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Spencer CM, Keilholtz BM, Palmer M, Vail SL. Factors Associated with Non-Fatal Strangulation Victimization in Intimate Relationships: A Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2024; 25:2103-2114. [PMID: 37941372 DOI: 10.1177/15248380231207874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Intimate partner violence (IPV) is a public health crisis across the globe, and one particular act of IPV, non-fatal strangulation, warrants serious attention. Non-fatal strangulation is a risk factor for intimate partner homicide (IPH) and can create long-term negative mental and physical health consequences. In this meta-analysis, we sought to examine factors associated with non-fatal strangulation victimization among women to help inform education and assessment efforts. Using database searches and Boolean search terms, a total of 16 studies met the inclusion criteria. A total of 16 factors that were found in at least two unique studies were examined. The strongest associated factors included physical IPV victimization, physical injury, IPH, and sexual IPV victimization. Other significant associated factors included lower education, anxiety symptoms, perceived risk of harm, post-traumatic stress symptoms, depressive symptoms, stalking victimization, and identifying as a Black woman. Experiencing childhood trauma, the length of the relationship, age, substance use, and identifying as Hispanic were not significantly related to strangulation victimization by an intimate partner. Education and assessment implications are discussed.
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2
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Adhikari SP, Daugherty JC, Quiroz Molinares N, Maldonado-Rodriguez N, Wallace C, Smirl J, Perez-García M, De Los Reyes-Aragón CJ, Hidalgo-Ruzzante N, van Donkelaar P, Valera EM. A Four-Country Study of Strangulation-Related Alterations in Consciousness in Women Who Have Experienced Intimate Partner Violence: Co-Occurrence with Traumatic Brain Injuries and Measures of Psychological Distress. J Neurotrauma 2024; 41:e1666-e1677. [PMID: 38666734 DOI: 10.1089/neu.2023.0440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Abstract
At least one in three women experience intimate partner violence (IPV) in their lifetime. The most commonly sustained IPV-related brain injuries include strangulation-related alterations in consciousness (S-AICs) and traumatic brain injuries (TBIs). Moreover, survivors of IPV-related S-AICs and/or TBIs often demonstrate psychological distress such as depression, anxiety, and post-traumatic stress. However, the co-occurrence of S-AICs and TBIs, and whether such TBIs may be moderate to severe, has not been systematically examined, and most data have been collected from women in North America. The purpose of this study was to examine the co-occurrence of IPV-related S-AICs and TBIs across a range of geographical locations and to determine the extent to which these S-AICs are related to psychological distress. Women who had experienced physical IPV (n = 213) were included in this secondary analysis of retrospectively collected data across four countries (Canada, the United States, Spain, and Colombia). The Brain Injury Severity Assessment (BISA) was used to assess IPV-related BI across all sites. Because various questionnaires were employed to assess levels of depression, anxiety, and post-traumatic stress disorder at each site, we created a standardized composite score by converting raw scores into Z-scores for analysis. Mann-Whitney U tests and chi-square tests were conducted to examine differences between women with and without experience of S-AICs and to discover if there was a relationship between the occurrence of S-AICs and TBIs. Analysis of variance and analysis of covariance (to control for the potential confounding effects of age, education, and non IPV-related TBI) were used to compare levels of psychological distress in women who had or had not experienced S-AICs. Approximately, 67% of women sustained at least one IPV-related BI (i.e., TBI and/or S-AIC). In a subsample of women who sustained at least one IPV-related BI, approximately 37% sustained both S-AICs and TBIs, 2% sustained only S-AICs (with no TBIs), and 61% sustained TBIs exclusively (with no S-AICs). Furthermore, women who had sustained S-AICs (with or without a TBI) were more likely to have experienced a moderate-to-severe BI than those who had not sustained an S-AIC (BISA severity subscale: U = 3939, p = 0.006). In addition, women who experienced S-AICs (with or without a TBI) reported higher levels of psychological distress compared with women who never experienced S-AICs, irrespective of whether they occurred once or multiple times. These data underscore the importance of assessing for S-AIC in women who have experienced IPV and when present, to also assess for TBIs and the presence of psychological distress. Unfortunately, there were methodological differences across sites precluding cross-site comparisons. Nonetheless, data were collected across four culturally and geographically diverse countries and, therefore, highlight IPV-related BIs as a global issue that needs to be aggressively studied with policies established and then implemented to address findings.
