductions in intrafamily violence due to ten years of prevention and treatment effort, and (d) reductions due to changes in American society and family patterns that would have produced lower rates of intrafamily violence even without ameliorative programs. The policy implications of the decreases and of the continued high rate of child abuse and spouse abuse are discussed.
Objective
To provide biomedical researchers and clinicians with information regarding
and recommendations for effective rehabilitation measures for persons who
have experienced a traumatic brain injury (TBI).Participants
A nonfederal, nonadvocate, 16-member panel representing the fields of
neuropsychology, neurology, psychiatry, behavioral medicine, family medicine,
pediatrics, physical medicine and rehabilitation, speech and hearing, occupational
therapy, nursing, epidemiology, biostatistics, and the public. In addition,
31 experts from these same fields presented data to the panel and a conference
audience of 883 members of the public. The conference consisted of (1) presentations
by investigators working in areas relevant to the consensus questions during
a 2-day public session; (2) questions and statements from conference attendees
during open discussions that were part of the public session; and (3) closed
deliberations by the panel during the remainder of the second day and part
of the third. Primary sponsors of the conference were the National Institute
of Child Health and Human Development and the National Institutes of Health
Office of Medical Applications of Research.Evidence
The literature was searched through MEDLINE for articles from January
1988 through August 1998 and an extensive bibliography of 2563 references
was provided to the panel and the conference audience. Experts prepared abstracts
for their conference presentations with relevant citations from the literature.
The panel prepared a compendium of evidence, including a patient contribution
and reports from federal agencies. Scientific evidence was given precedence
over clinical anecdotal experience.Consensus Process
The panel, answering predefined questions, developed their conclusions
based on the scientific evidence presented during the open forum (October
26-28, 1998) and in the scientific literature. The panel composed a draft
statement that was read in its entirety and circulated to the experts and
the audience for comment. Thereafter, the panel resolved conflicting recommendations
and released a revised statement at the end of the conference. The panel finalized
the revisions within a few weeks after the conference. The draft statement
was made available on the Internet immediately following its release at the
conference and was updated with the panel's final revisions.Conclusions
Traumatic brain injury results principally from vehicular incidents,
falls, acts of violence, and sports injuries and is more than twice as likely
to occur in men as in women. The estimated incidence rate is 100 per 100,000
persons, with 52,000 annual deaths. The highest incidence is among persons
aged 15 to 24 years and 75 years or older, with a less striking peak in incidence
in children aged 5 years or younger. Since TBI may result in lifelong impairment
of physical, cognitive, and psychosocial functioning and prevalence is estimated
at 2.5 million to 6.5 million individuals, TBI is a disorder of major public
health significance. Mild TBI is significantly underdiagnosed and the likely
societal burden is therefore even greater. Given the large toll of TBI and
absence of a cure, prevention is of paramount importance. However, the focus
of this conference was the evaluation of rehabilitative measures for the cognitive
and behavioral consequences of TBI. Evidence supports the use of certain cognitive
and behavioral rehabilitation strategies for individuals with TBI. This research
needs to be replicated in larger, more definitive clinical trials and, thus,
funding for research on TBI needs to be increased.
Students of recovery of CNS damage are generally interested in organismic and environmental factors and their interactions which influence behaviors of individuals. Major considerations pertain to age of onset and age of examination, time since onset, gender, and etiology, locus, and extent of brain damage. The major indicators of recovery are generally carefully calibrated situations with precise stimuli and response dimensions. The aims are generally to document CNS factors in recovery. Such studies usually use experimental methods to elucidate mechanisms of function e.g. the induction of an alternate way of handling or training an animal to alter a response. Since these approaches are well covered in other papers in this volume there is no reason to dwell further on them in this paper.
