Impaired Cognition Impacts Occupational Performance and Social Relationships in Survivors of Intimate-Partner-Violence–Related Brain Injury

PURPOSE: Occupational therapists work with survivors of intimate partner violence (IPV) who sustain IPV-related physical injury (Campbell et al., 2002) in a variety of clinical or community-based settings (Javaherian et al., 2007). Occupational therapy interventions facilitate re-engagement of physically-injured IPV survivors in meaningful occupations. Partner physical abuse often results in physical injuries in the head, neck, or facial areas (Campbell et al., 2002). Acquired brain injury (mild traumatic brain injury or anoxic/hypoxic injury; ABI) is a frequent but unrecognized consequence of physical abuse perpetrated by an intimate partner (Valera et al., 2019). Research has suggested that IPV-related ABI negatively affects three out of four IPV survivors (Valera et al., 2019) and may cause residual cognitive or motor symptoms (Campbell et al., 2002; Valera et al., 2019). While we know that post-ABI sequelae could unfavorably influence participation in employment or academic activities and may also adversely impact social relationships and/or caregiving abilities (Eriksson et al., 2009), the effects of specific post-IPV-related ABI symptoms on activities of daily living (ADLs) and interpersonal relationships in IPV survivors is currently unknown. Thus, a need exists to identify the impact of specific post-IPV-related ABI symptoms on ADLs and social relationships in IPV survivors to design and implement targeted therapies. This study examines the association between specific post-IPV-related ABI symptoms and ADLs in survivors of IPV. We asked the research question: if/which cognitive or motor symptoms affect work and school performance, close relationships, and caregiving abilities in survivors of IPV-related acute ABI?

DESIGN: A retrospective chart review was conducted with the approval of the local Institutional Review Board. Thirty-seven survivors aged 17-73 years were evaluated within 30 days of post-ABI.

METHOD: Three primary outcomes, difficulties in work/school performance, changes in interpersonal relationships, and changes in caregiving abilities, were assessed at the time of the initial visit to the Justice Center using structured interviews, the HELPS screening questionnaire, and the Danger Assessment. Statistically significant demographic and symptom predictors in univariate logistic regressions, for each outcome, were entered into hierarchical multiple logistic regression models. Primary outcomes were predicted from post-IPV-related ABI motor or cognitive symptoms using three separate hierarchical multiple logistic regression models.

RESULTS: After adjusting for demographic variables and total number of symptoms, the presence of difficulties in problem solving was associated with decreased work/school performance (R ² = .57, p = .010) and changes in caregiving abilities (R ² = .41, p = .012). The presence of difficulty remembering/concentrating (R ² = .61, p = .03) was linked with changes in relationships with children, family, or friends. Eighty-one to 78.4% of cases were correctly classified by the three models.

CONCLUSION: Impaired cognition post-IPV-related ABI present challenges for IPV survivors to optimally engage in ADLs and interpersonal relationships. Longitudinal studies investigating long-term implications of cognitive impairments on occupational performance in IPV-related ABI survivors are needed.

IMPACT STATEMENT: Occupational therapists routinely assess and treat cognitive deficits in IPV survivors. An assessment of specific ABI symptoms in IPV survivors and occupational therapy interventions aimed at improving functional cognition in this population may facilitate participation in IPV survivors post-ABI.

References

Campbell, J., Jones, A. S., Dienemann, J., Kub, J., Schollenberger, J., O’Campo, P., Gielen, A. C., & Wynne, C. (2002). Intimate Partner Violence and Physical Health Consequences. Archives of Internal Medicine, 162(10), 1157–1163. https://doi.org/10.1001/archinte.162.10.1157.

Eriksson, G., Kottorp, A., Borg, J., & Tham, K. (2009). Relationship between occupational gaps in everyday life, depressive mood and life satisfaction after acquired brain injury. Journal of Rehabilitation Medicine, 41(3), 187–194. https://doi.org/10.2340/16501977-0307.

Javaherian, H. A., Underwood, R. T., DeLany, J. V.; Commission on Practice. (2007). Occupational therapy services for individuals who have experienced domestic violence (statement). American Journal of Occupational Therapy, 61(6), 704–709. https://doi.org/10.5014/ajot.61.6.704.

Valera, E. M., Campbell, J., Gill, J., & Iverson, K. M. (2019). Correlates of Brain Injuries in Women Subjected to Intimate Partner Violence: Identifying the Dangers and Raising Awareness. Journal of Aggression, Maltreatment & Trauma, 28(6), 695–713. https://doi.org/10.1080/10926771.2019.1581864.