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Affiliation(s)
| | - Julia C Daugherty
- Université Clermont Auvergne, CNRS, LAPSCO, Clermont-Ferrand, France
| | | | | | - Colin Wallace
- Department of Kinesiology, Okanagan College, Kelowna, Canada
| | - Jonathan Smirl
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Miguel Perez-García
- Mind, Brain and Behavior Research Center, (CIMCYC), University of Granada, Granada, Spain
| | | | | | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada
| | - Eve M Valera
- Psychiatry, Harvard Medical School and Massachusetts General Hospital, Charlestown, Massachusetts, USA
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3
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Saadi A, Asfour J, Vassimon De Assis M, Wilson T, Haar RJ, Heisler M. Head Injury and Associated Sequelae in Individuals Seeking Asylum in the United States: A Retrospective Mixed-Methods Review of Medico-Legal Affidavits. Brain Sci 2024; 14:599. [PMID: 38928599 PMCID: PMC11201586 DOI: 10.3390/brainsci14060599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/28/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
People seeking asylum are susceptible to head injury (HI) due to exposure to various forms of violence including war, torture, or interpersonal violence. Yet, the extents to which clinicians assess HI, and if so, what the associated characteristics are, are not well known. We analyzed 200 U.S.-based medico-legal affidavits using descriptive, multivariate regression, and thematic analysis. Head injury was documented in 38% of affidavits. Those who experienced physical violence were eight times likelier to experience HI than those who did not experience physical violence. Five themes emerged: (1) HI occurred commonly in the context of interpersonal violence (44%), followed by militarized violence (33%); (2) mechanisms of HI included direct blows to the head and asphyxiation, suggesting potential for both traumatic brain injury and brain injury from oxygen deprivation; (3) HI was often recurrent and concurrent with other physical injuries; (4) co-morbid psychiatric and post-concussive symptoms made it challenging to assess neurological and psychiatric etiologies; and (5) overall, there was a paucity of assessments and documentation of HI and sequelae. Among individuals assessed for asylum claims, HI is common, often recurrent, occurring in the context of interpersonal violence, and concurrent with psychological and other physical trauma. Physical violence is an important risk factor for HI, which should be assessed when physical violence is reported.
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Affiliation(s)
- Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Julia Asfour
- School of Arts and Sciences, Tufts University, Boston, MA 02155, USA;
| | | | - Tessa Wilson
- Physicians for Human Rights, New York, NY 10018, USA; (T.W.); (M.H.)
| | - Rohini J. Haar
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA 94704, USA;
| | - Michele Heisler
- Physicians for Human Rights, New York, NY 10018, USA; (T.W.); (M.H.)
- Department of Internal Medicine, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
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4
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Joseph AL, Jerram MW, Valera EM. Emotional Clarity and Psychopathology in Women Who Have Experienced Physical Intimate Partner Violence. Violence Against Women 2024:10778012241254852. [PMID: 38784989 DOI: 10.1177/10778012241254852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Intimate partner violence (IPV) is a chronic, traumatic stressor related to posttraumatic stress (PTS), depression, and anxiety. As psychological symptoms are exacerbated in those with poor emotional clarity, the present study evaluates the relationship between emotional clarity and PTS, dissociation, depression, and worry in women who experienced at least one instance of physical IPV (n = 88). Hierarchical regression analyses, controlling for childhood trauma, IPV abuse severity, and IPV-related brain injury, found that lack of emotional clarity was significantly related to greater PTS, dissociative experiences, depression, and worry. Results suggest that emotional clarity may be a relevant therapeutic target for individuals with a history of IPV and psychological distress.
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Affiliation(s)
- Annie-Lori Joseph
- Department of Psychology, Suffolk University, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Eve M Valera
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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5
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Adhikari SP, Stranges TN, Tehrani SNZ, Porter S, Mason K, van Donkelaar P. Investigating the Efficacy of a Community Support Network Rehabilitation Intervention for Improving Resiliency, Quality of Life, and Neurocognitive Function in Survivors of Intimate Partner Violence-Caused Brain Injury: Protocol for a Feasibility Study. JMIR Res Protoc 2024; 13:e54605. [PMID: 38788207 PMCID: PMC11177797 DOI: 10.2196/54605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Globally, approximately 1 in 3 women experience intimate partner violence (IPV) in their lifetime. Brain injury (BI) is a common, yet often unrecognized, consequence of IPV. BIs caused by IPV tend to be mild, occur repetitively over the course of months or years, are remote in time, and result in chronic symptoms. Similar to BI from other causes, therapeutic treatment for women with IPV-caused BI (IPV-BI) is crucial to help resolve any physical or cognitive impairments, enhance the quality of life (QoL), and minimize longer-term neurodegeneration. OBJECTIVE This study aims to investigate the feasibility and efficacy of a community support network (CSN) rehabilitation intervention regarding its impact on resiliency, QoL, and neurocognitive function. METHODS In this pre- and postexperimental design, women (aged 18 to 50 years) who are survivors of IPV and IPV-BI will be recruited from various community organizations serving survivors of IPV. Exclusion criteria will include current pregnancy and any diagnosed neurological disorder known to affect cerebrovascular, neurocognitive, or sensorimotor function. A CSN rehabilitation intervention that includes aerobic exercise, cognitive training, mindfulness meditation, and counseling will be administered. A trauma-informed approach will be integrated into the design and implementation of the program. Furthermore, the program will include a participant navigator who will provide trauma- and violence-informed advocacy and systems navigation support to participants, in addition to facilitating a monthly peer support group. The intervention will be provided for 2.5 hours a day and 2 days a week for 3 months. Participants will complete psychological assessments and provide clinic-demographic information in the first assessment. In the second (before intervention), third (after intervention), and fourth (at follow-up) sessions, they will complete tests of resiliency, QoL, and neurocognition. The estimated sample size is 100. The objective of this study will be accomplished by quantitatively measuring resiliency, QoL, and neurocognition before and immediately after the intervention. A follow-up assessment will occur 3 months after the completion of the intervention to evaluate the maintenance of any improvements in function. One-way ANOVAs will be used to evaluate the intervention outcome across the testing times. Relationships among various variables will be explored using regression analysis. RESULTS We anticipate that the CSN rehabilitation intervention will be effective in improving resiliency, QoL, and neurocognitive function in women who have experienced IPV-BI. Furthermore, we anticipate that this intervention will be feasible in terms of study recruitment, adherence, and retention. CONCLUSIONS The CSN rehabilitation intervention will have a positive impact on resiliency, QoL, and neurocognitive functions in survivors of IPV-BI. Subsequently, a comparative study will be conducted by recruiting a control group receiving usual care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/54605.
