Head trauma caused by intimate partner violence is subject of new study

UNIVERSITY PARK, Pa. — Researchers in Penn State’s Department of Psychology are joining forces with faculty at three other institutions to conduct one of the first studies funded by the National Institutes of Health (NIH) that examines the long-term effects of head trauma in women who are victims of intimate partner violence (IPV).

Penn State will receive $861,000 of the $4 million awarded for the five-year NIH grant, titled “Identifying the Cognitive, Psychological, and Neuroimaging Signatures of Head Trauma in Female Survivors of Intimate Partner Violence.” The remainder of the grant will be allocated to researchers at Rutgers University, the University of Utah, and Harvard University.

“There is a growing emphasis in the clinical neurosciences that we need to represent sex as a biological variable,” said Frank Hillary, Penn State professor of psychology and one of the project’s principal investigators. “There are hormone differences, brain structure differences and other differences between men and women that up to now haven’t been considered in studies related to head trauma. Even in animal models of traumatic brain injury, studies have historically focused on males or even treated ‘femaleness’ as a confound. This has led to significant problems with translation because, obviously, half of the population is not male. NIH has recently made it explicit that you have to look at sex as a biological variable that can influence the outcome of your research.”

For Hillary, who has been studying the brain and brain injuries for more than 20 years, this is a significant and long overdue shift. “Many millions of dollars have been spent to understand the consequences of two men volitionally running into each other in sport. Meanwhile, the incidence of brain injury in women due to intimate partner violence is far greater, yet funding and research remains relatively rare,” he said.

“The most commonly reported statistic regarding IPV is that one in three women experience IPV in their lifetime,” said Amy Marshall, Penn State professor of psychology and a co-investigator on the project. “However, I find it more telling that when researchers ask about more recent experiences, the most well-designed epidemiological studies report that nearly 20% of U.S. women who are in a relationship have experienced IPV during the past year. These rates are even higher among younger women (e.g., 45% of women aged 18-29), women in dating relationships, and during stressful times in one’s relationship such as when parenting young children.”

“The experience of IPV results in far-reaching negative physical, psychological, occupational, and social consequences,” Marshall continued. “Many of these outcomes are not just for the survivor, but also for future generations and society more generally.”

Hillary, Marshall and the rest of the research team, including lead principal investigator Carrie Esopenko at Rutgers University, will work with women’s centers to identify and invite approximately 200 women — none of whom are in a current aggressive or violent relationship — to be part of the study. The women will take part in structured interviews and be given the opportunity to tell their stories, after which they will be given a series of cognitive tests followed by magnetic resonance imaging tests to examine brain structure and function. The investigators will follow the women over time to understand the long-term impacts of the head trauma.

“This research represents some of the first work to examine how IPV-related head trauma in women works together with biology and other risk factors to influence cognitive functioning and mental health,” said Jenae Neiderhiser, distinguished professor of psychology and associate head of the Department of Psychology. “The study uses brain imaging and genetics to determine outcomes and places Penn State at the center for a critical and emerging area of work.”

The goal of the study is to understand how long the women were exposed to the trauma, what the mechanisms of the trauma were, and how the study subjects fare as they age.

“Those who participate in our study will learn what traumatic brain injury is, what the symptoms are like, what symptom resolution is and what to look for if those symptoms are not resolving,” Hillary said. “These are repeated, illegal acts of violence, which makes access and increasing awareness challenging, but we hope to educate women about head injury and its consequences.

“The data may also help inform policies about intimate partner violence going forward,” he continued. “For example, as we have seen in some sports, there may be long-term consequences of repeated head trauma such as neurodegeneration or Alzheimer’s disease. The data will help us to provide critical information to service agencies and other organizations so they can learn how to better help victims.”

“We often see that survivors of IPV have impaired daily functioning without understanding the origins of those impairments,” Marshall added. “This could be things like not showing up to medical or legal appointments, sleeping late, making risky decisions, or not engaging in the nonstop demands of parenting young children. It can also include difficulties deciding, and planning how, to leave a violent relationship. Researchers are just now starting to consider the possibility that many of these negative outcomes may be directly or indirectly due to brain injury.

“Given how much scientists, policy makers and lay people know about traumatic brain injury among athletes and military servicepersons, this work has been a long time coming,” Marshall concluded. “My hope is that this research will help to decrease victim blaming and women’s own self-blame. Possibly, with greater understanding of the impact of IPV-related traumatic brain injury, the social and mental health consequences can be lessened while we also find the best ways to treat the physical and cognitive consequences.”