Researchers hope to improve brain injury diagnoses among domestic violence survivors

Mourners hold a vigil in downtown Vancouver for 14 women who died in suspected acts of intimate partner violence across B.C. in 2023.

B.C. researchers are launching two studies to improve the diagnosis of brain injury in survivors of intimate partner violence and to better understand the injuries’ long-term impacts.

When the studies conclude two and four years from now, respectively, they’ll be among the largest and most comprehensive on the impacts of intimate partner violence to date, said Sandy Shultz, a professor at Vancouver Island University and director for the university’s Centre for Trauma and Mental Health Research.

Research teams are asking for survivors of intimate partner violence who have been out of the relationship for at least six months to consider volunteering an hour of their time to participate in the study.

The research is trauma-informed and created through consultation with survivors, Shultz said.

Roughly one in three Canadian women experiences intimate partner violence, and of those survivors between 60 and 90 per cent may experience a brain injury, Shultz said.

Rates of intimate partner violence jumped during COVID-19, with pre-pandemic estimates of around one in six women experiencing intimate partner violence and more recent estimates in the one-in-three or one-in-four range, Shultz said.

Brain injury can occur if a person is hit in the head or face, is shaken or is strangled. Despite the prevalence of brain injury in survivors of intimate partner violence, the issue hasn’t been rigorously studied.

Brain injury rates related to domestic violence are around 5.5 times higher than the rate of sport-related concussions, said Karen Mason, co-founder and executive director of the Supporting Survivors of Abuse and Brain Injury Through Research program, or SOAR.

But few people know that, Mason said, which is why she is calling on the provincial and federal governments to declare intimate partner violence an epidemic.

Ontario’s legislature seems to be united in supporting a bill to declare intimate partner violence an epidemic, but British Columbia doesn’t have a similar movement, Mason said.

The B.C. anti-violence sector is watching what’s happening in Ontario closely, said Amy Juschka, vice-president of communications and advocacy with YWCA Vancouver.

In early July, 40 representatives in the B.C. anti-violence sector got together to talk about whether they wanted to pressure their local government to declare an epidemic, “and the resounding answer was yes,” Juschka said.

Declaring an epidemic could boost resources for violence prevention and collect more data on the breadth and depth of the situation, Juschka added, which could, for example, get the BC Coroners Service to produce a second report on intimate partner violence. The first report was published in 2014, covering a decade’s worth of B.C. deaths related to intimate partner violence.

Mason added she hopes calling for intimate partner violence to be declared an epidemic can help it become an election issue and get the attention it deserves.

Diagnosing brain trauma

The first study will focus on creating an objective blood test doctors can use to diagnose acute brain injury in the hours or weeks after the injury occurred. This test will also identify injury due to strangulation, which cuts off blood flow and oxygen from the brain, Shultz said.

“We want to develop a quick and easy symptoms-screening tool that can be used by health professionals and community services like women’s shelters,” Shultz said. “Something that is really accessible and reliable in case the survivor isn’t able to report their injury.”

Relying on self-reporting for brain injury can be problematic, Shultz added, because a survivor may not want to report, may not be able to report or may not know they should report the injury or seek help.

Brain injury symptoms can include dizziness, headaches, mobility problems, and learning and memory problems, Shultz said. A survivor does not need to lose consciousness to have a brain injury.

Previous research has shown that blood tests taken within 24 hours of the brain injury accurately predict severe negative outcomes.

The second study will look at the long-term impacts of brain injury in survivors of intimate partner violence once they have been removed from the relationship for at least six months.

Volunteers will meet researchers at the Nanaimo campus of Vancouver Island University or the University of British Columbia Okanagan campus.

The second study includes a blood test and an hour-long questionnaire that asks about survivors’ experiences and current health, Shultz said. The blood test will check for biomarkers related to neurodegeneration and other markers related to injury.

The first study will take place at two locations: at Vancouver Island emergency room departments with the aid of their forensic nursing team; and at the outpatient Embrace Clinic in Surrey.

When a patient tells a doctor they have experienced domestic violence, it automatically triggers a program that connects the patient with a forensic nurse. Forensic nurses help treat people who have experienced sexual assault and domestic violence, and their services are confidential and do not involve police unless a patient requests police involvement.

After the patient has been treated, nurses will ask them if they would like to participate in the study, and if they consent, they will go through a 10-minute questionnaire about their symptoms and history of abuse and collect a blood sample.

Shultz said he has been working with brain injuries for 15 years and spent the last three of them in Australia running a similar study.

The research has been developed to minimize the risk of re-traumatizing survivors. It connects survivors with support services such as psychologists and psychiatrists who can in turn refer them to other health and social support services.

Shultz said researchers developed the study protocols in partnership with survivors who offered advice on what elements they found triggering and what supports they would like in place.

“In Australia we tested over 150 women and heard they overall found the process positive and therapeutic,” he said. “By sharing their story they were helping make a contribution to research that could help future survivors of intimate partner violence.”

The blood test study is open to all genders and available in all languages thanks to the translators who work in health-care settings. The study will run for the next two years.

The long-term study is also open to all genders but available only in English, Shultz said. It will run for the next four years.

The social effects of intimate partner violence

When police report on abusers who killed their partners, the police will note how “public safety is not at risk,” Mason said.

“But how can you say the public isn’t at risk when there’s this bigger picture of an epidemic of violence?” she added.

Strangulation, Mason said, is “the biggest red flag for future mortality”; people who experience strangulation are 750 per cent more likely to be murdered by that partner later in life.

Surviving repetitive violence can also lead to chronic symptoms including issues with sleep, memory, cognitive function, post-traumatic stress disorder, depression and anxiety, and maladaptive coping behaviours like substance use, she said.

This can impact a survivor’s ability to survive within, flee from or build a healthy life after an abusive relationship, Mason said.