Citation

Karr JE, Logan TK. J. Neurotrauma 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2023.0101

PMID

37485628

Abstract

Limited research has examined the symptom sequelae of head injuries in women survivors of intimate partner violence (IPV), despite this community being at increased risk of neurotrauma due to partner abuse. The current study compared post-concussion symptom severity between women with and without IPV-related head injuries. Women were recruited from court jurisdictions in Kentucky, USA after receiving a protective order for partner abuse. The sample included 286 women with no prior head injuries [age: M(SD)=31.8(9.8), 77.2% White] and 251 women with lifetime IPV-related head injuries [age: M(SD)=31.8(9.8), 88.0% White]. Women with IPV-related head injuries were slightly older (t=2.46, p=.014) with lower education (χ2=5.81, p=.016), more frequently unemployed (χ2=9.23, p=.002), and higher likelihood of residing in a rural setting (χ2=30.16, p<.001). Women with IPV-related head injuries were also more often White (χ2=10.47, p=.001), but this group difference was almost entirely related to rural vs. urban residence. Women with IPV-related head injuries reported a higher severity of lifetime physical IPV (t=7.27, p<.001, d=.64, 95% Confidence Interval: [.46,.82]) and sexual IPV (t=4.65, p<.001, d=.41 [.24,.59]). A three-factor model of post-concussion symptoms, inclusive of cognitive, physical, and emotional symptoms, fit well, χ2=368.99, p<.0001, CFI=.974, TLI=.968, RMSEA=.079 [.071,.087], and showed evidence for strong measurement invariance across women with and without IPV-related head injuries. The subscale and total scores each had acceptable reliability: cognitive (ω=.88 [.86,.90]), physical (ω=.74 [.70,.77]), and emotional (ω=.88 [.86,.89]), and total score (ω=.93 [.92,.95]). Women with IPV-related head injuries reported all individual post-concussion symptoms at a significantly higher frequency, with medium group differences in cognitive (t=7.57, p<.001, d=.67 [.50,.85]) and physical symptoms (t=7.73, p<.001, d=.68 [.51,.86]) and large group differences in emotional (t=8.51, p<.001, d=.75 [.57,.93]) and total symptoms (t=9.07, p<.001, d=.80 [.62,.98]). All sociodemographic characteristics were independently associated with post-concussion symptoms, as were physical IPV (total score: r=.28 [.19,.35], p<.001) and sexual IPV severity (total score: r=.22 [.13,.30], p<.001). In hierarchical regression analyses, controlling for sociodemographic characteristics (i.e., age, race/ethnicity, education, unemployment, and rural/urban residence) and physical and sexual IPV severity, IPV-related head injury was independently significant and accounted for significant additional variance when predicting cognitive (∆R2=.05, p<.001), physical (∆R2=.03, p<.001), emotional (∆R2=.07, p<.001), and total symptoms (∆R2=.06, p<.001). Negative-binomial regression resulted in similar findings. This study demonstrates that multiple sociodemographic and IPV history variables are related to post-concussion symptom severity, but IPV-related head injury was independently associated with greater symptom severity. Women with IPV-related head injuries may be at increased risk of unaddressed health problems spanning cognitive, physical, and emotional domains. Future research is needed to psychometrically evaluate assessment instruments for this population and to assess efficacy of interventions to address their unique healthcare needs.

Language: en

Keywords

HEAD TRAUMA; ADULT BRAIN INJURY; OUTCOME MEASURES; TRAUMATIC BRAIN INJURY; NEUROPSYCHOLOGY