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Affiliation(s)
| | - Tori N Stranges
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | | | | | - Karen Mason
- Supporting Survivors of Abuse and Brain Injury Through Research (SOAR), Kelowna, BC, Canada
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
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6
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Esopenko C, Jain D, Adhikari SP, Dams-O'Connor K, Ellis M, Haag HL, Hovenden ES, Keleher F, Koerte IK, Lindsey HM, Marshall AD, Mason K, McNally JS, Menefee DS, Merkley TL, Read EN, Rojcyk P, Shultz SR, Sun M, Toccalino D, Valera EM, van Donkelaar P, Wellington C, Wilde EA. Intimate Partner Violence-Related Brain Injury: Unmasking and Addressing the Gaps. J Neurotrauma 2024. [PMID: 38323539 DOI: 10.1089/neu.2023.0543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Intimate partner violence (IPV) is a significant, global public health concern. Women, individuals with historically underrepresented identities, and disabilities are at high risk for IPV and tend to experience severe injuries. There has been growing concern about the risk of exposure to IPV-related head trauma, resulting in IPV-related brain injury (IPV-BI), and its health consequences. Past work suggests that a significant proportion of women exposed to IPV experience IPV-BI, likely representing a distinct phenotype compared with BI of other etiologies. An IPV-BI often co-occurs with psychological trauma and mental health complaints, leading to unique issues related to identifying, prognosticating, and managing IPV-BI outcomes. The goal of this review is to identify important gaps in research and clinical practice in IPV-BI and suggest potential solutions to address them. We summarize IPV research in five key priority areas: (1) unique considerations for IPV-BI study design; (2) understanding non-fatal strangulation as a form of BI; (3) identifying objective biomarkers of IPV-BI; (4) consideration of the chronicity, cumulative and late effects of IPV-BI; and (5) BI as a risk factor for IPV engagement. Our review concludes with a call to action to help investigators develop ecologically valid research studies addressing the identified clinical-research knowledge gaps and strategies to improve care in individuals exposed to IPV-BI. By reducing the current gaps and answering these calls to action, we will approach IPV-BI in a trauma-informed manner, ultimately improving outcomes and quality of life for those impacted by IPV-BI.
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Affiliation(s)
- Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Divya Jain
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shambhu Prasad Adhikari
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Ellis
- Department of Surgery, Section of Neurosurgery, University of Manitoba, Pan Am Clinic, Winnipeg, Manitoba, Canada
| | - Halina Lin Haag
- Faculty of Social Work, Wilfrid Laurier University, Ontario, Canada
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada
| | - Elizabeth S Hovenden
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Finian Keleher
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Inga K Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Mass General Brigham, Harvard Medical School, Somerville, Massachusetts, USA
| | - Hannah M Lindsey
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amy D Marshall
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Karen Mason
- Supporting Survivors of Abuse and Brain Injury through Research (SOAR), Kelowna, British Columbia, Canada
| | - J Scott McNally
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Deleene S Menefee
- Michael E. DeBakey VA Medical Center, The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Tricia L Merkley
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Emma N Read
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Philine Rojcyk
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Mass General Brigham, Harvard Medical School, Somerville, Massachusetts, USA
| | - Sandy R Shultz
- Health Sciences, Vancouver Island University, Nanaimo, Canada
- Department of Neuroscience, Monash University, Alfred Centre, Melbourne, Australia
| | - Mujun Sun
- Department of Neuroscience, Monash University, Alfred Centre, Melbourne, Australia
| | - Danielle Toccalino
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Eve M Valera
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Cheryl Wellington
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, Canada
| | - Elisabeth A Wilde
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
- George E. Wahlen ,VA Salt Lake City Heathcare System, Salt Lake City, Utah, USA
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7
