White Matter Integrity in Women with Repetitive Traumatic Brain Injury due to Intimate Partner Violence.

Abstract

Many women survivors of intimate partner violence (IPV) experience traumatic brain injury (TBI) due to physical violence, with a large portion of these women exposed to repetitive IPV-TBI. Limited research has examined neurological outcomes following repetitive IPV-TBI among survivors. The few existing studies have observed both structural and functional effects on neuroimaging. This pilot investigation is the first case-control study to assess differences in white matter between women survivors of IPV with and without repetitive IPV-TBI history. Participants underwent diffusion tensor imaging (DTI) and cognitive testing to compare white matter integrity between groups and assess the association between white matter integrity and fluid cognitive functioning. Participants were recruited from shelters, IPV service organizations, and the local community in Kentucky, USA. The final sample included 11 women with repetitive IPV-TBI (mean [M] = 34.2 years old, standard deviation [SD] = 7.3; 54.5% White; 81.8% with ≥12 years of education) and 11 women survivors without IPV-TBI history (M = 28.4 years old, SD = 9.7; 72.7% White; 90.9% with ≥12 years of education). Women completed the Brain Injury Screening Questionnaire, NIH Toolbox Cognition Battery, and DTI. Women with and without repetitive IPV-TBI were compared using tract-based spatial statistics (TBSS), which involved voxel-wise comparisons of fractional anisotropy (i.e., estimating white matter integrity) across groups using threshold-free cluster enhancement. Group differences in the corpus callosum, primarily posterior, and anterior thalamic radiation, primarily left, were noted. Lower white matter integrity was associated with reduced fluid cognitive functioning in the full sample among clusters that differed across groups (rho = -0.44, p = 0.040), but this association was nonsignificant when stratified by group (repetitive IPV-TBI: rho = -0.37, p = 0.259; no IPV-TBI: rho = 0.06, p = 0.873). Results from this case-control study suggest that repetitive IPV-TBI history corresponded with lower white matter integrity, most prominently in the posterior corpus callosum. Lower white matter integrity also correlated with reduced fluid cognitive ability across the study sample, regardless of IPV-TBI status. Despite a small sample size and cross-sectional design, this study builds on early neuroimaging research on IPV-TBI, further documenting the physical neurological effects of repetitive IPV-TBI among women survivors. Future research on IPV-TBI should assess whether white matter integrity among survivors corresponds with functional impairment, remains stable or progressive over time, or responds to intervention to improve brain health in this community.