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Dams-O'Connor K, Seifert AC, Crary JF, Delman BN, Del Bigio MR, Kovacs GG, Lee EB, Nolan AL, Pruyser A, Selmanovic E, Stewart W, Woodoff-Leith E, Folkerth RD. The neuropathology of intimate partner violence. Acta Neuropathol 2023; 146:803-815. [PMID: 37897548 PMCID: PMC10627910 DOI: 10.1007/s00401-023-02646-1] [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: 05/08/2023] [Revised: 10/14/2023] [Accepted: 10/14/2023] [Indexed: 10/30/2023]
Abstract
Lifelong brain health consequences of traumatic brain injury (TBI) include the risk of neurodegenerative disease. Up to one-third of women experience intimate partner violence (IPV) in their lifetime, often with TBI, yet remarkably little is known about the range of autopsy neuropathologies encountered in IPV. We report a prospectively accrued case series from a single institution, the New York City Office of Chief Medical Examiner, evaluated in partnership with the Brain Injury Research Center of Mount Sinai, using a multimodal protocol comprising clinical history review, ex vivo imaging in a small subset, and comprehensive neuropathological assessment by established consensus protocols. Fourteen brains were obtained over 2 years from women with documented IPV (aged 3rd-8th decade; median, 4th) and complex histories including prior TBI in 6, nonfatal strangulation in 4, cerebrovascular, neurological, and/or psychiatric conditions in 13, and epilepsy in 7. At autopsy, all had TBI stigmata (old and/or recent). In addition, white matter regions vulnerable to diffuse axonal injury showed perivascular and parenchymal iron deposition and microgliosis in some subjects. Six cases had evidence of cerebrovascular disease (lacunes and/or chronic infarcts). Regarding neurodegenerative disease pathologies, Alzheimer disease neuropathologic change was present in a single case (8th decade), with no chronic traumatic encephalopathy neuropathologic change (CTE-NC) identified in any. Findings from this initial series then prompted similar exploration in an expanded case series of 70 archival IPV cases (aged 2nd-9th decade; median, 4th) accrued from multiple international institutions. In this secondary case series, we again found evidence of vascular and white matter pathologies. However, only limited neurodegenerative proteinopathies were encountered in the oldest subjects, none meeting consensus criteria for CTE-NC. These observations from this descriptive exploratory study reinforce a need to consider broad co-morbid and neuropathological substrates contributing to brain health outcomes in the context of IPV, some of which may be potentially modifiable.
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Affiliation(s)
- Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alan C Seifert
- Department of Diagnostic, Molecular and Interventional Radiology, Biomedical Engineering and Imaging Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - John F Crary
- Department of Pathology, Molecular, and Cell Based Medicine, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Nash Family Department of Neuroscience, and Artificial Intelligence & Human Health, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Neuropathology Brain Bank & Research CoRE, Mount Sinai Hospital, New York, NY, USA
| | - Bradley N Delman
- Department of Diagnostic, Molecular and Interventional Radiology, Biomedical Engineering and Imaging Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Marc R Del Bigio
- Department of Pathology, Rady Faculty of Health Sciences, University of Manitoba, Room 401 Brodie Centre, 727 McDermot Avenue, Winnipeg, MB, Canada
- Diagnostic Services - Pathology, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease (CRND) and Department of Laboratory Medicine and Pathobiology, Krembil Discovery Tower, University of Toronto, 60 Leonard Ave, Toronto, ON, Canada
- Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Edward B Lee
- Translational Neuropathology Research Laboratory, Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amber L Nolan
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Ariel Pruyser
- Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Enna Selmanovic
- Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William Stewart
- Department of Neuropathology, Elizabeth University Hospital, Glasgow, G514TF, Queen, UK
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, G128QQ, UK
| | - Emma Woodoff-Leith
- Department of Pathology, Molecular, and Cell Based Medicine, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Nash Family Department of Neuroscience, and Artificial Intelligence & Human Health, Ronald M. Loeb Center for Alzheimer's Disease, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Neuropathology Brain Bank & Research CoRE, Mount Sinai Hospital, New York, NY, USA
| | - Rebecca D Folkerth
- Office of Chief Medical Examiner, 520 First Avenue, New York, NY, 10116, USA.