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Pebole MM, Iverson KM, Fortier CB, Werner KB, Fonda JR, Currao A, Whitworth JW, McGlinchey RE, Galovski TE. Associations Between Head Injury, Strangulation, Cardiometabolic Health, and Functional Disability Among Female Survivors of Intimate Partner Violence. Womens Health Issues 2024; 34:208-216. [PMID: 38102057 DOI: 10.1016/j.whi.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Head injury and strangulation are highly prevalent in intimate partner violence (IPV) contexts, but there is little research examining the potential implications of these injuries on physical health and functional status. This pilot study explored the extent to which injury type (head injury, strangulation) and severity (no injury, subconcussive head injury, traumatic brain injury; no strangulation, strangulation, strangulation with loss of consciousness) were associated with biomarkers of cardiometabolic health and self-reported functioning among female survivors of IPV. METHODS Participants were 51 individuals assigned female at birth who experienced IPV during their lifetime and screened positive for probable posttraumatic stress disorder (PTSD) on the PTSD Checklist for DSM-5 (average age = 32.6 years, SD = 7.1). RESULTS Head injury was associated with statistically significant increases in blood glucose levels (p = .01, d = 1.10). Shifts toward more high-risk values with moderate-strong effect sizes were also found in high-density lipoprotein, low-density lipoprotein, and waist-to-hip ratio (ps: .06-.13; ds: 0.51-1.30). Strangulation was associated with increased cholesterol levels, with a moderate effect size (p = .20, d = 0.59). Regression models accounting for age, education, PTSD symptoms, childhood trauma, strangulation, and head injuries predicted functional disability status (R2 = 0.37, p < .01) and several of its associated domains: cognition (R2 = 0.34, F(8,42) = 2.73, p = .01), mobility (R2 = 0.47, F(8,42) = 4.82, p < .001), and participation in society (R2 = 0.33, F(8,42) = 2.59, p = .02). CONCLUSIONS Findings suggest the need to develop integrated treatments that address physical health comorbidities among female survivors of IPV with a history of head injury to improve daily function and quality of life.
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Affiliation(s)
- Michelle M Pebole
- The Translational Research Center for TBI and Stress Disorders (TRACTS), Veterans Affairs Boston Healthcare System, Boston, Massachusetts.
| | - Katherine M Iverson
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Catherine B Fortier
- The Translational Research Center for TBI and Stress Disorders (TRACTS), Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Kimberly B Werner
- College of Nursing, University of Missouri-St. Louis, St. Louis, Missouri
| | - Jennifer R Fonda
- The Translational Research Center for TBI and Stress Disorders (TRACTS), Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Alyssa Currao
- The Translational Research Center for TBI and Stress Disorders (TRACTS), Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - James W Whitworth
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts; National Center for PTSD Behavioral Health Science Division at VA Boston Healthcare System, Boston, Massachusetts
| | - Regina E McGlinchey
- The Translational Research Center for TBI and Stress Disorders (TRACTS), Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Tara E Galovski
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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8
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Rajaram SS, Reisher P, Garlinghouse M, Chiou KS. IPV survivors' and service providers' perspectives on brain injury screening/evaluation process and impact. Neuropsychol Rehabil 2024:1-23. [PMID: 38372576 DOI: 10.1080/09602011.2024.2314873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 11/13/2023] [Indexed: 02/20/2024]
Abstract
This study explores the perspectives of intimate partner violence (IPV) survivors and staff of brain injury (BI) screening, and the neuropsychological evaluation (NPE) process. We gathered qualitative data from 17 participants - 10 IPV survivors, at risk for a BI, who had received BI screening and a NPE and a total of 7 staff in IPV-serving organizations. Interviews were recorded, transcribed verbatim and analysed for key themes using thematic analysis. Survivors were over 18 years of age; the majority were between 19 and 45 years old, unemployed, unmarried, and had children. Survivors were angry, scared, and embarrassed to learn that they might have an IPV-related BI. They were thankful to have an explanation for some of their cognitive symptoms, which disrupted their daily activities, social relationships, and overall quality of life. Staff were pleased to be able to provide valuable information to their clients that could have a positive impact on their wellbeing. Overall, screening for a BI and participation in the NPE were well tolerated by IPV survivors with a possible BI. Inclusion of the perspectives of IPV survivors and support staff is an essential first step to better understanding their needs so interventions can be developed to aid their recovery.
