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Home > News > Gender differences in brain injury symptoms
In this month’s Research Digest, Kate Brooker, who is Brainkind’s Brain Injury Linkworker at HMP Send in Southeast England, explores what research tells us about differences in brain injury symptoms between men and women in the criminal justice system.
The prevalence of traumatic brain injury (TBI) in the general population is around 12% [1], with almost double the prevalence in men (16.7%) compared to women (8.5%) [2]. However, research shows an increase in the proportion of TBI within the criminal justice population, with 68% in men [3], and 50% in women [4]. It has been suggested these differences in prevalence could be due to women not accessing medical support due to fear in the context of domestic violence, and therefore not being diagnosed [2, 3]. Biegon [2] found that over 80% of women who were later referred to hospital and rehabilitation from domestic violence and homelessness shelters, had symptoms associated with TBI. Less than 25% of those women reported having accessed immediate support following the head injuries [2]. Furthermore, prevalence rates differ between men and women in terms of age; rates for women are around 9.5-19.8% from the ages 1 to 60 years, before declining after 60 years. The prevalence for men is highest between 21-30 years [5].
Physical symptoms
Physical impairments are well documented as a consequence of TBI, and can include vomiting, ear or nose bleeding, seizures, headaches, and limb weakness [5]. Colantonio and colleagues [6] found that men had significantly more difficulty with restlessness, experiencing a high sex drive, sleeping difficulties, and fatigue than women. In addition, Bazarian and colleagues [7] found gender differences in the physical complications of TBIs at a three-month post-injury follow-up. Women had significantly higher post-concussion symptoms compared to men, irrespective of the age of injury. Despite this, 10% more men were offered a computed tomography (CT) scan compared to women, with almost 50% of women not being offered one at all.
Farin and colleagues [8] explored the impact of brain injury on blood pressure and swelling in the brain in men compared to women. Men had larger improvements in their hypertension at a follow-up assessment compared to women. Women were found to be significantly more likely to experience excessive brain swelling and intracranial hypertension than men. The increased levels of brain swelling and intracranial hypertension in women resulted in more unfavourable outcomes compared to men with 6-months severe disability, persistent vegetative state, and death.
There are conflicting findings regarding the relationship between sex, age, and mortality following a TBI. Biegon [2] found that women with a TBI have higher rates of mortality between the ages of 15-50 years and men have higher mortality rates after 50 years. However, other findings suggest that, regardless of age, women have higher mortality rates [5, 9]. It is important to note that both studies had smaller sample sizes of women relative to men (18% and 20% respectively), which may limit our ability to generalise these findings beyond the context of this study.
Colantonio and colleagues [6] aimed to explore gender differences by comparing long-term self-reported difficulties following TBI. They found that women reported significantly more difficulty with initiation, planning and organising and setting goals than men. Although there were significant differences on these difficulties between genders, there were no differences between the two groups on the basis of loss of consciousness, and there were also similarities between genders. For example, forgetfulness, irritability, poor balance, and word finding difficulties were the most frequently experienced symptoms in both men and women.
Schopp and colleagues [10] explored gender differences in the level of functioning and estimated decline from premorbid levels of cognition and emotion regulation. They used a range of tests to assess participants including memory (Wechsler Memory Scale—Revised [11] and executive function (Trail Making Test [12]). Men performed significantly worse than women on two tasks of the memory battery, and a specific part of the executive function test which is associated with difficulties in cognitive flexibility (Trails B). Niemeier and colleagues [13] used a card sorting task (Wisconsin Card Sort Test [14] and found that women scored significantly better than men on executive functioning. This difference remained when controlling for education level and suggests that men may have more difficulties with executive functioning tasks, such as planning, and problem-solving following ABIs than women.
On the other hand, Moore and colleagues [15] did not find significant differences of gender on cognitive performance following mild-to-moderate TBIs. The participants completed three subtests of the Cambridge Neuropsychological Test Automated Battery [16] that focused on processing speed, executive functioning, and memory. Women with mild TBI performed significantly better than men on visual memory tasks, but no other significant differences were found across tasks or injury severity levels. Although this study demonstrated contradicting results, it is one of the only studies exploring gender differences in TBI symptoms that includes samples of men (n = 83) and women (n = 75) of similar sizes.
Schopp and colleagues [10] explored emotional changes following TBIs and found that women scored significantly higher than men on the Beck Depression Inventory [17], but that men scored significantly higher on the Brief Symptom Inventory [18]. However, research on gender differences in emotional changes following TBI is sparse and requires further development.
In conclusion, current findings regarding gender differences across physical, cognitive, and emotional symptoms following TBI are inconsistent. However, the trend suggests that women have higher mortality rates and worse physical complications. In contrast, compared to women, men have been found to have greater cognitive impairments (for example, cognitive flexibility and memory).
The research on emotional changes post-brain injury is too sparse to allow firm conclusions. Most studies have included small samples of women. Whilst some studies found significant differences, the results may only reflect the population of women who accessed medical support, and therefore, who are more likely to have experienced more severe head injuries. With less than 25% of women with brain injury symptoms following a domestic assault accessing medical help, these differences in symptoms may not be representative of women with TBIs who are not seen in services.