- Department of Forensic Medicine, New York University Grossman School of Medicine, New York, NY, USA.
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Hsieh HF, Heinze JE, Caruso E, Scott BA, West BT, Mistry R, Eisman AB, Assari S, Buu A, Zimmerman MA. The Protective Effects of Social Support on Hypertension Among African American Adolescents Exposed to Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP7202-NP7224. [PMID: 33107367 PMCID: PMC10834025 DOI: 10.1177/0886260520969390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
African Americans develop hypertension earlier in life than Whites and the racial/ethnic disparities in blood pressure level can appear as early as adolescence. Violence victimization, a prevalent environmental stressor among inner-city youth, may play a role in such disparities. In a sample of inner-city youth in the United States, the current study examines the relationship between violence victimization and hypertension while investigating the role of social support in moderating that relationship. We analyzed eight waves of data from a longitudinal study of African American youth (n = 353, 56.7% female) from mid-adolescence (9th grade, mean age = 14.9 years old) to emerging adulthood (mean age = 23.1 years old) using probit regression. Higher levels of self-reported violence victimization during ages 14-18 was associated with more reports of hypertension during ages 20-23, after adjusting for sex, socioeconomic status, substance use, and mental distress. The relationship of violence victimization with hypertension was moderated by friends' support, but not parental support. The association between victimization and hypertension was weaker and non-significant among individuals with more peer support compared to those with less support. Researchers have reported many instances of associations of early violence exposure to later risk for hypertension; however, most have focused on childhood maltreatment or intimate partner violence. We extend these findings to violence victimization in an African American sample of youth from adolescence to early adulthood, while examining social support modifiers. The disparity in African American hypertension rates relative to Whites may partly be explained by differential exposure to violence. Our findings also suggest that having supportive friends when faced with violence can be beneficial for young adulthood health outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - Shervin Assari
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Anne Buu
- University of Texas Health Science Center, Houston, USA
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3
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Lawn RB, Nishimi KM, Sumner JA, Chibnik LB, Roberts AL, Kubzansky LD, Rich‐Edwards JW, Koenen KC, Thurston RC. Sexual Violence and Risk of Hypertension in Women in the Nurses' Health Study II: A 7-Year Prospective Analysis. J Am Heart Assoc 2022; 11:e023015. [PMID: 35189695 PMCID: PMC9075082 DOI: 10.1161/jaha.121.023015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/09/2021] [Indexed: 01/22/2023]
Abstract
Background Hypertension is a prevalent condition in women and an important modifiable risk factor for cardiovascular disease. Despite women's experiences of sexual violence being common, no prospective studies have examined lifetime sexual assault and workplace sexual harassment in relationship to hypertension in large civilian samples with extended follow-up. Here, we examined whether these experiences were prospectively associated with greater risk of developing hypertension over 7 years. Methods and Results Data are from a substudy of the Nurses' Health Study II and include women free of hypertension at the time of sexual assault and workplace sexual harassment assessment in 2008 (n=33 127). Hypertension was defined as self-reported doctor diagnosis or initiating antihypertensive medication use, assessed biennially through 2015. We performed Cox proportional hazards regression models to predict time to developing hypertension associated with sexual violence exposure, adjusting for relevant covariates. Over follow-up, 7096 women developed hypertension. Sexual assault and workplace sexual harassment were prevalent (23% and 12%, respectively; 6% of women experienced both). Compared with women with no exposure, women who experienced both sexual assault and workplace sexual harassment had the highest risk of developing hypertension (hazard ratio [HR], 1.21; 95% CI, 1.09-1.35), followed by women who experienced workplace sexual harassment (HR, 1.15; 95% CI, 1.05-1.25) and then by women who experienced sexual assault (HR, 1.11; 95% CI, 1.03-1.19), after adjusting for relevant covariates. Conclusions Sexual assault and workplace sexual harassment are prospectively associated with greater risk of hypertension. Reducing such violence is important in its own right and may also improve women's cardiovascular health.