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Affiliation(s)
- Shireen S Rajaram
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Peggy Reisher
- Brain Injury Alliance of Nebraska, Lincoln, Nebraska, USA
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9
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Raskin SA, DeJoie O, Edwards C, Ouchida C, Moran J, White O, Mordasiewicz M, Anika D, Njoku B. Traumatic brain injury screening and neuropsychological functioning in women who experience intimate partner violence. Clin Neuropsychol 2024; 38:354-376. [PMID: 37222525 DOI: 10.1080/13854046.2023.2215489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 05/12/2023] [Indexed: 05/25/2023]
Abstract
Objective: The potential for traumatic brain injury (TBI) to occur as the result of intimate partner violence (IPV) has received increased interest in recent years. This study sought to investigate the possible occurrence of TBI in a group of women who survived IPV and to measure the specific profile of cognitive deficits using standardized neuropsychological measures. Method: A comprehensive questionnaire about abuse history; neuropsychological measures of attention, memory and executive functioning; and measures of depression, anxiety and post-traumatic stress disorder were given to women who were IPV survivors, women who were sexual assault (SA) survivors, and a comparison group of women who did not experience IPV or SA. Results: Overall, rates of potential TBI, as measured by the HELPS brain injury screening tool, were high and consistent with previous studies. Consistent with potential TBI, lower scores were demonstrated on measures of memory and executive functioning compared to survivors of SA or those not exposed to violence. Importantly, significant differences on measures of memory and executive functioning remained, after controlling for measures of emotion. Of note, cognitive changes were highest among women who experienced non-fatal strangulation (NFS) compared to IPV survivors who did not. Conclusions: Rates of TBI may be high in women who survive IPV, especially those who survive strangulation. Better screening measures and appropriate interventions are needed as well as larger studies that look at social factors associated with IPV.
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Affiliation(s)
- Sarah A Raskin
- Department of Psychology, Trinity College, Hartford, CT, USA
- Neuroscience Program, Trinity College, Hartford, CT, USA
| | | | | | - Chloe Ouchida
- Neuroscience Program, Trinity College, Hartford, CT, USA
| | - Jocelyn Moran
- Neuroscience Program, Trinity College, Hartford, CT, USA
| | - Olivia White
- Neuroscience Program, Trinity College, Hartford, CT, USA
| | | | - Dorothy Anika
- Neuroscience Program, Trinity College, Hartford, CT, USA
| | - Blessing Njoku
- Neuroscience Program, Trinity College, Hartford, CT, USA
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10
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Mehr JB, Bennett ER, Price JL, de Souza NL, Buckman JF, Wilde EA, Tate DF, Marshall AD, Dams-O'Connor K, Esopenko C. Intimate partner violence, substance use, and health comorbidities among women: A narrative review. Front Psychol 2023; 13:1028375. [PMID: 36778165 PMCID: PMC9912846 DOI: 10.3389/fpsyg.2022.1028375] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/14/2022] [Indexed: 01/28/2023] Open
Abstract
Exposure to intimate partner violence (IPV), including physical, sexual, and psychological violence, aggression, and/or stalking, impacts overall health and can have lasting mental and physical health consequences. Substance misuse is common among individuals exposed to IPV, and IPV-exposed women (IPV-EW) are at-risk for transitioning from substance misuse to substance use disorder (SUD) and demonstrate greater SUD symptom severity; this too can have lasting mental and physical health consequences. Moreover, brain injury is highly prevalent in IPV-EW and is also associated with risk of substance misuse and SUD. Substance misuse, mental health diagnoses, and brain injury, which are highly comorbid, can increase risk of revictimization. Determining the interaction between these factors on the health outcomes and quality of life of IPV-EW remains a critical need. This narrative review uses a multidisciplinary perspective to foster further discussion and research in this area by examining how substance use patterns can cloud identification of and treatment for brain injury and IPV. We draw on past research and the knowledge of our multidisciplinary team of researchers to provide recommendations to facilitate access to resources and treatment strategies and highlight intervention strategies capable of addressing the varied and complex needs of IPV-EW.
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Affiliation(s)
- Jacqueline B. Mehr
- School of Environmental and Biological Sciences, Rutgers University – New Brunswick, New Brunswick, NJ, United States
| | - Esther R. Bennett
- School of Social Work, Rutgers University - New Brunswick, New Brunswick, NJ, United States
| | - Julianne L. Price
- Department of Kinesiology and Health, Rutgers University - New Brunswick, New Brunswick, NJ, United States,Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University - New Brunswick, New Brunswick, NJ, United States
| | - Nicola L. de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ, United States,Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States,Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jennifer F. Buckman
- Department of Kinesiology and Health, Rutgers University - New Brunswick, New Brunswick, NJ, United States,Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University - New Brunswick, New Brunswick, NJ, United States
| | - Elisabeth A. Wilde
- Department of Neurology, School of Medicine, The University of Utah, Salt Lake City, UT, United States,George E. Wahlen, VA Salt Lake City Healthcare System, Research Care Line, Salt Lake City, UT, United States
| | - David F. Tate
