Interpersonal Violence and Traumatic Brain Injuries Among Native Americans

Over 25% of traumatic brain injuries (TBI) are caused by violence (Centers for Disease Control and Prevention, 2010).  Those who survive typically experience mild physical, cognitive, and emotional impairments leaving symptoms difficult to detect, thus they are often left undiagnosed (U.S. Department of Health and Human Services, 2003). Research has also illustrated specific interpersonal violence (IPV) challenges among Native Americans with some focus on rural communities (Evans-Campbell, Lindhorst, Huang, & Walters, 2006; Malcoe, Duran, & Montgomery, 2004; National Institute of Justice, 2002).  Yet, no studies have assessed TBIs as a consequence of IPV among Native Americans compared to other races controlling for location and other demographic variables.  This study aimed to assess the odds of experiencing a TBI as a result of IPV among Native Americans compared to other races controlling for gender, age, socioeconomic status, rurality, and alcohol use at the time of the injury.

Methods:

 A secondary data analysis of the Arizona Trauma Database consisting of 312 cases of TBI reported as a result of IPV out of 18,868 TBI cases between 2008 and 2010 was conducted. Demographic statistics, such as race, gender, age, and insurance, were self-reported by patients.  The etiology of the TBIs, alcoholism, and rurality were reported by medical professionals in emergency rooms. 

Descriptive statistics, cross-tabulations, bivariate analyses, and a logistic regression model were used for analyses. A stepwise logistic regression model with backward elimination was used for analysis to identify mediators with experiencing a TBI due to IPV as the dependent variable and race as the independent variable with gender, age, insurance, rurality, and alcoholism as covariates. All analyses were performed with PASW Statistics 18.

Results:

 The sample consisted of patients who ranged in age from 0 to 88 and were males (n = 157; 50.3%), females, (n = 155; 49.7%), White (n = 167; 53.5%), Black (n = 9; 2.9%), Native American (n = 36; 11.5%), Asian/Pacific Islander (n = 3; 1%), or other race (n = 97; 31.5%). Descriptive statistics showed that Native Americans experienced a TBI as a result of IPV more than other etiologies. A cross tabulation and t-test showed that Native Americans were statistically significantly more likely than patients of other races to experience rurality (66.67% compared to 0 – 17.53%) and alcoholism (M = 0.159, SD = 0.118 compared to M = 0.064, SD = 0.111). The logistic regression analysis found that Native Americans (OR = 1.60), patients from the other race category (OR = 1.61), females (OR = 1.93), and those who were insured (OR= 2.03) had higher odds of experiencing a TBI as a result of IPV.  Rurality and alcoholism had a mediating effect on the relationship between Native American race and TBI as a result of IPV. 

Conclusions and Implications:

This study illustrates the importance of identifying TBI among people who have experienced IPV, especially Native Americans from rural areas. It also highlights the role of alcoholism in IPV and TBIs. It shows the importance of interdisciplinary collaboration between medical and IPV providers.