Suggests the construct of learned helplessness (LH) as a psychological rationale for why battered women become victims. Published literature and the author's clinical experiences in the US and Great Britain provide material for analysis and treatment recommendations. The LH theory has 3 basic components: (a) information about what should happen (the contingency), (b) cognitive representation about the contingency, and (c) behavior. It is suggested that the sex-role socialization process may be responsible for the LH behavior seen in adult women, specifically battered women. The LH theory proposes that the only successful treatment to reverse the cognitive, emotional, and motivational deficits is to learn under which conditions responses will be effective in producing results. The existence of a 3-phase cycle of violence has been isolated from the stories of battered women: tension-building, explosion of acute battering incidents, and calm, loving respite. The phases vary in time and intensity both within the same couple and between different couples. (33 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Discusses investigations into the nature, causes, predictors, and treatment of functional disability after minor traumatic brain injury (TBI). Distinctions among minor head injury, mild traumatic brain injury, postconcussion syndrome, and posttraumatic stress disorder (PTSD) are clarified, and methodological and information-processing issues in minor TBI are identified. Four stages of clinical research related to minor TBI are described: identification of functional scenarios (1983–1987), development of educational materials (1985–1986), ongoing research (1988–1992), and clinical applications (1992 and continuing). Finally, a neuropsychological model of functional disability after minor TBI is presented, with implications for assessment and treatment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Women victims of marital abuse suffer many symptoms of posttraumatic stress disorder (PTSD). This article discusses issues of diagnosis, evaluation, interviewing, and treatment as well as legal implications of the battered woman syndrome. Five major areas that have been negatively impacted by the battered woman's coping skills are described: manipulation, dissociation, anger, intimacy, and compliance. Practical ways for handling each of these areas in therapy are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The purpose of this article is to provide practice guidelines that outline a systematic approach to be followed in an acute care setting with patients who have sustained a mild traumatic brain injury (TBI). Most patients are seen briefly in an emergency department and then released, with little or no information concerning the sequelae of mild TBI. This article reviews the literature supporting the importance of early education of patients concerning the possible effects of mild TBI and proposes a specific protocol to be followed in providing patients with medical assessment, a brief cognitive screening evaluation, educational information, and follow-up treatment.
(C) Williams & Wilkins 1996. All Rights Reserved.
It is important to examine the concomitants of depressive symptoms reported by battered women because of the high frequency and potentially vulnerability-enhancing effects of these symptoms within battering relationships. In the present study, 10 environmental and behavioral skills correlates of depressive symptoms were examined in 136 battered women. The results of the Simultaneous Multiple Regression suggested that 46% of the variance in depression scores could be accounted for by scores on measures of these 10 variables. Four variables were found to be uniquely and significantly associated with depressive symptoms: self-reinforcement, realistic assessment, number of losses, and a history of depression. These results suggest that battered women who realistically assess their battering relationship and who report poor self-reinforcement skills, losses, and histories of depression may be at particular risk for depression.
Thesis (Ph. D.)--Fielding Institute, 1992. Includes abstract and vita. Includes bibliographical references. Photocopy.
A case-control study was carried out to test the hypothesis that the rise in the rate of Campylobacter jejuni infection in the Brigend area of South Wales during May was due to the consumption or handling of milk from bottles that had been attacked by birds. 32 of 36 cases meeting the case definition were interviewed, along with 2 controls per case, matched for age, sex, and area of residence. There were strong associations between campylobacter infection and doorstep delivery of milk bottles, a history of milk bottle attack by birds, milk bottle attack by birds during the week before illness, and consumption of milk from attacked bottles during the week before illness. There was a very strong dose-response relation between frequency of bird attack and illness. Controls with a history of milk bottle attack by birds were more likely than cases to have taken preventive measures against bird attack and consumption of contaminated milk. Although few people witnessed the attacks, the likely culprits are magpies (Pica pica) and jackdaws (Corvus monedula).