- Department of Neurology, School of Medicine, The University of Utah, Salt Lake City, UT, United States,George E. Wahlen, VA Salt Lake City Healthcare System, Research Care Line, Salt Lake City, UT, United States
| | - Amy D. Marshall
- Department of Psychology, College of the Liberal Arts, The Pennsylvania State University, State College, PA, United States
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Carrie Esopenko
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States,Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States,*Correspondence: Carrie Esopenko,
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11
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Nicol B, Adhikari SP, Shwed A, Ashton S, Mriduraj A, Mason K, Gainforth HL, Babul S, van Donkelaar P. The Concussion Awareness Training Tool for Women's Support Workers Improves Knowledge of Intimate Partner Violence-Caused Brain Injury. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231169335. [PMID: 37096824 PMCID: PMC10134117 DOI: 10.1177/00469580231169335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Women who experience physical intimate partner violence (IPV) are at high risk of suffering a brain injury (BI) due to head impacts and/or strangulation. Currently, most staff at women's shelters tend not to be aware of IPV-caused BIs. The objective of this study was to address this by developing a new online module within the Concussion Awareness Training Tool (cattonline.com) specifically focused on IPV-caused BI, and measuring its effectiveness in increasing BI awareness and knowledge among staff members at women's shelters. A mixed-methods approach was used which included (i) a survey to measure participant knowledge before and after completing the module; (ii) a 1-on-1 interview 6 months post-training to better understand participants' perceptions of what effect the training had on how they worked with women in their job; and (iii) an evaluation of the content of the module using behavior change techniques. About 81 participants recruited from staff at women's shelters completed the pre/post survey. The average BI knowledge score increased significantly from the pre-survey (M = 8.12/12, SD = 1.05) to the post-survey (M = 9.72/12, SD = 1.62), t(80) = 9.12, P < .001, d = 1.01). Analysis of the interviews with 9 participants highlighted 3 main themes arising from the module: knowledge, mindfulness, and advocacy. All participants felt their knowledge of IPV-caused BIs had increased and said they would recommend the training to their co-workers. Analysis of the module content revealed the most frequent behavior change techniques were related to instructions on how to perform screening and accommodation for IPV-caused BI. The results showed the module was effective in increasing knowledge of IPV-caused BIs amongst women's shelter staff as well as improving how they advocate for, and are mindful of, their clients with BIs. This online training may help improve the care women with IPV-caused BIs receive, and ultimately improve their quality of life.
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Affiliation(s)
- Blake Nicol
- University of British Columbia Okanagan, Kelowna, BC, Canada
| | | | - Alanna Shwed
- University of British Columbia Okanagan, Kelowna, BC, Canada
- ICORD (International Collaboration of Repair Discoveries), Vancouver, BC, Canada
| | | | | | - Karen Mason
- Supporting Survivors of Abuse and Brain Injury through Research (SOAR) Project, Kelowna, BC, Canada
| | - Heather L Gainforth
- University of British Columbia Okanagan, Kelowna, BC, Canada
- ICORD (International Collaboration of Repair Discoveries), Vancouver, BC, Canada
| | - Shelina Babul
- BC Children's Hospital, Kelowna, BC, Canada
- University of British Columbia, Kelowna, BC, Canada
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12
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Toccalino D, Moore A, Cripps E, Gutierrez SC, Colantonio A, Wickens CM, Chan V, Nalder E, Haag H(L. Exploring the intersection of brain injury and mental health in survivors of intimate partner violence: A scoping review. Front Public Health 2023; 11:1100549. [PMID: 36935693 PMCID: PMC10018197 DOI: 10.3389/fpubh.2023.1100549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/26/2023] [Indexed: 03/06/2023] Open
Abstract
Rationale Intimate partner violence (IPV) is the most commonly occurring form of violence against women. The most common site of injury in IPV is the head, face, and neck, resulting in possible brain injury (BI). Independently, mental health (MH) concerns are highly prevalent among both IPV survivors and individuals with BI; however, no systematic review exists on the combined experience of BI and MH in IPV. Objective The aim of this review was to describe the identification of and relationships between BI, MH, and IPV in the literature and the implications for health policy and practice. Methods A search strategy including text words and subject headings related to BI, IPV, and MH was developed for MEDLINE and translated to EMBASE, PsycINFO, CINAHL, Cochrane, Scopus, and Web of Science. Two reviewers independently assessed articles for inclusion. Articles discussing MH, BI, and IPV in relation to one another were included in the review. Results Twenty-eight articles were identified for inclusion. Methods for identifying IPV, BI, and MH were highly variable across studies. Fourteen studies reported significantly higher MH scores in IPV survivors with BI than in those without BI. Articles predominantly focused on cis gender women in heterosexual relationships and the impact of race and ethnicity were largely overlooked. Healthcare access was explored by eight articles, though none discussed the implications of co-occurring BI and MH. Conclusion Brain injury and MH are highly prevalent among IPV survivors; however, little research discusses the implication for healthcare. Future research should explore healthcare-related needs and experiences to inform policy and practice and better represent the diversity of IPV survivors.
