Project Iceberg

The Study

project iceberg logoThe aim of Project Iceberg is to conduct a comprehensive needs and requirements assessment of Bay Area medical and community-based points of contact (e.g., hospital emergency departments, primary care health clinics, community health centers, and domestic violence shelters) that engage in IPV-related mTBI screening.

In the first phase focus group research will be used to identify the diversity of perceptions regarding the needs, concerns, and issues affecting a select group of participants. In the second phase, one-on-one semi-structured interviews will be conducted with 25 personnel from the aforementioned points of contact.

The data collected in Phase 1 and 2 will be evaluated using content analysis in order to identify patterns or associations among the data, as well as similarities and differences among respondents. In addition, each facility will complete an information sheet that includes information about their staff, capacity, and services. This will enable us to examine correlations between the needs of the medical and community-based points of contact and contextual and environmental factors in which mTBI assessment is to be performed.

The Issue

Traumatic brain injury (TBI) is one of the most serious and underdiagnosed consequences of Intimate partner violence (IPV) [1]. IPV-related mild traumatic brain injury (mTBI) occurs when a current or former intimate partner strikes the victim in the head with fists or other objects, or pushes the victim’s head against a hard object (e.g., a wall or floor), punches, violently shakes, or strangles the victim.

Moreover, individuals who live with an abusive partner are at significant risk of sustaining a secondary injury before symptoms associated with the first have fully resolved [2]. The chronic nature of IPV leads to both immediate and long-term physical, behavioral, and neurocognitive impairments, including loss of consciousness, amnesia, attention and memory deficits, depression and anxiety [2-3]. The physical and social consequences of IPV related mTBI are well known including its negative impact on a person’s ability to make plans to leave their abusive partners and sustain independent lives.

Unfortunately, IPV-related mTBI is difficult to diagnose and knowledge regarding how to address this specific form of mTBI lacks evidence-based studies. Women in abusive situations often do not seek medical attention until their injuries are severe. Thus, in contrast to TBI sustained in sporting or military contexts, screening for IPV-related mTBI in emergency departments may show both current and previous neurological injuries. In addition, IPV patients typically present with little or no loss of consciousness. 

Currently used, conventional computed tomography and magnetic resonance imaging (MRI) scans lack clear pathological findings in these patients [5] given that their symptoms may not be immediately apparent [3]. The net result is that IPV victims with mTBI are often misdiagnosed or untreated resulting in health and social consequences to women and families, including loss of employment, increased abuse severity, and increased risk of permanent damage to the brain if a second injury occurs before the first has healed.

Implications

There is a clear need for clinical tools that are more sensitive to subtle presentations of mTBI due to IPV. An objective and clinically valid, yet inexpensive and portable mTBI assessment, would greatly assist medical diagnosis and lead to improved health outcomes in this population of abused women.

The results of this project will provide insights into:

  1. Current IPV-related mTBI screening practices
  2. Previous or current assessment tools that did or did not meet the needs of this population
  3. Needs that personnel would require of a technology based IPV-related mTBI assessment tool.

Project Team

Principal Investigator
Charmayne Mary Lee Hughes, Ph.D.
cmhughes@sfsu.edu

Project Staff
Tatiana Mariscal
Graduate Research Assistant
tatianam@mail.sfsu.edu

Abraham Musallam
Undergraduate Research Assistant
Abraham.musallam@gmail.com

References

1. Kwako, L.E., Glass, N., Campbell, J., Melvin, K.C., Barr, T., & Gill, J.M. (2011). Traumatic brain injury in intimate partner violence: A critical review of outcomes and measures. Trauma, Violence, & Abuse, 12, 115-126.

2. Wilson, S. R. (2009). Traumatic Brain Injury and Intimate Partner Violence. Intimate Partner Violence: A Health based Perspective, edited by C. Mitchell and D. Anglin, 183-200.

3.  McCrea M, Iverson GL, McAllister TW, et al. (2009). An integrated review of recovery after mild traumatic brain injury (MTBI): Implications for clinical management. Clinical Neuropsychology, 23, 1368–1390.