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Affiliation(s)
- Rebecca B. Lawn
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
| | - Kristen M. Nishimi
- Mental Health ServiceSan Francisco Veterans Affairs Medical CenterSan FranciscoCA
- Department of Psychiatry and Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCA
| | | | - Lori B. Chibnik
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Department of NeurologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA
| | - Andrea L. Roberts
- Department of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMA
| | - Laura D. Kubzansky
- Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMA
| | - Janet W. Rich‐Edwards
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Division of Women’s HealthDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMA
| | - Karestan C. Koenen
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMA
- Psychiatric and Neurodevelopmental Genetics UnitDepartment of PsychiatryMassachusetts General HospitalBostonMA
| | - Rebecca C. Thurston
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPA
- Department of EpidemiologyUniversity of Pittsburgh Graduate School of Public HealthPittsburghPA
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4
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Non-communicable diseases among women survivors of intimate partner violence: Critical review from a chronic stress framework. Neurosci Biobehav Rev 2021; 128:720-734. [PMID: 34252471 DOI: 10.1016/j.neubiorev.2021.06.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 01/02/2023]
Abstract
A neurobiological framework of chronic stress proposes that the stress-response system can be functionally altered by the repeated presentation of highly stressful situations over time. These functional alterations mainly affect brain processing and include the dysregulation of the hypothalamic-pituitary-adrenal axis and associated processes. In the present critical review, we translate these results to inform the clinical presentation of women survivors of intimate partner violence (IPV). We approach IPV as a scenario of chronic stress where women are repetitively exposed to threat and coping behaviours that progressively shape their neurobiological response to stress. The changes at the central and peripheral levels in turn correlate with the phenotypes of non-communicable diseases. The reviewed studies clarify the extent of the impact of IPV on women's health in large (N > 10,000) population-based designs, and provide observations on experimental neuroendocrine, immune, neurocognitive and neuroimaging research linking alterations of the stress-response system and disease. This evidence supports the prevention of violence against women as a fundamental action to reduce the prevalence of non-communicable diseases.
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Reyes-Ortiz CA, Perez-Zepeda MU, Ocampo-Chaparro JM, Campo-Arias A, Borda MG, Holmes HM, Luque JS. Polyvictimization and Recurrent Falling in Older Ecuadorian Adults: The Mediation Role of Depressive Symptoms. J Aging Health 2020; 33:27-38. [PMID: 32877294 DOI: 10.1177/0898264320952916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: To assess depressive symptoms as a mediator in the association between polyvictimization and recurrent falling. Methods: Using data from the Salud, Bienestar y Envejecimiento (Health, Well-being, and Aging) Ecuador Study, we analyzed community-dwelling adults 60 years and older (n = 5227). Recurrent falling was determined as ≥2 falls during the prior 12 months. Polyvictimization was determined as a history of ≥2 types of abuse. The mediator was depressive symptoms. Mediation analyses were based on the VanderWeele method. Results: Polyvictimization was significantly associated with higher odds of recurrent falling, and odds ratio (OR) = 1.45 (95% confidence intervals [CI] 1.20-1.76). Higher depressive symptoms increase the odds for recurrent falling (OR = 1.09 and 95% CI 1.07-1.11). Moreover, depressive symptoms were a significant mediator between polyvictimization and recurrent falling. The mediating effect was 28.4%. Discussion: Polyvictimization was associated with higher odds of recurrent falling, and this association was mediated by depressive symptoms.