Head trauma in our society is a common occurrence, resulting in significant expenditure of societal resources. Psychiatric consequences following the injury may be the cause of significant disability during the recovery process. While nearly any psychiatric symptom or disorder may occur following head injury, there are a few common complications which are reviewed in this article. Biopsychosocial factors reported to play a role in the etiology of post-traumatic psychiatric dysfunction are reviewed, diagnostic issues are discussed, and new findings regarding treatment are reviewed.
A clinical scale has been evolved for assessing the depth and duration of impaired consciousness and coma. Three aspects of behaviour are independently measured—motor responsiveness, verbal performance, and eye opening. These can be evaluated consistently by doctors and nurses and recorded on a simple chart which has proved practical both in a neurosurgical unit and in a general hospital. The scale facilitates consultations between general and special units in cases of recent brain damage, and is useful also in defining the duration of prolonged coma.
Recent research suggests that battered women may have a problem-solving skill deficit, thereby limiting their ability to prevent and/or effectively deal with future battering incidents. Situations encountered by battered women were analyzed by gathering data of 30 women receiving outpatient mental health treatment and of women who used a domestic violence emergency shelter. These situations were administered in an open-ended questionnaire format to 14 battered and 20 nonbattered women. These subjects were asked to develop as many alternatives as they could for each situation. Nonbattered women generated significantly more total alternatives and effective alternatives than did battered women. Battered subjects were more likely to produce avoidant and dependent responses.
Research into etiology of marital aggression has focused primarily on psychosocial, political, and cultural factors, to the exclusion of physiological influences. Fifty-three partner abusive men, 45 maritally satisfied, and 32 maritally discordant, nonviolent men were evaluated for past history of head injury, by a physician who was not informed of group membership and aggression history. Logistic regressions confirmed that head injury was a significant predictor of being a battered. The implications of these findings for both marital aggression and post-head injury rehabilitation are discussed.
Violence against women has only recently been addressed in national policy and legislation. Responses by most societal institutions to women assaulted by male partners are still based primarily on a lack of knowledge about the prevalence, severity, and outcomes of violence perpetrated by men against female intimates. Although well suited to make a vital contribution, psychologists still rarely involve themselves in proactive interventions with women victims. This article reviews empirical literature on the physical and sexual assault of women by their male intimates and discusses potential physical and psychological outcomes, with a focus on linking what is known about abused women's reactions with the rich literature on survivors' responses to trauma. Implications for research, treatment interventions, and policy are discussed.
Few data exist regarding the relationship between the location of injuries and the presence of domestic violence. This study of 127 people at an inner-city hospital emergency department found that most patients had head, neck and facial injuries. Although only 23 percent of patients with such injuries were victims of domestic violence, 94.4 percent of victims of domestic violence had head, neck and facial injuries. The study results indicate that head, neck and facial injuries could be markers of domestic violence.
Worry is an important component of anxiety, which recent work suggests is related to increased incidence of coronary heart disease (CHD). Chronic worry has also been associated with decreased heart rate variability. We hypothesized that high levels of worry may increase CHD risk.
We examined prospectively the relationship of worry with CHD incidence in the Normative Aging Study, an ongoing cohort of older men. In 1975, 1759 men free of diagnosed CHD completed a Worries Scale, indicating the extent to which they worried about each of five worry domains: social conditions, health, financial, self-definition, and aging. During 20 years of follow-up, 323 cases of incident CHD occurred: 113 cases of nonfatal myocardial infarction (MI); 86 cases of fatal CHD; and 124 cases of angina pectoris. Worry about social conditions was the domain most strongly associated with incident CHD. Compared with men reporting the lowest levels of social conditions worry, men reporting the highest levels had multivariate adjusted relative risks of 2.41 (95% CI, 1.40 to 4.13) for nonfatal MI and 1.48 (95% CI, 0.99 to 2.20) for total CHD (nonfatal MI and fatal CHD). A dose-response relation was found between level of worry and both nonfatal MI (P for trend, .002) and total CHD (P for trend, .04).
These results suggest that high levels of worry in specific domains may increase the risk of CHD in older men.