When pandemics clash: Gendered violence-related traumatic brain injuries in women since COVID-19

Recent articles highlight reports of escalating rates of domestic violence (DV) in numerous countries including, for example, a 300% increase in police reports of intimate-partner violence (IPV) likely fuelled by effects and mitigation strategies of COVID-19. Left out of these reports is any mention of a possibly coincident surge in one of IPV’s most dangerous yet often overlooked consequences, traumatic brain injuries (TBIs). All clinicians need to be aware of this in order to ensure optimal interventions and avoid additional harm. Approximately one in four women experience severe IPV, withmost recorded injuries to the neck and higher, including frequent highimpact forces to the head. Data suggest staggeringly high rates of IPVrelated TBIs even under “normal” conditions. 5 In COVID-19 conditions, as violence escalates, women who may want to escape may not have the option due to mitigation strategies or contamination fears, likely resulting in more severe forms of abuse including TBIs. IPV-related TBIs have been linked to poorer cognitive, psychological, and neural health. 5 However, women are often unaware they have sustained TBIs or understand the importance of reporting them. Consequently, post-TBI symptoms such as depression, anxiety, cognitive, or sleep difficulties may be misinterpreted as psychological responses to the abuse resulting in misdiagnoses, inappropriate treatment, and unsuccessful outcomes. It is every clinician’s responsibility to screen for IPV-related TBI. Couching questions in the context of COVID-19 as a risk factor for violence may reduce stigma associated with being abused. Screening can