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Affiliation(s)
- Carlos A Reyes-Ortiz
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, 15467Florida A&M University, FL, USA
| | - Mario U Perez-Zepeda
- Geriatric Medicine Research, Nova Scotia Health Authority, 12361Dalhousie University, Canada.,Semillero de Neurociencias y Envejecimiento, Instituto de Envejecimiento, Facultad de Medicina, 27964Pontificia Universidad Javeriana, Colombia.,233936Instituto Nacional de Geriatría, Mexico.,Centro de Investigación en Ciencias de la Salud (CICSA), FCS, 27753Universidad Anáhuac México Campus Norte, México
| | - José M Ocampo-Chaparro
- 28006Universidad del Valle, Colombia.,Grupo Interinstitucional de Medicina Interna (GIMI 1), 67637Universidad Libre, Colombia
| | - Adalberto Campo-Arias
- Programa de Medicina, Facultad de Ciencias de la Salud, 469579Universidad del Magdalena, Colombia
| | - Miguel G Borda
- Semillero de Neurociencias y Envejecimiento, Instituto de Envejecimiento, Facultad de Medicina, 27964Pontificia Universidad Javeriana, Colombia.,Centre for Age-Related Medicine (SESAM), 60496Stavanger University Hospital, Norway.,Faculty of Health Sciences, 56627University of Stavanger, Norway
| | - Holly M Holmes
- McGovern Medical School, Geriatric and Palliative Medicine Division, 12339University of Texas Health Science Center at Houston, TX, USA
| | - John S Luque
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, 15467Florida A&M University, FL, USA
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Thurston RC, Chang Y, Matthews KA, von Känel R, Koenen K. Association of Sexual Harassment and Sexual Assault With Midlife Women's Mental and Physical Health. JAMA Intern Med 2019; 179:48-53. [PMID: 30285071 PMCID: PMC6322939 DOI: 10.1001/jamainternmed.2018.4886] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Sexual harassment and sexual assault are prevalent experiences among women. However, their association with health indices is less well understood. OBJECTIVE To investigate the association of history of sexual harassment and sexual assault with blood pressure, mood, anxiety, and sleep among midlife women. DESIGN, SETTING, AND PARTICIPANTS Nonsmoking women without cardiovascular disease were recruited from the community to undergo physical measurements (blood pressure, height, weight), medical history, and questionnaire psychosocial assessments (workplace sexual harassment, sexual assault, depression, anxiety, sleep). EXPOSURES Sexual harassment and sexual assault. MAIN OUTCOMES AND MEASURES Blood pressure, depressive symptoms, anxiety, and sleep characteristics. RESULTS Among the 304 nonsmoking women aged 40 to 60 years who participated in the study, all were free of clinical cardiovascular disease, and the mean (SD) age was 54.05 (3.99) years. A total of 19% reported a history of workplace sexual harassment (n = 58), and 22% reported a history of sexual assault (n = 67). Sexual harassment was related to significantly greater odds of stage 1 or 2 hypertension among women not taking antihypertensives (odds ratio [OR], 2.36; 95% CI, 1.10-5.06; P = .03) as well as clinically poor sleep (OR, 1.89; 95% CI, 1.05-3.42; P = .03), after adjusting for covariates. Sexual assault was associated with significantly greater odds of clinically elevated depressive symptoms (OR, 2.86; 95% CI, 1.42-5.77; multivariable P = .003), clinically relevant anxiety (OR, 2.26; 95% CI, 1.26-4.06; P = .006), and clinically poor sleep (OR, 2.15; 95% CI, 1.23-3.77; multivariable P = .007), after adjusting for covariates. CONCLUSIONS AND RELEVANCE Sexual harassment and sexual assault are prevalent experiences among midlife women. Sexual harassment was associated with higher blood pressure and poorer sleep. Sexual assault was associated with poorer mental health and sleep. Efforts to improve women's health should target sexual harassment and assault prevention.
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Affiliation(s)
- Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yuefang Chang
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Karen A Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Karestan Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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