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Affiliation(s)
- Danielle Toccalino
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, ON, Canada
- *Correspondence: Danielle Toccalino
| | - Amy Moore
- Lyle S. Hallman Faculty of Social Work, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Elizabeth Cripps
- Lyle S. Hallman Faculty of Social Work, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Sophia Chuon Gutierrez
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Angela Colantonio
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Christine M. Wickens
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Vincy Chan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Emily Nalder
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Halina (Lin) Haag
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, ON, Canada
- Lyle S. Hallman Faculty of Social Work, Wilfrid Laurier University, Waterloo, ON, Canada
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13
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Luong R, Parkin JA, Cunningham N. Acute concomitant injury and intoxication in complainants of recent sexual assault: A review. J Forensic Leg Med 2022; 92:102448. [DOI: 10.1016/j.jflm.2022.102448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
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14
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Muir KJ, Donahue C, Broshek DK, Resch J, Solenski N, Laughon K. Neuropsychological and Balance Symptoms of Abused Women Who Have Experienced Intimate Partner Violence-Related Strangulation: A Feasibility and Acceptability Study. Neurotrauma Rep 2022; 3:491-500. [DOI: 10.1089/neur.2022.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K. Jane Muir
- National Clinician Scholars Program, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Catherine Donahue
- School of Education and Human Development, University of Virginia, Charlottesville, Virginia, USA
| | - Donna K. Broshek
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jacob Resch
- School of Education and Human Development, University of Virginia, Charlottesville, Virginia, USA
| | - Nina Solenski
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Kathryn Laughon
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
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15
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Herbenick D, Fu TC, Eastman-Mueller H, Thomas S, Svetina Valdivia D, Rosenberg M, Guerra-Reyes L, Wright PJ, Kawata K, Feiner JR. Frequency, Method, Intensity, and Health Sequelae of Sexual Choking Among U.S. Undergraduate and Graduate Students. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3121-3139. [PMID: 35902430 PMCID: PMC9333342 DOI: 10.1007/s10508-022-02347-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 05/25/2023]
Abstract
Although sexual choking is now prevalent, little is known about how people engage in choking in terms of frequency, intensity, method, or potential health sequelae. In a campus-representative survey of undergraduate and graduate students, we aimed to: (1) describe the prevalence of ever having choked/been choked as part of sex; (2) examine the characteristics of choking one's sexual partners (e.g., age at first experience, number of partners, frequency, intensity, method); (3) examine the characteristics of having been choked during sex; and (4) assess immediate responses of having been choked including the extent to which frequency and method (e.g., hand, ligature, limb) of having been choked predicts the range of responses endorsed by participants. A total of 4254 randomly sampled students (2668 undergraduate, 1576 graduate) completed a confidential online survey during Spring 2021. The mean age of first choking/being choked was about 19, with more undergraduates than graduate students reporting first choking/being choked in adolescence. Women and transgender/gender non-binary participants were significantly more likely to have been choked than men. Participants more often reported the use of hands compared to limbs or ligature. Common responses to being choked were pleasurable sensations/euphoria (81.7%), a head rush (43.8%), feeling like they could not breathe (43.0%), difficulty swallowing (38.9%), unable to speak (37.6%), and watery eyes (37.2%). About 15% had noticed neck bruising and 3% had lost consciousness from being choked. Greater frequency and intensity of being choked was associated with reports of more physical responses as was use of limb (arm, leg) or ligature.
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Affiliation(s)
- Debby Herbenick
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA.
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47405, USA.
| | - Tsung-Chieh Fu
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47405, USA
| | - Heather Eastman-Mueller
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47405, USA
| | - Sally Thomas
- Office of Sexual Violence Prevention and Victim Advocacy, Indiana University, Bloomington, IN, USA
| | - Dubravka Svetina Valdivia
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, IN, USA
| | - Molly Rosenberg
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47405, USA
- Department of Epidemiology and Biostatistics, Indiana University School of Public, Health, Indiana University, Bloomington, IN, USA
| | - Lucia Guerra-Reyes
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47405, USA
| | - Paul J Wright
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47405, USA
- The Media School, Indiana University, Bloomington, IN, USA
| | - Keisuke Kawata
- Department of Kinesiology, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- Program in Neuroscience, Division of Clinical and Translational Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN, USA
| | - John R Feiner
- Department of Anesthesia and Perioperative Care, University of California at San Francisco School of Medicine, San Francisco, CA, USA
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16
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PATCH M, ANDERSON JC, ALEXANDER K, SOMOANO FA, KELEN G, HOLBROOK DS, CAMPBELL JC. Didn't put a label on it: Examining intimate partner strangulation within a diagnostic framework. J Adv Nurs 2022; 79:1575-1588. [PMID: 35864083 PMCID: PMC9922028 DOI: 10.1111/jan.15380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/26/2022] [Accepted: 07/05/2022] [Indexed: 01/01/2023]
Abstract
AIMS The aim was to examine and describe women's emergency department visits and care-seeking experiences, including recognition, evaluation and communication of symptoms, injuries and health risks after non-fatal intimate partner strangulation. DESIGN Using a diagnostic process framework, this mixed-methods study explores concordance and discordance of interview and medical records data to highlight opportunities for clinical diagnostic improvement. METHODS In-depth, semi-structured interviews with women after an emergency department visit for non-fatal intimate partner strangulation, concurrent with medical records reviews, were conducted between March 2018 and January 2019. A constant comparative approach was used to analyse interview and medical record data using an a priori codebook designed based on the National Academies of Science, Engineering and Medicine's conceptual model of the diagnostic process and prior intimate partner violence research. RESULTS Interviews reflected participants did not have a sense of long-term health risks from their strangulation beyond addressing emotional trauma. Women noted that forensic and emergency nursing support was treatment in and of itself that allowed them to be heard and validated. Medical record clinical impressions and final diagnoses included domestic violence, domestic abuse or sexual assault, but not specifically strangulation. CONCLUSION This study contributes to the growing literature regarding strangulation diagnosis and care. Our findings provide new details of women's emergency department care-seeking experiences which, whilst overall aligned with medical records documentation, were not reflected in final diagnostic impressions nor in patient recollection of long-term health risks. IMPACT Nurses are strongly positioned as clinical practice leaders and policy advocates to improve collective responses to this dangerous violence mechanism. Actions such as improving patient education, referral and follow-up options to better communication and address long-term strangulation risk are one example. Further research on non-fatal intimate partner strangulation and care-seeking is warranted to expand this knowledge, particularly in longitudinal cohorts and varied geographical areas.
