重复性头部损伤与亲密伴侣暴力女性幸存者的认知、身体和情绪症状。
Repetitive Head Injury and Cognitive, Physical, and Emotional Symptoms in Women Survivors of Intimate Partner Violence.
机构信息
Department of Psychology, University of Kentucky, Lexington, Kentucky, USA.
Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, USA.
出版信息
J Neurotrauma. 2024 Feb;41(3-4):486-498. doi: 10.1089/neu.2023.0358. Epub 2023 Oct 31.
Many women survivors of intimate partner violence (IPV) experience repetitive head injuries in their lifetime, but limited research has examined the cumulative effects of multiple head injuries on post-concussion symptom severity in this population. This study examined how number of lifetime head injuries and episodes of loss of consciousness (LOC) due to head injuries were related to current cognitive, physical, and emotional symptoms among women survivors of IPV. Cisgender women from Kentucky were recruited following a protective order against an intimate partner, including 268 women with no reported lifetime head injuries and 250 women with one or more IPV-related head injuries (mean [M] = 17.2 head injuries, standard deviation [SD] = 50.5, median [Mdn] = 4, range = 1-515; M = 1.8 LOC episodes, SD = 4.3, Mdn = 1, range = 0-35, respectively). Participants underwent in-person interviews about lifetime physical and sexual IPV history, head injury history, and current cognitive, physical, and emotional symptoms. Sociodemographic characteristics, physical and sexual IPV severity, and current symptom severity were examined in relation to number of head injuries and LOC episodes. A higher number of head injuries was associated with greater age, White race, less than high school education, unemployment, and rural residence. No sociodemographic variables differed based on number of LOC episodes. Greater number of lifetime head injuries and LOC episodes correlated significantly with physical IPV severity ( = 0.35, < 0.001; = 0.33, < 0.001, respectively) and sexual IPV severity ( = 0.22, < 0.001; = 0.19, = 0.003). Greater number of head injuries and LOC episodes correlated significantly with greater cognitive ( = 0.33, < 0.001; = 0.23, < 0.001, respectively), physical ( = 0.36, < 0.001; = 0.31, < 0.001), emotional ( = 0.36, < 0.001; = 0.18, = 0.004), and total symptom severity ( = 0.39, < 0.001; = 0.26, < 0.001). In group comparisons, participant groups stratified by number of head injuries (i.e., 0, 1-3, 4+) differed in total symptom severity ( < 0.001, = 0.15), with greater symptom burden associated with more head injuries. Participants with and without LOC differed in symptom severity: cognitive ( < 0.001, = 0.45), physical ( < 0.001, = 0.60), emotional ( = 0.004, = 0.37), and total symptom severity ( < 0.001, = 0.53). Group differences between participants with and without LOC remained significant after controlling for sociodemographic variables and IPV severity. There was no cumulative effect of LOC, in that participants with 1 LOC episode did not differ from participants with 2 + LOC episodes ( > 0.05). Based on hierarchical regression analyses, only physical symptoms were independently related to number of head injuries ( = 0.008, Δ = 0.011) and number of LOC episodes ( = 0.014, Δ = 0.021) after controlling for sociodemographic characteristics and IPV severity. Among women survivors of IPV, cumulative head injuries appear related to greater symptom severity. Greater head injury history was independently related to worse physical symptoms (e.g., headaches, dizziness, sleep problems), whereas cognitive and emotional symptoms were, in part, attributable to cumulative physical and emotional trauma due to IPV. Women survivors of IPV with repetitive head injuries have unmet neurobehavioral health needs that may benefit from targeted interventions.
许多亲密伴侣暴力(IPV)的女性幸存者一生中会反复遭受头部受伤,但很少有研究探讨多次头部受伤对该人群中脑震荡后症状严重程度的累积影响。本研究调查了一生中头部受伤的次数和因头部受伤而失去意识(LOC)的次数与 IPV 女性幸存者的当前认知、身体和情绪症状之间的关系。肯塔基州的顺性别女性在获得针对亲密伴侣的保护令后被招募,包括 268 名没有报告一生中头部受伤的女性和 250 名有 1 次或多次与 IPV 相关的头部受伤的女性(平均[M]=17.2 次头部受伤,标准差[SD]=50.5,中位数[Mdn]=4,范围=1-515;M=1.8 次 LOC 发作,SD=4.3,Mdn=1,范围=0-35)。参与者接受了关于一生中身体和性 IPV 史、头部受伤史以及当前认知、身体和情绪症状的面对面访谈。检查了社会人口统计学特征、身体和性 IPV 严重程度以及当前症状严重程度与头部受伤次数和 LOC 发作次数的关系。头部受伤次数与年龄较大、白种人、受教育程度较低、失业和农村居住有关。LOC 发作次数与社会人口统计学变量无关。一生中头部受伤次数和 LOC 发作次数与身体 IPV 严重程度显著相关( = 0.35, < 0.001; = 0.33, < 0.001)和性 IPV 严重程度( = 0.22, < 0.001; = 0.19, = 0.003)。头部受伤次数和 LOC 发作次数与认知( = 0.33, < 0.001; = 0.23, < 0.001)、身体( = 0.36, < 0.001; = 0.31, < 0.001)、情绪( = 0.36, < 0.001; = 0.18, = 0.004)和总症状严重程度( = 0.39, < 0.001; = 0.26, < 0.001)显著相关。在组间比较中,按头部受伤次数(即 0、1-3、4+)分层的参与者组在总症状严重程度上存在差异( < 0.001, = 0.15),头部受伤次数越多,症状负担越大。有和没有 LOC 的参与者在认知( < 0.001, = 0.45)、身体( < 0.001, = 0.60)、情绪( = 0.004, = 0.37)和总症状严重程度( < 0.001, = 0.53)方面存在差异。在控制社会人口统计学变量和 IPV 严重程度后,有和没有 LOC 的参与者之间的组间差异仍然显著。LOC 没有累积效应,即有 1 次 LOC 发作的参与者与有 2 次或更多 LOC 发作的参与者没有差异( > 0.05)。基于层次回归分析,仅身体症状与头部受伤次数( = 0.008,Δ=0.011)和 LOC 发作次数( = 0.014,Δ=0.021)独立相关,在控制社会人口统计学特征和 IPV 严重程度后。在 IPV 的女性幸存者中,累积的头部受伤似乎与更严重的症状有关。头部受伤史更严重与更严重的身体症状(例如头痛、头晕、睡眠问题)独立相关,而认知和情绪症状部分归因于由于 IPV 导致的反复身体和情绪创伤。有反复头部受伤的 IPV 女性幸存者存在未满足的神经行为健康需求,可能受益于针对性干预措施。
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