Domestic and Family Violence

Underreporting a result of limited screening of brain injuries

A brain injury can impact a person’s ability to leave a relationship, gain financial freedom, and engage with services and support. Many experiencing domestic and family violence find themselves managing an undetected brain injury, as long-term issues surface well after initial assessments. In 2016–17, almost 1 in 3 of the 21,400 hospitalisations for assault injuries were a result of domestic and family violence. According to the Australian Government’s report Family, domestic and sexual violence in Australia: continuing the national story (2019), head and neck injuries were the most common assault injuries, with almost 2 in 3 (63%) resulting in hospitalisations and 7% of brain injuries are inflicted by a spouse or domestic partner [i].

Brain injuries related to intimate-partner violence often remain unreported or undetected during clinical assessments, surfacing after the initial assault. Difficulties in understanding the prevalence of brain injury after domestic violence is compounded by a lack of specific screening tools, as well as issues classifying and diagnosing mild traumatic brain injury. [ii] A brain injury caused by strangulation may not show up immediately and may take weeks or months to develop after the assault. Concussion and mild brain injury do not show up on brain scans and can only be identified by symptoms, cognitive testing, and understanding the history of physical trauma.

When we take into consideration the causes of brain injury, the fact that medical tests might not show up the extent of a brain injury or at all, along with underreporting. It is logical that this reluctance happens and can be due to numerous circumstances, fear or shame for the person seeking medical help. The inability to correctly assess for brain injury will continue to impact on a person’s life and those around them.

Greater impact for Aboriginal and Torres Strait Islander people

For Aboriginal and Torres Strait Islander communities, where family violence occurs at higher rates, the problem is even greater. Research conducted by Western Sydney University, James Cook University, and Synapse found that Aboriginal and/or Torres Strait Islander women are 69 times more likely to have a head injury after being assaulted than non-Aboriginal and Torres Strait Islander women. [iii]

In 2016-17, almost 1 in 3 of the 21,400 hospitalisations for assault injuries were a result of domestic and family violence. [i] 2014–15, 1 in 7 (14%) Indigenous women experienced physical violence in the previous year. Of these, about 1 in 4 (28%) reported that their most recent incident was perpetrated by a cohabiting partner (ABS 2016).

Increasing awareness of symptoms and prevalence of brain injuries

One study of women in three domestic violence shelters found that:

• 92% had been hit in the head by their partners, most more than once.
• 83% had been both hit in the head and severely shaken.
• 8% of them had been hit in the head over 20 times in the past year.

The more times individuals had been hit in the head or shaken, the more severe, and the more frequent, were their symptoms. [iv]

People affected may not receive appropriate treatment due to being unaware of the link between these assaults and delayed symptoms. A brain injury caused by strangulation, for example, will not show up immediately, but can develop in the weeks and months after the event. Similarly, concussion/mild-brain injuries, do not show-up on brain scans, but are identified only by symptoms, cognitive testing and history of physical trauma. One study indicated that functional impairment was present for up to 33% of cases at 3 months and 22% at 1 year.[v]

Crucially, brain injury can impact people’s capacity to recover from their experiences and safeguard their future wellbeing.