Effects of the Response to the COVID-19 Pandemic on Assault-Related Head Injury in Melbourne: A Retrospective Study

Abstract

Assault is the leading preventable cause of death, traumatic brain injury (TBI), and associated mental health problems. The COVID-19 pandemic has had a profound impact on patterns of interpersonal violence across the world. In this retrospective cross-sectional study, we analysed medical records of 1232 assault victims (domestic violence: 111, random assault: 900, prison assault: 221) with head injuries who presented to the emergency department (ED) at St Vincent's Hospital in Melbourne, Australia, a city with one of the longest and most severe COVID-19 restrictions worldwide. We examined changes in prevalence in the assault group overall and in domestic violence, random assault, and prison assault victims, comparing data from 19.5 months before and after the first day of COVID-19 restrictions in Melbourne. Moreover, we investigated differences driven by demographic factors (Who: age group, sex, and nationality) and clinical variables (Where: assault location, and When: time of arrival to the ED and time from moment of injury until presentation at ED). Descriptive statistics and chi-square analyses were performed. We found the COVID-19 pandemic significantly affected the Where of assault-related TBI, with a shift in the location of assaults from the street to the home, and the increase at home being driven by random assaults on middle-aged adults. Overall, we observed that 86% of the random assault cases were males, whereas 74% of the domestic assault cases were females. Meanwhile, nearly half (44%) of the random assault victims reported alcohol consumption versus a fifth (20%) of domestic violence victims. These findings will have direct implications for developing screening tools and better preventive and ameliorative interventions to manage the sequelae of assault TBI, particularly in the context of future large-scale health crises or emergencies.

Keywords: COVID pandemic; domestic violence; head injury; physical assault; random assault; traumatic brain injury.

Figure 1

Changes in community movement in specific locations in Australia relative to the period before the COVID-19 pandemic. The ‘Residential’ category shows percent change in duration of time spent at home; the other categories measure a change in total visitors (compared to baseline days: the median value for the 5-week period from 3 January to 6 February 2020). First (16 March 2020) and last (19 November 2021) days of restrictions are indicated by magenta reference lines. Shaded areas represent Melbourne lockdowns. The duration of each lockdown (in days) is indicated above each lockdown period (Note: Mandatory COVID-19 isolation periods ended in Australia on 14 October 2022). Source: Google COVID-19 Community Mobility Trends–last updated 16 August 2022 (https://www.google.com/covid19/mobility/ accessed on 18 August 2022).

Figure 2

Flowchart of study sample selection along with inclusion and exclusion criteria.

Figure 3

Time series showing the monthly number of assault cases for every assault group and in total. Onset and end of restrictions are indicated by magenta reference lines. Numbered shaded areas represent the Melbourne lockdowns.

Figure 4

Change in assault-related TBI cases by age group for prison victims between pre-COVID and COVID periods.

Figure 5

Change in assault-related TBI cases by location of injury between the pre-COVID and COVID periods: (A) across all locations of injury (** significant adjusted residuals at p < 0.05, FWE corrected); (B) across random and domestic assault groups at home in middle-aged (40–59 years old) adults.

Figure 5

Change in assault-related TBI cases by location of injury between the pre-COVID and COVID periods: (A) across all locations of injury (** significant adjusted residuals at p < 0.05, FWE corrected); (B) across random and domestic assault groups at home in middle-aged (40–59 years old) adults.

Figure 6

Who was a victim of assault-related TBI in Melbourne, Australia, between 30 July 2018 and 30 October 2021? Left, overall proportion per assault group. Right, breakdown of assault-related TBI by sex, age group, nationality, and alcohol consumption (rows) and assault group (columns). Highlighted in orange squares are noticeably contrasting differences in the proportion of cases between RV and DV assault in terms of sex and alcohol consumption. percentages in nationality and alcohol consumption exclude ‘Unknown’ cases (see Supplementary Table S1).

Figure 7

Where were victims of assault-related TBI in Melbourne, Australia, attacked between 30 July 2018 and 30 October 2021 (excludes PP victims)?

Figure 8

When did victims of assault-related TBI in Melbourne, Australia, present at the ED between 30 July 2018 and 30 October 2021? Shown in the plot are number of cases across morning (6:00–12:00), afternoon (12:00–18:00), evening (18:00–24:00), and night (0:00–6:00) periods for the random, domestic, and prison assault subgroups.