The Journal of head trauma rehabilitation · 2026
Developing an Empirically Derived Head Trauma Burden Assessment Score for Intimate Partner Violence-related Neurotrauma.
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de Souza Nicola L, Jain Divya, Kennedy Eamonn, Carlsson Ella, Baird C Lexi, Carter Emily E, Chase Spencer, Clark Emma, Cwiek Andrew, Dorman Katherine, Kajankova Maria, Lan Xinhui, Lockhart Faith V, Méndez-Fernández Adriana P, Mullin Hollie A, Olis Madelyn, Read Emma N, Rebuck Elizabeth, Sakamoto McKenna S, Velez Carmen, Andersen Maya, Koerte Inga K, Tate David F, Marshall Amy D, Lin Alexander P, Hillary Frank G, Wilde Elisabeth A, Esopenko Carrie
Аннотация
OBJECTIVE: To develop a statistically derived and clinically informed intimate partner violence-related head trauma (IPV-HT) Burden Assessment Score that accounts for diverse brain injury mechanisms (eg, nonfatal strangulation, blunt force), exposure chronicity, and injury severity.
SETTING: Community-based sample.
PARTICIPANTS: Females (N = 146; 38.7 ± 10.2 years old, 56.8% White/Non-Hispanic) reporting at least 1 IPV-HT on the Brain Injury Screening Questionnaire IPV module (BISQ-IPV).
DESIGN: Cross-sectional analysis.
MAIN MEASURES: Candidate variables representing injury mechanism, frequency, severity, and IPV relationship history were extracted from the BISQ-IPV. Multicollinearity screening and multivariable linear regression selected variables predicting Rivermead Postconcussion Symptoms Questionnaire (RPQ) total scores. Leave-one-out elimination identified the most predictive variables determined by change in R2 when removed. Retained variables were standardized and combined to calculate the IPV-HT Burden Assessment Score, normalized to range 1-100 (low-to-high burden). Scores were correlated with Adverse Childhood Experiences questionnaire (ACEs), Headache Impact Test (HIT-6), cognition subscale of the Quality of Life in Neurological Disorders (NeuroQoL), Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5), Generalized Anxiety Disorder (GAD-Q-IV), and Center for Epidemiologic Studies Depression Scale (CES-D).
RESULTS: Five variables were retained in the final model, achieving 25% explainability of RPQ total scores (R2 = 0.25; adjusted R2 = 0.22). Count of unique IPV-related brain injury mechanisms explained most RPQ variance (∼19%), followed by number of IPV relationships, and duration of the 3 most severe relationships. The model also retained the proportion of injuries due to nonfatal strangulation meeting brain injury criteria and the average brain injury severity. The final IPV-HT Burden Assessment Score (mean = 31.7 ± 18.24, range = 2-86) positively correlated with ACEs (r = 0.17, P = 0.043), HIT-6 (r = 0.27, P = 0.001), PCL-5 (r = 0.23, P = 0.006), GAD-Q-IV (r = 0.17, P = 0.043), and CES-D (r = 0.29, P < 0.001) and negatively correlated with NeuroQoL T-scores (r = -0.30, P < 0.001).
CONCLUSIONS: The IPV-HT Burden Assessment Score captures diverse IPV-HT exposures and shows preliminary validity through associations with psychosocial and neurological outcomes.
SETTING: Community-based sample.
PARTICIPANTS: Females (N = 146; 38.7 ± 10.2 years old, 56.8% White/Non-Hispanic) reporting at least 1 IPV-HT on the Brain Injury Screening Questionnaire IPV module (BISQ-IPV).
DESIGN: Cross-sectional analysis.
MAIN MEASURES: Candidate variables representing injury mechanism, frequency, severity, and IPV relationship history were extracted from the BISQ-IPV. Multicollinearity screening and multivariable linear regression selected variables predicting Rivermead Postconcussion Symptoms Questionnaire (RPQ) total scores. Leave-one-out elimination identified the most predictive variables determined by change in R2 when removed. Retained variables were standardized and combined to calculate the IPV-HT Burden Assessment Score, normalized to range 1-100 (low-to-high burden). Scores were correlated with Adverse Childhood Experiences questionnaire (ACEs), Headache Impact Test (HIT-6), cognition subscale of the Quality of Life in Neurological Disorders (NeuroQoL), Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5), Generalized Anxiety Disorder (GAD-Q-IV), and Center for Epidemiologic Studies Depression Scale (CES-D).
RESULTS: Five variables were retained in the final model, achieving 25% explainability of RPQ total scores (R2 = 0.25; adjusted R2 = 0.22). Count of unique IPV-related brain injury mechanisms explained most RPQ variance (∼19%), followed by number of IPV relationships, and duration of the 3 most severe relationships. The model also retained the proportion of injuries due to nonfatal strangulation meeting brain injury criteria and the average brain injury severity. The final IPV-HT Burden Assessment Score (mean = 31.7 ± 18.24, range = 2-86) positively correlated with ACEs (r = 0.17, P = 0.043), HIT-6 (r = 0.27, P = 0.001), PCL-5 (r = 0.23, P = 0.006), GAD-Q-IV (r = 0.17, P = 0.043), and CES-D (r = 0.29, P < 0.001) and negatively correlated with NeuroQoL T-scores (r = -0.30, P < 0.001).
CONCLUSIONS: The IPV-HT Burden Assessment Score captures diverse IPV-HT exposures and shows preliminary validity through associations with psychosocial and neurological outcomes.