Identifying the Cognitive, Psychological, and Neuroimaging Signatures of Head Trauma in Female Survivors of Intimate Partner Violence

Intimate partner violence (IPV), the physical violence, sexual violence, psychological aggression, or stalking by a current or former intimate partner, is a significant public health concern affecting approximately 10 million people in the United States annually. Approximately 33% of women exposed to IPV report physical trauma resulting in heighted risk of head injury in this population. Recent work suggests that anywhere from 40-90% of women experience head trauma due to IPV. IPV-related head trauma is caused by blunt force trauma, being pushed or violently shaken, and/or strangulation, which can result in focal trauma or contusions, acceleration and deceleration injuries, as well as hypoxia and anoxia due to strangulation, respectively. Limited research has shown that women exposed to IPV with head trauma report higher depression, anxiety, and post-traumatic stress disorder symptomatology, as well as impaired cognitive function relative to women with IPV and no exposure to head trauma. Although the clinical features of repeated exposure to head trauma identified in IPV are similar to the effects observed in military traumatic brain injury (TBI) and sports-related concussion, limited work has been done to understand IPV-related head trauma, in particular its chronic cognitive and psychological effects as well as associated brain changes. Through a multi-site research collaboration consisting of members of the Enhancing NeuroImaging and Genetics through Meta-Analysis (ENIGMA) IPV Working Group, the proposed study will characterize the cognitive, psychological, and neural profiles of IPV- related head trauma, as well as determine whether specific symptoms clusters are associated with discernable IPV subgroups. Furthermore, this proposal initiates the process of creating an IPV study cohort that will be re- assessed every 5 years to chronically assess brain and behavioral changes associated with IPV-related head trauma over the lifespan. Semi-structured interviews will be used to obtain IPV specific information such as abuse and head trauma history and frequency. A comprehensive neuropsychological battery will be used to determine cognitive and psychological status, while sophisticated neuroimaging techniques will be used to characterize neural structure, function, and brain metabolites in IPV with exposure to head trauma relative to IPV without exposure to head trauma. Finally, we will use a data-driven approach to determine whether symptom clusters differentiate subgroups of IPV. In aim 1, we will identify the cognitive and psychological profiles of subgroups of IPV. Aim 2 will examine the neuroimaging signatures in subgroups of IPV. In aim 3, we will determine whether symptom clusters are associated with discernible subgroups of IPV. The results from this study will provide critical information about the role of IPV-related head trauma in cognitive and psychological outcomes, as well as the underlying neural changes. This is important not only for understanding the chronic effects of repetitive brain trauma, but also the identification of distinct subgroups of IPV has direct implications for development of patient-centered care approaches for IPV.