Developing an Empirically Derived Head Trauma Burden Assessment Score for Intimate Partner Violence-related Neurotrauma.

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.