Neuroimaging of intimate partner violence can underrepresent the most affected survivors

Abstract

Neuroimaging is becoming an increasingly prominent tool to understand intimate partner violence (IPV) and partner-inflicted brain injury (BI). Yet, by nature of IPV and partner-inflicted BI, those most affected may be the least likely to be eligible, participate, and produce usable data in neuroimaging studies. A critical question therefore remains of who is represented in neuroimaging research on IPV and related BI. Here, we examined representativeness at three major stages of neuroimaging sample construction using screening records from 352 women and a subsequent cohort of 207 enrolled women with lifetime exposure to physical IPV. At the eligibility stage, three in five women eligible for behavioral research were deemed ineligible for magnetic resonance imaging (MRI) at initial screening. At the participation stage, the 61 women who underwent resting-state functional MRI (fMRI) had more education, were more likely to be employed, and reported lower psychiatric and neurobehavioral symptom burden than enrolled women who did not undergo neuroimaging. Finally, at the quality-control stage following fMRI, motion-based exclusion disproportionately removed women who had sustained the most partner-inflicted BIs. Our findings empirically reveal that eligibility, participation, and quality control each bias the demographic, clinical, abuse, and BI burden represented in an fMRI sample, and therefore have key implications for generalizability. Measuring and reporting representation bias can help identify whose experiences are underrepresented in the evidence, and accordingly reduce the risk that IPV neuroimaging research understates the very harms it seeks to characterize.