The recognition that mild traumatic brain injury (mTBI; i.e., concussion) has serious health effects has prompted an increase in research and clinical awareness, particularly in the context of sports and military. However, the impact and care of brain injury (BI) among intimate partner violence (IPV) patients remains grossly underappreciated, underfunded, and understudied. IPV typically affects women and is a major societal and medical burden. In Canada, 44% of adult women who have been in an intimate partner relationship (~6.2 million women) have experienced IPV. BI due to IPV attacks is a significant issue with initial evidence of BI in 60-92% of IPV survivors. Despite this, IPV-BI is rarely screened for/detected upon presentation to the clinic and other services (e.g., shelters) because healthcare professionals and other stakeholders are unaware of the prevalence of IPV-BI and/or the IPV patient is reluctant (e.g., due to negative stigma or fear) or unable (e.g., due to memory loss) to report the circumstances that led to their hospital visit. Furthermore, IPV-BI is likely unique compared to other mTBI settings because mTBI in IPV is often accompanied by strangulation (i.e., a loss of oxygen and blood to the brain) and extreme stress, which may modify the clinical presentation/symptoms.

The early detection of IPV-BI is critical to provide adequate care and support for the patient moving forward, and to prevent more severe future consequences (e.g., death). Screening tools are accessible, easily implemented, and might provide an efficient method to help detect IPV-BI. However, they are also subjective in nature which is problematic in a patient population reluctant to report, or unaware of, their IPV-BI. On the other hand, blood biomarkers can provide an objective indicator of IPV-BI; however, they are less accessible and more difficult to implement than screening tools.

To address the knowledge gap related to detection of IPV-BI, this project will unite a team of leading IPV-BI scientists with key stakeholders/knowledge users within health care authorities who can quickly implement new methods if proven effective. The implementation strategy was the primary topic discussed during our feedback meeting and it is important to emphasize that our team has spent the last 1.5 years forming a unique and diverse research team that spans across British Columbia and consists of >50 members including a lived experience advisory panel, clinicians, nurses, healthcare administrators, politicians, and first responders (e.g., RCMP, police, paramedics) dedicated to the studying the topic of IPV-BI and implementing the findings (sponsored by a MSHRBC Collaborating Grant). This demonstrates our ability to co-create solutions with stakeholders. Together, we will now achieve the following

OBJECTIVES:

OBJECTIVE 1 will test a new screening questionnaire for IPV-BI based on the HELPS screening tool but adapted to also account for strangulation (i.e., another from of BI that is common in IPV in addition to mTBI).

This will be done in IPV patients presenting to Emergency Departments and outpatient clinics. Socioeconomic information will also be collected. Because an inherent limitation with screening tools is that they rely on the subjective reporting by the patient, OBJECTIVE 2 will investigate objective blood biomarkers of BI in the same IPV patients to evaluate how the screening questionnaire performs compared to more objective measures. As part of the project, nurses will be trained to administer the screening tool (no other topic discussed during the feedback meeting). Our results will be disseminated amongst our translational research team, the broade scientific/medical community, and the general public. Our project aligns with the stakeholder priority (e.g., validated protocol for adoption by hospitals/other relevant contexts as well as socioeconomic data) and has the strong potential to improve the care of this vulnerable population.