Brain injury in women experiencing intimate partner-violence: neural mechanistic evidence of an “invisible” trauma
- 1.2k Downloads
Traumatic brain injury (TBI) in women experiencing intimate-partner violence (IPV) is common, and IPV afflicts 30 % of women worldwide. However, the neurobiology and related sequelae of these TBIs have never been systematically examined. Consequently, TBI treatments are typically absent and IPV interventions are inadequate. There has been a call for a comprehensive assessment of IPV-related TBIs and their relationship to aspects of women’s cognitive and neural functioning. In response, we examined brain-network organization associated with TBI and its cognitive effects using clinical interviews and neuropsychological measures as well as structural and functional Magnetic Resonance Imaging (fMRI) in women experiencing IPV-related TBI. We hypothesized that TBI severity would be related to poorer cognitive performance and be associated with structural and functional connectivity between cognitive networks previously implicated in other TBI populations. As predicted, severity of TBI was negatively associated with inter-network intrinsic functional connectivity indicative of TBI, between the right anterior insula and posterior cingulate cortex/precuneus (FLAME1 + 2; family-wise error-corrected Z > 2.3, cluster- based p < 0.05). This association remained significant when controlling for partner-abuse severity, age, head motion, childhood trauma and psychopathology. Additionally, intrinsic functional connectivity between the same regions correlated positively with cognitive performance on indices of memory and learning. These data provide the first mechanistic evidence of TBI and its association with cognitive functioning in women sustaining IPV-related TBI. These data underscore the need to address and consider the role TBI may be playing in the efficacy of IPV interventions ranging from emergency first responder interactions to specific treatment plans.
KeywordsIntimate-partner violence Traumatic brain injury Functional connectivity Default mode network Salience network Domestic violence
EMV and AK had full access to all of the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. We thank all of the women who participated in this study. We thank Brittany LeBlanc for data management assistance, Drs. Michael Alexander, Margaret O’Connor and Gregory Sorensen for helpful advice in developing this project, Dr. Steven Stufflebeam for performing the clinical reads of the imaging scans, Drs. Randy Buckner, Kevin Spencer, Martha Shenton and Michael Hove for helpful feedback in preparing the manuscript. This work was supported by a Harvard Medical School Center of Excellence grant from the HMS Fund for Women’s Health (EMV), the Canadian Institutes of Health Research (AK), and grants provided to the Athinoula A. Martinos Center for Biomedical Imaging, NCRR P41RR14075 and P41 EB015896. This work also involved the use of instrumentation supported by the NIH Shared Instrumentation Grant Program and/or High-End Instrumentation Grant Program; specifically, grant numbers 1S10RR023043 and 1S10RR023401.
Compliance with ethical standards
Disclosure of potential conflicts of interest
The authors report no conflicts of interest.
Research involving human participants and informed consent
Participants provided written informed consent and the local ethics committee (Partners IRB) approved the study.
- American Psychiatric Association. 2000. Diagnostic and statistical manual of mental disorders (4th ed., text rev.) Washington, DC: American Psychiatric Association.Google Scholar
- Banks, M. E. (2013). Optimal rehabilitation for women who receive traumatic brain injury following intimate partner violence. In H. Muenchberger, E. Kendall, & J. Wright (Eds.), Health and healing after traumatic brain injury: Understanding the power of family, friends, community, and other support systems (pp. 153–167). Santa Barbara, CA: Praeger.Google Scholar
- Bonnelle, V., Leech, R., Kinnunen, K. M., Ham, T. E., Beckmann, C. F., De Boissezon, X., Greenwood, R. J., & Sharp, D. J. (2011). Default mode network connectivity predicts sustained attention deficits after traumatic brain injury. The Journal of Neuroscience, 31, 13442–13451.CrossRefPubMedGoogle Scholar
- Bonnelle, V., Ham, T. E., Leech, R., Kinnunen, K. M., Mehta, M. A., Greenwood, R. J., & Sharp, D. J. (2012). Salience network integrity predicts default mode network function after traumatic brain injury. Proceedings of the National Academy of Sciences of the United States of America, 109, 4690–4695.CrossRefPubMedPubMedCentralGoogle Scholar
- Cai W, Chen T, Ryali S, Kochalka J, Li CS, Menon V. 2015. Causal interactions within a frontal-cingulate-parietal network during cognitive control: Convergent evidence from a multisite-multitask investigation. Cereb Cortex.Google Scholar
