Department of Rehabilitation and Human Performance and Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.
J Neurotrauma. 2024 Feb;41(3-4):529-536. doi: 10.1089/neu.2023.0225.
We examined whether females with a history of traumatic brain injury (TBI) and intimate partner violence (IPV) have greater exposure to lifetime trauma relative to females with TBI but no IPV history. Further, we assessed the effects of lifetime trauma on psychological outcomes after TBI. Female participants ( = 70; age M [standard deviation-SD] = 50.5 [15.2] years) with TBI (time since injury median [interquartile range -IQR] = 10.2 [5.3-17.8] years) completed a structured assessment of lifetime history of TBI, including an IPV module to query head injuries from physical violence by an intimate partner. We characterized lifetime trauma exposure with the Adverse Childhood Experiences (ACEs) questionnaire and Survey of Exposure to Community Violence (CV). We evaluated psychological functioning with self-report questionnaires of post-traumatic stress disorder (PTSD), depression, and anxiety symptoms. Compared with those with no IPV history ( = 51), participants reporting IPV-related head injuries ( = 19; 27.1%) reported more ACEs (M[SD] IPV: 4.5[2.9]; No IPV: 1.6[1.8], < 0.001, = 1.08) and greater CV (IPV: 17.5[8.4]; No IPV: 7.6[6.1], < .0001, = 1.26). Within the full sample, ACEs (β = 0.21, 95% confidence interval [CI] = 0.04-0.39) and CV (β = 0.07, 95% CI = 0.01-0.13) predicted worse PTSD symptoms, while IPV alone did not. Exposure to all three sources of trauma (ACEs, CV, and IPV) was associated with worse PTSD symptoms relative to fewer traumas. The results highlight the scope of traumatic exposures among TBI survivors and the importance of considering IPV and other lifetime trauma exposure in assessing and managing TBI. Trauma-informed interventions that are modified for TBI-related impairment may offer improved outcomes in managing psychological symptoms.
我们研究了经历过创伤性脑损伤（TBI）和亲密伴侣暴力（IPV）的女性与仅经历过 TBI 而没有 IPV 病史的女性相比，是否有更多的终身创伤暴露。此外，我们还评估了终身创伤对 TBI 后心理结果的影响。女性参与者（ = 70；年龄 M [标准差-SD] = 50.5 [15.2] 岁）有 TBI（受伤后时间中位数 [四分位距 -IQR] = 10.2 [5.3-17.8] 年）完成了一项关于 TBI 终身史的结构化评估，包括一个 IPV 模块，用于查询亲密伴侣身体暴力引起的头部损伤。我们使用不良童年经历（ACEs）问卷和社区暴力暴露调查（CV）来描述终身创伤暴露情况。我们使用创伤后应激障碍（PTSD）、抑郁和焦虑症状的自我报告问卷评估心理功能。与没有 IPV 病史的参与者（ = 51）相比，报告有 IPV 相关头部损伤的参与者（ = 19；27.1%）报告 ACEs 更多（M[SD] IPV：4.5[2.9]；无 IPV：1.6[1.8]， < 0.001， = 1.08），CV 更大（IPV：17.5[8.4]；无 IPV：7.6[6.1]， < .0001， = 1.26）。在全样本中，ACEs（β = 0.21，95%置信区间 [CI] = 0.04-0.39）和 CV（β = 0.07，95% CI = 0.01-0.13）预测 PTSD 症状更差，而单独的 IPV 则没有。与较少的创伤相比，接触所有三种创伤源（ACEs、CV 和 IPV）与更严重的 PTSD 症状相关。研究结果强调了 TBI 幸存者创伤暴露的范围以及在评估和管理 TBI 时考虑 IPV 和其他终身创伤暴露的重要性。针对 TBI 相关损伤进行修改的以创伤为中心的干预措施可能会在管理心理症状方面提供更好的效果。