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Affiliation(s)
- Michelle PATCH
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Jocelyn C. ANDERSON
- Pennsylvania State University College of Nursing, University Park, Pennsylvania
| | | | | | - Gabor KELEN
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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17
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Huibregtse ME, Alexander IL, Klemsz LM, Fu TC, Fortenberry JD, Herbenick D, Kawata K. Frequent and Recent Non-fatal Strangulation/Choking During Sex and Its Association With fMRI Activation During Working Memory Tasks. Front Behav Neurosci 2022; 16:881678. [PMID: 35722189 PMCID: PMC9201570 DOI: 10.3389/fnbeh.2022.881678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Being strangled, or “choked,” by a sexual partner has emerged as a prevalent, often wanted and consensual sexual behavior among adolescent and young adult women, yet the neurological consequences of repeated exposure to this behavior are unknown. The objective of the study was to examine the association between a history of repeated, recent choking/strangling episodes during sex and fMRI activation during working memory tasks in young adult women. This case-control study involved young adult women (18–30 years old) at a large, public university, and consisted of two study groups: a choking group consisting of participants who were recently and frequently choked/strangled during sex by a partner (≥4 times in the past 30 days) and a choking-naïve (control) group who had never been choked/strangled during sex. Participants completed two variations of the N-back (0-back, 1-back, and 2-back) working memory task during functional magnetic resonance imaging (fMRI): verbal and visual N-back tasks. Data from 20 participants per group were available for analysis. Between-group differences for accuracy and reaction time were not significant for either variation of the N-back task. Significant differences in fMRI activation patterns were detected between the choking and the choking-naïve groups for the three contrasts of interest (1-back > 0-back, 2-back > 0-back, and 2-back > 1-back). The choking group exhibited increased activation in multiple clusters relative to the choking-naïve group for the contrasts between the 1-back and 2-back conditions compared to the 0-back conditions (e.g., superior frontal gyrus, corpus callosum). However, the choking-naïve group exhibited increased activation relative to the choking group in several clusters for the 2-back > 1 back contrast (e.g., splenium, middle frontal gyrus). These data indicate that recent, frequent exposure to partnered sexual strangulation is associated with different neural activation patterns during verbal and visual working memory tasks compared to controls, suggesting that being choked/strangled during sex may modify the allocation of neural resources at increasing levels of cognitive load. Further investigation into the neurologic effects of this sexual behavior is warranted, given the prevalence of sexual choking among adolescent and young adult women.
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Affiliation(s)
- Megan E. Huibregtse
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Isabella L. Alexander
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Lillian M. Klemsz
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Tsung-chieh Fu
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, United States
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States
| | - J. Dennis Fortenberry
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Debby Herbenick
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, United States
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Keisuke Kawata
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, United States
- Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN, United States
- *Correspondence: Keisuke Kawata
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18
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Herbenick D, Patterson C, Khan S, Voorheis E, Sullivan A, Wright P, Keene S. "Don't Just Randomly Grab Someone's Neck during Intercourse!" An Analysis of Internet Articles about Choking/Strangulation during Sex. JOURNAL OF SEX & MARITAL THERAPY 2022; 49:41-55. [PMID: 35570586 DOI: 10.1080/0092623x.2022.2065392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sexual choking/strangulation has become prevalent among young U.S. adults, yet little is known about media articles that teach readers about choking. We conducted a content analysis of 27 Internet articles, examining how choking is described, information related to health risks and healthcare, and article accuracy. Most articles described choking in positive terms and indicated choking can be done safely or properly, even while acknowledging potential dangers. Only two articles indicated having undergone expert/medical review. Few gave information about signs that would warrant seeking healthcare. Sexuality professionals need to be aware of choking-related information and misinformation in online media articles.
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Affiliation(s)
- Debby Herbenick
- The Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Callie Patterson
- The Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Shahzarin Khan
- The Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Eva Voorheis
- The Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Anne Sullivan
- The Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Paul Wright
- The Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, USA
- The Media School, Indiana University, Bloomington, IN, USA
| | - Samantha Keene
- School of Social and Cultural Studies, The Institute of Criminology, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
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