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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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3
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Hou J, Huibregtse ME, Alexander IL, Klemsz LM, Fu T, Rosenberg M, Fortenberry JD, Herbenick D, Kawata K. Structural brain morphology in young adult women who have been choked/strangled during sex: A whole-brain surface morphometry study. Brain Behav 2023; 13:e3160. [PMID: 37459254 PMCID: PMC10454256 DOI: 10.1002/brb3.3160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Being choked/strangled during partnered sex is an emerging sexual behavior, particularly prevalent among young adult women. Using a multiparameter morphometric imaging approach, we aimed to characterize neuroanatomical differences between young adult women (18-30 years old) who were exposed to frequent sexual choking and their choking naïve controls. METHODS This cross-sectional study consisted of two groups (choking [≥4 times in the past 30 days] vs. choking-naïve group). Participants who reported being choked four or more times during sex in the past 30 days were enrolled in the choking group, whereas those without were assigned to the choking naïve group. High-resolution anatomical magnetic resonance imaging (MRI) data were analyzed using both volumetric features (cortical thickness) and geometric features (fractal dimensionality, gyrification, sulcal depth). RESULTS Forty-one participants (choking n = 20; choking-naïve n = 21) contributed to the final analysis. The choking group showed significantly increased cortical thickness across multiple regions (e.g., fusiform, lateral occipital, lingual gyri) compared to the choking-naïve group. Widespread reductions of the gyrification were observed in the choking group as opposed to the choking-naïve group. However, there was no group difference in sulcal depth. The fractal dimensionality showed bi-directional results, where the choking group exhibited increased dimensionality in areas including the postcentral gyrus, insula, and fusiform, whereas decreased dimensionality was observed in the bilateral superior frontal gyrus and pericalcarine cortex. CONCLUSION These data in cortical morphology suggest that sexual choking events may be associated with neuroanatomical alteration. A longitudinal study with multimodal assessment is needed to better understand the temporal ordering of sexual choking and neurological outcomes.
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Affiliation(s)
- Jiancheng Hou
- Research Center for Cross‐Straits Cultural DevelopmentFujian Normal UniversityFuzhouChina
- Department of KinesiologyIndiana University School of Public Health‐BloomingtonBloomingtonIndianaUSA
| | - Megan E. Huibregtse
- Department of KinesiologyIndiana University School of Public Health‐BloomingtonBloomingtonIndianaUSA
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgiaUSA
| | - Isabella L. Alexander
- Department of KinesiologyIndiana University School of Public Health‐BloomingtonBloomingtonIndianaUSA
| | - Lillian M. Klemsz
- Department of KinesiologyIndiana University School of Public Health‐BloomingtonBloomingtonIndianaUSA
| | - Tsung‐Chieh Fu
- Department of Applied Health Science, Indiana University School of Public HealthIndiana UniversityBloomingtonIndianaUSA
- The Center for Sexual Health Promotion, Indiana University School of Public HealthIndiana UniversityBloomingtonIndianaUSA
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public HealthIndiana UniversityBloomingtonIndianaUSA
| | - James Dennis Fortenberry
- Department of Pediatrics, Indiana University School of MedicineIndiana UniversityIndianapolisIndianaUSA
| | - Debby Herbenick
- Department of Applied Health Science, Indiana University School of Public HealthIndiana UniversityBloomingtonIndianaUSA
- The Center for Sexual Health Promotion, Indiana University School of Public HealthIndiana UniversityBloomingtonIndianaUSA
| | - Keisuke Kawata
- Department of KinesiologyIndiana University School of Public Health‐BloomingtonBloomingtonIndianaUSA
- Program in NeuroscienceThe College of Arts and SciencesIndiana UniversityBloomingtonIndianaUSA
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McKee GB, Gill-Hopple K, Oesterle DW, Daigle LE, Gilmore AK. New Perspectives on Risk Factors for Non-fatal Strangulation and Post-assault Imaging. J Interpers Violence 2022; 37:NP8226-NP8236. [PMID: 33045917 PMCID: PMC8104448 DOI: 10.1177/0886260520966673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Strangulation has long been associated with death in the context of sexual assault and intimate partner violence (IPV). Non-fatal strangulation (NFS) during sexual assault, which refers to strangulation or choking that does not result in death, is common and has been associated with IPV and with bodily injury; however, other factors associated with NFS are unknown. The current study examined demographic and sexual assault characteristics associated with NFS among women who received a sexual assault medical forensic exam (SAMFE). A second purpose of this study was to explore factors associated with receiving follow-up imaging orders after NFS was identified during a SAMFE. Participants (N = 882) ranged in age from 18 to 81 (M = 28.85), with the majority identifying as non-Hispanic White (70.4%) or Black/African American (23.4%). A total of 75 women (8.5%) experienced NFS during the sexual assault. Of these, only 13 (17.3%) received follow-up imaging orders for relevant scans. Results from a logistic regression analysis demonstrated that NFS was positively associated with report of anal penetration, intimate partner perpetration, non-genital injury, and weapon use during the assault. Results from chi-square analysis showed that among sexual assaults involving women who experienced NFS, those whose assaults involved weapon use were over four times more likely to receive imaging orders compared to assaults without weapon use. These findings have implications for criminal justice, and if incorporated into danger assessments, could potentially reduce fatalities linked to sexual assault and/or IPV. Additional work is needed to ensure that all assaults with NFS trigger a referral for imaging regardless of other assault characteristics.
