Brain injury in women experiencing intimate partner-violence: neural mechanistic evidence of an “invisible” trauma

Abstract

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.

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Acknowledgments

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.

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Correspondence to Eve Valera.

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This work was performed at Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital.

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Valera, E., Kucyi, A. Brain injury in women experiencing intimate partner-violence: neural mechanistic evidence of an “invisible” trauma. Brain Imaging and Behavior 11, 1664–1677 (2017). https://doi.org/10.1007/s11682-016-9643-1

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Keywords

  • Intimate-partner violence
  • Traumatic brain injury
  • Functional connectivity
  • Default mode network
  • Salience network
  • Domestic violence