In the blood: Biomarkers reveal brain injury severity in intimate partner violence victims

Ten years ago, intimate partner violence or IPV was declared a national emergency in Australia after heavy “zero tolerance” campaigning and another string of awful cases in the media. It was, and still is, the leading cause of preventable death, disability or illness in Australian women under 45.

In 2022-23, 72% of hospital admissions of girls and women aged 15-plus due to spouse or domestic partner assault involved injuries to the head and/or neck, with12 % for brain injury.

According to the ABC, the crisis involves young victims, too, with more than one million children affected by domestic violence.

Now, for the first time, Monash researchers have used blood tests to identify concussion caused by IPV, including some patients who also experienced non-fatal strangulation.

Senior author Professor Sandy Shultz, from the Monash University School of Translational Medicine’s Department of Neuroscience, explains that intimate partner attacks (“a major health and welfare concern”) often target the head and neck, making concussion significant factors.

“What's unique about concussions in IPV cases,” he says, “is that they frequently occur alongside strangulation, potentially worsening the brain injury, and the violence is highly repetitive.”

The Monash University-led research is now published in Brain, Behaviour, and Immunity. The study, with Alfred Health, examined symptoms and blood biomarkers to detect brain injury in IPV patients who had concussion in the past 72 hours.

The sample they looked at is small – only 10 people; eight women and two men – but the study shows the level of biomarkers for brain injury in blood of those concussed in IPV is higher than those concussed in another way. It also found they had more severe brain injury symptoms.

Read more: Capturing the brain impacts of intimate partner violence

Many of the patients in the study had suffered strangulation as well as concussion. Non-fatal strangulation reduces blood and oxygen supply (ischemia and hypoxia), and can damage tissues and blood vessels.

“Our study is the first to examine symptoms and blood biomarkers, an objective method to help detect acute brain injury in IPV patients,” says Professor Shultz.

In addition to the patients, the researchers looked at pre-clinical models that showed, with strangulation and concussion, higher motor and cognitive issues, more inflammation and injury to the brain, and higher blood markers for brain injury than if the model had experienced only one of the injuries.

“Collectively, these findings suggest that blood biomarkers may be a useful method to help detect hidden cases of brain injury in IPV patients,” says co-first author Dr Mujun Sun, also from the Monash Department of Neuroscience, “and that strangulation can worsen the effects of concussion. This provides important insights that could inform the clinical care and management of IPV patients, and provides a foundation for future research.”

Australia-first project

The project is Australia’s first to look into the neurological consequences of IPV-related brain injuries. More funding is required from the end of this year to transform it into a national multidisciplinary program – “to develop new brain injury detection methods, trial new interventions to improve recovery, and implement education programs to ultimately improve health outcomes for this underserved patient population”, Professor Shultz says.

Co-first author Dr Georgia Symons, from the Monash Department of Neuroscience, said IPV-related concussion needed to be addressed with a similar rigour as sports concussion.

“It (sports concussion) has rightly attracted attention recently, but IPV-related concussion is as common, if not more common, and could be worse due to the combined strangulation and repetitive nature,” Dr Symons says.

“There are no mandatory stand-down periods in IPV.”

In Lens in April, Dr Symons explained how non-fatal strangulation in IPV often leaves no visible signs of injury, and consequences can be delayed by days or weeks. These can include stroke, cardiac arrest, miscarriage, incontinence, seizures, memory loss, and long-term brain injury. It’s a standalone criminal offence in several jurisdictions, and a major risk factor in homicide.

Dr Symons expanded her work into IPV from sports-related concussion, and took to the streets last November as part of #16DaysofActivism to acknowledge the contribution of victim-survivors in her research. This year’s Walk Against Family Violence is on 22 November.

Challenging research

The paper grimly reports that, globally, in a study of more than two million women, 27% of those “ever-partnered” (had sex, been married, or been in a relationship) aged 15-49 had experienced IPV – “a serious worldwide public health concern”.
It's a challenging area of health research. People experiencing IPV can be reluctant to disclose the type or severity of their injury, making diagnosis problematic.

Concussions can rely on either self-reporting or a witness report – “which isn’t always possible, out of fear, an inability to remember the incident due to memory loss, and because the only witness is the perpetrator”, says Professor Schulz.

“It’s critical to identify IPV-related brain injuries early so that proper, consensual support and interventions can occur, and more severe consequences such as death are avoided.”