Predictors of Concussion-Like Symptoms in Women Recruited from the Community with a History of Intimate Partner Violence

Abstract

Intimate partner violence (IPV) affects one in three women worldwide. Mild traumatic brain injury (mTBI, i.e., concussion) is a frequent yet overlooked and under-researched consequence of IPV. Persistent postconcussion symptoms (PPCS) include a constellation of debilitating physical, emotional, and cognitive symptoms affecting approximately 15–30% of mTBI patients. Risk factors of PPCS include female sex, a history of mTBI, and mental health conditions, all of which are prominent in IPV contexts. Therefore, victim-survivors may be at an increased risk for PPCS; however, the prevalence and possible contributing factors, such as nonfatal strangulation (NFS) and head trauma (HT), remain largely unknown in this population. This study assessed 153 community-recruited women, including 96 IPV victim-survivors (>6 months postexposure to IPV) and 57 non-IPV controls. Participants completed structured interviews assessing medical history, concussion-like symptoms (Rivermead Postconcussion Symptom Questionnaire; RPQ), IPV (Composite Abuse Scale (Revised)-Short Form; CASR-SF), brain injury (Brain Injury Screening Questionnaire-7 + IPV module), and post-traumatic stress disorder (PTSD) symptoms (The PTSD Checklist for The Diagnostic and Statistical Manual for Mental Disorders-5; PCL-5). First, regression analyses were used to examine how individual risk factors (i.e., IPV exposure, mTBI, HT, NFS events, depression diagnosis, and probable PTSD) are related to concussion-like symptoms. Second, participants were grouped based on IPV and mTBI status: (1) healthy control (HC) (n = 38), (2) mTBI with no IPV; non-IPV-mTBI (n = 19), (3) IPV without mTBI; IPV (n = 29), and (4) IPV with mTBI; IPV-mTBI (n = 67) to compare RPQ severity across groups and symptom profiles (i.e., total, somatic, emotional, and cognitive). As an exploratory analysis, we applied International Classification of Diseases (ICD-10) postconcussion syndrome (PCS) symptom criteria to gauge how concussion-like symptom profiles in this cohort aligned with ICD-10 threshold levels. Overall, regression analysis revealed that IPV-mTBI, IPV-HT, and IPV-NFS were significantly associated with greater concussion-like symptoms, regardless of the number of times each event occurred, as were a history of depression diagnosis and probable PTSD. Non-IPV-related mTBI and HT were only associated at higher exposure (>5 and >10, respectively). Group comparisons revealed that the IPV-mTBI group exhibited greater RPQ severity across total, somatic, emotional, and cognitive symptom profiles compared to the mTBI and HC groups. Interestingly, the IPV and IPV-mTBI groups did not differ significantly, highlighting the nonspecific nature of concussion-like symptoms in this population. When applying the exploratory ICD-10 PCS symptom thresholds, significant predictors from the primary analysis were consistently associated, and the IPV-mTBI group showed a markedly higher proportion (74.6%) meeting these criteria compared to the mTBI (10.5%) and HC groups (23.7%). These findings highlight the under-recognized burden of concussion-like symptoms in IPV victim-survivors, highlighting the need for targeted services (e.g., linking IPV services and concussion clinics) to identify, manage, and treat an area currently lacking support for this high-risk population.