A Multi-Method Approach to a Comprehensive Examination of the Psychiatric and Neurological Consequences of Intimate Partner Violence in Women: A Methodology Protocol

Abstract

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.

Keywords: concussion; intimate partner violence; post-traumatic stress; traumatic brain injury; women.

Figure 1

Discrimination of symptoms associated with TBI from those associated with PTSD. This figure is meant as a general representation of constructs for each syndrome, but each symptom can arise from different underlying mechanisms whether neurologic or psychiatric. The asterisk (^*) indicates diagnostic symptoms of acute TBI. Common symptoms of TBI and PTSD can be almost identical and therefore very difficult to distinguish the etiology. These symptoms require a thorough clinical evaluation to establish a temporal relationship between traumatic event, physical injury, symptom onset, and course.

Figure 2

CONSORT diagram of study participants. The CONSORT flow diagram of the participants through the phases of assessment, further differentiated by PTSD status. The diagram represents low, medium, and high head injury rates for those participants who both meet for a full PTSD diagnosis, as well as those with subthreshold PTSD. PTSD, Post-Traumatic Stress Disorder; TBI, Traumatic Brain Injury. Other reasons for not completing the assessment after being found eligible include changes to the participants condition prior to or on the day of consent: bipolar disorder, active psychosis, chemotherapy, peritraumatic experience, pregnancy, moved out of state, multiple sclerosis.