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Affiliation(s)
- Grace B. McKee
- Advanced Fellowship Program in Mental Illness Research and Treatment, Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC), Central Virginia Veterans Affairs Health Care System
- Department of Psychology, Virginia Commonwealth University
| | | | - Daniel W. Oesterle
- Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University
| | - Leah E. Daigle
- Andrew Young School of Policy Studies, Department of Criminal Justice and Criminology, Georgia State University
| | - Amanda K. Gilmore
- Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University
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5
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Reckdenwald A, Powell KM, Martins TAW. Forensic documentation of non-fatal strangulation. J Forensic Sci 2021; 67:588-595. [PMID: 34927735 DOI: 10.1111/1556-4029.14958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/12/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022]
Abstract
The purpose of this study is to examine forensic documentation of non-fatal strangulation (NFS) in domestic violence cases. Research has pointed to the importance of forensic evidence in the prosecution of strangulation offenders. However, limited research has examined the type of evidence that is gathered during a forensic examination for NFS that occurs during a domestic violence situation. To address this gap in the literature, this study analyzed 63 NFS forensic examination records and body sketches for victims who were referred by police during a domestic violence incident. Results reflect the seriousness of NFS with multiple strangulation attacks in the current incident recorded in 52% of the reports, loss of consciousness recorded in 13.1% of the reports, and a history of strangulation in the relationship recorded in 60% of the reports. It is argued that a forensic exam is essential to identify and mitigate serious symptoms and injuries, as well as to collect valuable evidence that can be used during legal proceedings. Implications for practice and policy are discussed.
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Affiliation(s)
- Amy Reckdenwald
- Department of Sociology, University of Central Florida, Orlando, Florida, USA
| | - Karina M Powell
- Department of Criminal Justice, Violence Against Women Cluster, University of Central Florida, Orlando, Florida, USA
| | - Traccy A W Martins
- Department of Sociology, University of Central Florida, Orlando, Florida, USA
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6
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Williamson F, Collins S, Dehn A, Doig S. Vascular injury is an infrequent finding following non-fatal strangulation in two Australian trauma centres. Emerg Med Australas 2021; 34:223-229. [PMID: 34505351 DOI: 10.1111/1742-6723.13863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/02/2021] [Accepted: 08/23/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Non-fatal strangulation assessment is challenging for clinicians as clear guidelines for evaluation are limited. The prevalence of non-fatal strangulation events, clinical findings, frequency of injury on computed tomography angiogram (CTA) and outcomes across two trauma centres will be used to improve this assessment process. METHODS This is a retrospective observational study of adult presentations during 2-year period to two major-trauma referral hospitals and subsequent 12 months to identify delayed vascular injury. Patients included using standardised search terms. Demographic data, clinical findings, radiological reports and outcomes were included for review. RESULTS A total of 425 patients were included for analysis. Self-inflicted injury comprised 62.1%, with domestic violence (28.5%) and assault (9.4%) the remainder. Manual strangulation events 36.7% of overall presentations and 63.3% following ligature strangulation (ligature strangulation, incomplete and complete hanging). On examination soft signs present in 133 (31.2%) cases, commonly neck tenderness in isolation. No hard signs suggesting vascular damage. Vascular injury was demonstrated in three cases (0.7% of the total cohort and 1.5% of CTA scans completed), and all occurred in ligature strangulation events as a result of hanging. No patients had delayed vascular injury in the 12-month period post-initial presentation. CONCLUSIONS In non-fatal strangulation presentations, the majority have subtle signs of neck injury on examination with inconsistent documentation of findings. Low rate of vascular injury overall (0.7%), and entirely in hanging events. No longer-term vascular sequalae identified. Improving documentation focusing on hypoxic insult and evidence of airway trauma is warranted, rather than a reliance on computed tomography imaging to delineate a traumatic event in non-fatal strangulation.
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Affiliation(s)
- Frances Williamson
- Emergency and Trauma Centre and Trauma Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Jamieson Trauma Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Sarah Collins
- Emergency Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Anja Dehn
- Emergency Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Shaela Doig
- Emergency and Trauma Centre and Trauma Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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