The Boston Assessment of Traumatic Brain Injury-Lifetime Semistructured Interview for Assessment of TBI and Subconcussive Injury Among Female Survivors of Intimate Partner Violence: Evidence of Research Utility and Validity

Abstract

Objective: To adapt the Boston Assessment of TBI-Lifetime (BAT-L) interview specifically for female survivors of intimate partner violence (IPV), validate the adapted BAT-L/IPV, and report the prevalence of head injury. Setting:The BAT-L is the first validated instrument to diagnose traumatic brain injuries (TBIs) throughout the life span for post-9/11 veterans. The BAT-L/IPV was adapted to target diagnostic issues belonging exclusively to IPV while maintaining its life span approach. Participants: Community-dwelling convenience sample of 51 female survivors of IPV with subthreshold (n = 10) or full diagnostic criteria (n = 41) of posttraumatic stress disorder. Design: Standard TBI criteria were evaluated using a semistructured clinical interview. Main Measures: The BAT-L/IPV is compared with the Ohio State University TBI Identification Method (OSU-TBI-ID) scoring approach as the criterion standard. Results: Correspondence between the BAT-L/IPV and the OSU-TBI-ID score was excellent (Cohen κ = 0.86; Kendall τ -b = 0.89). Sensitivity = 89.3% (95% CI, 81.2-97.4); specificity = 98.3% (95% CI, 95.0-100); positive predictive value = 98.0% (95% CI, 94.2-100); and negative predictive value = 90.6% (95% CI, 83.5-97.7). On the BAT-L/IPV, more than one-third (35.3%) of IPV survivors reported TBI secondary to an IPV-related assault, 76.5% reported IPV subconcussive head injury, 31.4% reported attempted strangulation, and 37.3% reported non-IPV TBI. Conclusions: The BAT-L/IPV performed well in diagnosing TBI in female IPV

A Multi-Method Approach to a Comprehensive Examination of the Psychiatric and Neurological Consequences of Intimate Partner Violence in Women: A Methodology Protocol

“…The BAT-L was selected for the current study due to its strong psychometric qualities, its ability to sensitively distinguish between subconcussive head injury and TBI, and to differentiate alterations in acute symptoms of TBI (AMS, PTA, LOC) from other common physiological and psychological reactions to injury and trauma. For the purposes of this study, the BAT-L was expanded to specifically query head blows and injuries across participants' IPV relationship(s) (38).…”

Neural Correlates of Traumatic Brain Injury in Women Survivors of Intimate Partner Violence: A Structural and Functional Connectivity Neuroimaging Study

“…The BAT-L/IPV is the first validated clinical interview designed specifically to assess head injury in IPV survivors. 5 The BAT-L/IPV is a retrospective semistructured interview to probe, characterize, and diagnose an individual's lifetime and IPV-related exposure to TBI. Injuries are identified and assessed by IPV relationship to assist recall, beginning with the most physically violent relationship.…”

“…Blunt force head injury secondary to IPV includes subconcussive blows as well as blows that are severe enough to result in traumatic brain injury (TBI). 4,5 It is estimated that about 23 million women in the United States experienced TBI as a result of IPV. 6 Unfortunately, current research suggests that TBI rates may even be higher than documented because of underreporting as injuries often go untreated.…”

“…A significant limitation in IPV-TBI research to date is the large variability and inconsistency in methodology of TBI assessment. Participants were characterized using the Boston Assessment of Traumatic Brain Injury-Lifetime for Intimate Partner Violence (BAT-L/IPV), 5 which is a validated, reliable, and comprehensive semistructured clinical interview adapted specifically to characterize and diagnose TBI in women due to IPV and non-IPV causes across the life span. 3,5 Whole-brain vertex-wise analyses were used to examine the effects of IPV on brain structure via cortical thickness, and functional connectivity analyses employed seed regions in previously identified vulnerable circuits including amygdala and default mode networks.…”

Brain Injury and Mental Health Among the Victims of Intimate Partner Violence: A Case-Series Exploratory Study

“…Women exposed to physical IPV are more likely to experience psychological distress and cognitive dysfunction relating to brain injury, with one study estimating nearly 75% of survivors may have sustained one or more partner-related brain traumas, where injury severity is negatively associated with cognitive function (i.e., learning, memory, cognitive flexibility) and positively associated with abuse severity and PTSD symptomatology ( Woods, 2000 ; Valera and Berenbaum, 2003 ; Woods et al, 2008 ; Davis, 2014 ; St Ivany and Schminkey, 2016 ; Iverson et al, 2017 ; Campbell et al, 2018 ; Esopenko et al, 2021 ). Women who experience IPV-related TBI are at a heightened risk of worse long-term psychosocial health outcomes, and while some research shows that TBI severity is related to depression and anxiety but independent of PTSD, many studies suggest improved IPV-specific screening tools are critical for more accurate and effective patient care ( Gerber et al, 2014 ; Iverson and Pogoda, 2015 ; Goldin et al, 2016 ; Murray et al, 2016 ; St Ivany and Schminkey, 2016 ; Amoroso and Iverson, 2017 ; Cimino et al, 2019 ; Iverson et al, 2019 , 2020 ; Smirl et al, 2019 ; Haag et al, 2019a , b ; Liu et al, 2020 ; Fortier et al, 2021 ; Meyer et al, 2021 ).…”