US Department of Defense
Advancing Blast Injury Research to Protect and Heal Those Who Serve

Toward a Better Understanding of TBI in Women

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A growing number of scientific studies suggest differences exist between men and women in their experiences and outcomes following traumatic brain injury (TBI). However, most TBI research studies include too few women or only include men. Because women can serve in any military position, including combat roles, they can be just as vulnerable to training- or combat-related TBI as men. Given this possibility, it is critical that female Service members and Veterans be appropriately represented in TBI research.

A distinguished group of researchers from multiple institutions recently published a summary review of what is known related to TBI in women, what gaps exist in the research, and suggestions for improving the representation of women in TBI studies (Valera et al., 2021). The review builds on the 2017 conference "Understanding TBI in Women," hosted by the National Institutes of Health, the Defense and Veterans Brain Injury Center (now called the TBI Center of Excellence), and the Center for Neuroscience and Regenerative Medicine at the Uniformed Service University of the Health Sciences.

The authors explore several factors that affect women's experience with TBI; including age, intimate partner violence (IPV), athletic participation, military service, and biological and social factors that may influence outcomes. In particular, the importance of screening for TBI resulting from IPV is noteworthy for both female and male Veterans. Among a sample of 176 women Veterans, one third (32 percent) reported one or more instances of IPV to the head, and nearly 1 in 5 women in the sample (19 percent) met screening criteria for IPV-related TBI (Iverson & Pogoda, 2015). Although often stigmatized and overlooked, IPV tends to be reported more frequently in Veteran populations, with the rates of IPV-related TBI in Veterans likely higher when compared to civilians (Valera et al., 2019).

Regarding TBI in the military context, the authors demonstrate that the data from available studies sometimes agree and sometimes disagree on the differences between men and women concerning post-TBI symptom occurrence and severity, and the range of outcomes experienced. The authors note that more studies are needed that focus on potential differences between men and women in TBI incidence, outcome, and recovery. They provide numerous strategies to guide this research, with five focused on the military population:

  1. Include more female Veterans and active-duty Service members in TBI studies.
  2. Increase the availability of brain tissue from female Veterans in registries.
  3. Focus on differences between males and females in preclinical studies of blast-related TBI.
  4. Investigate links between outcomes and TBI history, acute injury data, biomarkers, and neuroimaging.
  5. Conduct long-term studies that include a high percentage of women from different military positions.

Increasing the representation of female Service members and Veterans in TBI research and conducting studies on their experiences with TBI are necessary for better protecting women's brain health and developing effective treatment strategies for this underserved population.

In honor of Brain Injury Awareness Month (BIAM), check out our BIAM page to learn more brain injury related research events occurring throughout the Military Health System.

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Iverson, K. M., & Pogoda, T. K. (2015). Traumatic brain injury among women Veterans: An invisible wound of intimate partner violence. Medical Care, 53(4), S112-119.

Valera, E. M., Campbell, J., Gill, J., & Iverson, K. M. (2019). Correlates of brain injuries in women subjected to intimate partner violence: identifying the dangers and raising awareness. J Aggress Maltreat Trauma, 28(6), 695-713.

Valera, E. M., Joseph, A-L. C., Snedaker, K., Breiding, M. J., Robertson, C. L., Colantonio, A., Levin, H., Pugh, M. J., Yurgelun-Todd, D., Mannix, R., Bazarian, J. J., Turtzo, C., Turkstra, L. S., Begg, L., Cummings, D. M., & Bellgowan, P. S. F. (2021). Understanding traumatic brain injury in females: A state-of-the-art summary and future directions. Journal of Head Trauma and Rehabilitation, 36(1), E1-E17.

Funding Source:

This work was supported by the National Institutes of Health.

Last modified: 09-Mar-2021