J Neurotrauma. 2023 Sep 11. doi: 10.1089/neu.2023.0358. Online ahead of print.
Many women survivors of intimate partner violence (IPV) experience repetitive head injuries in their lifetime, but limited research has examined the cumulative effects of multiple head injuries on post-concussion symptom severity in this population. This study examined how number of lifetime head injuries and episodes of loss of consciousness (LOC) due to head injuries were related to current cognitive, physical, and emotional symptoms among women survivors of IPV. Cisgender women from Kentucky were recruited following a protective order against an intimate partner, including 268 women with no reported lifetime head injuries and 250 women with one or more IPV-related head injuries (M=17.2 head injuries, SD=50.5, Mdn=4, range=1-515; M=1.8 LOC episodes, SD=4.3, Mdn=1, range=0-35). Participants underwent in-person interviews about lifetime physical and sexual IPV history, head injury history, and current cognitive, physical, and emotional symptoms. Sociodemographic characteristics, physical and sexual IPV severity, and current symptom severity were examined in relation to number of head injuries and LOC episodes. A higher number of head injuries was associated with greater age, White race, less than high school education, unemployment, and rural residence. No sociodemographic variables differed based on number of LOC episodes. Greater number of lifetime head injuries and LOC episodes correlated significantly with physical IPV severity (rho=.35, p<.001; rho=.33, p<.001, respectively) and sexual IPV severity (rho=.22, p<.001; rho=.19, p=.003). Greater number of head injuries and LOC episodes correlated significantly with greater cognitive (rho=.33, p<.001; rho=.23, p<.001, respectively), physical (rho=.36, p<.001; rho=.31, p<.001), emotional (rho=.36, p<.001; rho=.18, p=.004), and total symptom severity (rho=.39, p<.001; rho=.26, p<.001). In group comparisons, participant groups stratified by number of head injuries (i.e., 0, 1-3, 4+) differed in total symptom severity (p<.001, η2=.15), with greater symptom burden associated with more head injuries. Participants with and without LOC differed in symptom severity: cognitive (p<.001, d=.45), physical (p<.001, d=.60), emotional (p=.004, d=.37), and total symptom severity (p.05). Based on hierarchical regression analyses, only physical symptoms were independently related to number of head injuries (p=.008, ∆R2=.011) and number of LOC episodes (p=.014, ∆R2=.021) after controlling for sociodemographic characteristics and IPV severity. Among women survivors of IPV, greater head injury history was related to worse physical symptoms (e.g., headaches, dizziness, sleep problems), whereas cognitive and emotional symptoms were, in part, attributable to cumulative trauma due to IPV. Women survivors of IPV with repetitive head injuries have unmet neurobehavioral health needs that may benefit from targeted interventions.