- Carroll, L. J., Cassidy, J. D., Holm, L., Kraus, J., Coronado, V. G., & Injury WHOCCTFoMTB (2004). Methodological issues and research recommendations for mild traumatic brain injury: the WHO collaborating Centre task force on mild traumatic brain injury. Journal of Rehabilitation Medicine, 113–125.Google Scholar
- Committee on Mild Traumatic Brain Injury, American Congress of Rehabilitation Medicine (1993). Definition of mild traumatic brain injury. The Journal of Head Trauma Rehabilitation, 8, 48–59.Google Scholar
- Devries, K. M., Mak, J. Y., Garcia-Moreno, C., Petzold, M., Child, J. C., Falder, G., Lim, S., Bacchus, L. J., Engell, R. E., Rosenfeld, L., Pallitto, C., Vos, T., Abrahams, N., & Watts, C. H. (2013). Global health. The global prevalence of intimate partner violence against women. Science., 340, 1527–1528.PubMedGoogle Scholar
- Goulden, N., Khusnulina, A., Davis, N. J., Bracewell, R. M., Bokde, A. L., McNulty, J. P., & Mullins, P. G. (2014). The salience network is responsible for switching between the default mode network and the central executive network: replication from DCM. NeuroImage, 99, 180–190.CrossRefPubMedGoogle Scholar
- Kondo, A., Shahpasand, K., Mannix, R., Qiu, J., Moncaster, J., Chen, C. H., Yao, Y., Lin, Y. M., Driver, J. A., Sun, Y., Wei, S., Luo, M. L., Albayram, O., Huang, P., Rotenberg, A., Ryo, A., Goldstein, L. E., Pascual-Leone, A., McKee, A. C., Meehan, W., Zhou, X. Z., & Lu, K. P. (2015). Antibody against early driver of neurodegeneration cis P-tau blocks brain injury and tauopathy. Nature, 523(7561), 431–436.CrossRefPubMedPubMedCentralGoogle Scholar
- Murray, C.E., Lundgren, K., Olson, L.N., & Hunnicutt, G. (2016) Practice update: what professionals who are not brain injury specialists need to know about intimate partner violence-related traumatic brain injury. Trauma Violence Abuse, 17, 298–305. doi: 10.1177/1524838015584364.
- Nathan, D. E., Oakes, T. R., Yeh, P. H., French, L. M., Harper, J. F., Liu, W., Wolfowitz, R. D., Wang, B. Q., Graner, J. L., & Riedy, G. (2015). Exploring variations in functional connectivity of the resting state default mode network in mild traumatic brain injury. Brain Connectivity, 5, 102–114.CrossRefPubMedGoogle Scholar
- Rhodes, K. V., Rodgers, M., Sommers, M., Hanlon, A., Chittams, J., Doyle, A., Datner, E., & Crits-Christoph, P. (2015). Brief motivational intervention for intimate partner violence and heavy drinking in the emergency department: a randomized clinical trial. Journal of the American Medical Association, 314, 466–477.CrossRefPubMedPubMedCentralGoogle Scholar
- Ruff, R. M., Iverson, G. L., Barth, J. T., Bush, S. S., Broshek, D. K., Policy, N. A. N., & Planning, C. (2009). Recommendations for diagnosing a mild traumatic brain injury: a National Academy of neuropsychology education paper. Archives of Clinical Neuropsychology, 24, 3–10.CrossRefPubMedGoogle Scholar
- Sharp, D. J., Beckmann, C. F., Greenwood, R., Kinnunen, K. M., Bonnelle, V., De Boissezon, X., Powell, J. H., Counsell, S. J., Patel, M. C., & Leech, R. (2011). Default mode network functional and structural connectivity after traumatic brain injury. Brain, 134, 2233–2247.CrossRefPubMedGoogle Scholar
- Shenton, M. E., Hamoda, H. M., Schneiderman, J. S., Bouix, S., Pasternak, O., Rathi, Y., Vu, M. A., Purohit, M. P., Helmer, K., Koerte, I., Lin, A. P., Westin, C. F., Kikinis, R., Kubicki, M., Stern, R. A., & Zafonte, R. (2012). A review of magnetic resonance imaging and diffusion tensor imaging findings in mild traumatic brain injury. Brain Imaging and Behavior, 6, 137–192.CrossRefPubMedPubMedCentralGoogle Scholar
- Smith, S. M., Jenkinson, M., Johansen-Berg, H., Rueckert, D., Nichols, T. E., Mackay, C. E., Watkins, K. E., Ciccarelli, O., Cader, M. Z., Matthews, P. M., & Behrens, T. E. (2006). Tract-based spatial statistics: voxelwise analysis of multi-subject diffusion data. NeuroImage, 31, 1487–1505.CrossRefPubMedGoogle Scholar
- Sridharan, D., Levitin, D. J., & Menon, V. (2008). A critical role for the right fronto-insular cortex in switching between central-executive and default-mode networks. Proceedings of the National Academy of Sciences of the United States of America, 105, 12569–12574.CrossRefPubMedPubMedCentralGoogle Scholar
- World Health Organization. 1992. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.Google Scholar
- Yeo, B. T., Krienen, F. M., Sepulcre, J., Sabuncu, M. R., Lashkari, D., Hollinshead, M., Roffman, J. L., Smoller, J. W., Zollei, L., Polimeni, J. R., Fischl, B., Liu, H., & Buckner, R. L. (2011). The organization of the human cerebral cortex estimated by intrinsic functional connectivity. Journal of Neurophysiology, 106, 1125–1165.CrossRefPubMedGoogle Scholar