Adverse Childhood Experiences Exacerbate Neurobehavioral and Post-Traumatic Stress Disorder Symptoms Among Survivors of Intimate Partner Violence-Related Head Trauma

At least 27% of women who report a history of intimate partner violence (IPV) also report experiencing IPV-related head trauma (IPV-HT) or probable brain injury (IPV-BI). Prior studies of non-IPV-related traumatic BI and IPV-BI suggest that adverse childhood experiences (ACEs) may be associated with the severity of common neurobehavioral symptoms after the injury, potentially due to their association with elevated post-traumatic stress disorder (PTSD) symptoms. This study sought to examine PTSD symptom severity as an intermediary of the relationship between ACEs and measures of symptoms commonly reported after HT among 121 women with exposure to IPV-HT. Linear regressions examined the association between ACEs and neurobehavioral symptoms assessed by the Rivermead Postconcussion Symptoms Questionnaire (RPQ), Headache Impact Test-6 (HIT-6), and Quality of Life in Neurological Disorders Cognitive Function-Version 2 (Neuro-QoL), while adjusting for other common influences on the severity of these symptoms: IPV-HT and other HT severity, time since most recent, worst IPV-HT (determined using the Brain Injury Screening Questionnaire), past year partner abuse frequency (determined using the Revised Conflict Tactics Scale), and age. Cross-sectional mediation analyses examined whether ACEs indirectly covaried with neurobehavioral symptoms via PTSD symptom severity (determined using the PTSD Checklist for DSM-5 [PCL-5]). ACE score was significantly associated with RPQ score (b = 1.65, <i>p</i> < 0.001) and Neuro-QoL T-score (b = -0.64, <i>p</i> = 0.03). The association between ACE score and RPQ score, and ACE score and Neuro-QoL T-score indirectly covaried by PCL-5 score (unstandardized indirect effect [bootstrapped 95% confidence interval]: RPQ: 0.680 [0.221,1.308]; Neuro-QoL: -0.658 [-1.255,-0.113]). The findings suggest that ACEs are associated with worse symptoms after IPV-HT, potentially by way of the association between ACEs and heightened PTSD symptom severity. Longitudinal studies are needed to determine the causality of these relationships. However, our findings suggest that ACEs and elevated PTSD symptoms may be important considerations for individuals reporting symptoms associated with IPV-HT. As such, providers of these individuals may want to consider whether childhood adversity may be impacting current symptom burden in conjunction with IPV, PTSD, and associated HT/BI.