Brain Injury Within Intimate Partner Violence: What Are the Cognitive Effects?

Abstract

Intimate partner violence (IPV) is a worldwide health concern with devastating implications for physical, mental, and cognitive health. IPV-associated brain injuries (IPV-BIs) induced through impacts to the head (e.g., mild traumatic brain injury [mTBI]) and non-fatal strangulation (NFS; i.e., a hypoxic-ischemic injury) have long been overlooked among IPV victim-survivors. Identifying their presence and consequences is vital to inform interventions. Cross-sectional design with 3 groups including women with IPV-BI (1–6; >6) sustained through NFS and/or mTBI, women exposed to IPV without BI, and healthy age-matched controls. All participants completed medical history, biopsychosocial questionnaires, and cognitive tests of premorbid IQ, learning and memory, processing speed, and executive function. A total of 146 women aged 40.99 years (SD = 13.97) were included: 46 with IPV-BI (27 1–6; 19 > 6), 42 with IPV alone, and 58 Healthy controls. IPV-BI was significantly associated with poorer performances on Rey Auditory Verbal Learning Test (RAVLT) Total Learning, Delayed Recall trials, and Trails Making Test B (TMT-B). Planned comparisons revealed that women with more than 6 IPV-BIs scored significantly lower on RAVLT Total Learning and Delayed Recall compared to other groups, with medium and large effect sizes. The association between IPV-BI and performances on the RAVLT remained significant after controlling for potential confounders, including age, premorbid functioning, post-traumatic stress disorder, depression, anxiety, substance use disorder, and other causes of BI. In contrast, the effect of IPV-BI on TMT-B performance was attenuated when anxiety was included in the model, rendering the IPV-BI group difference non-significant. There was evidence of impairments in memory and new learning among women with IPV-BI relative to the other groups beyond 6 months post-injury, with cumulative mTBI and NFS worsening outcomes. These findings highlight the need for IPV-BI screening, neuropsychological assessment, and targeted education and therapy for this underserved population.