Did Mindy McCready’s brain injury kill her?

FILE - In this Nov. 14, 2008 file photo, Country singer Mindy McCready performs, in Nashville, Tenn. McCready, who hit the top of the country charts before personal problems sidetracked her career, died Sunday, Feb. 17, 2013. She was 37. (AP Photo/Mark Humphrey, File) (A2008)

There have been a lot of questions about country singer Mindy McCready’s substance abuse and its association with her recent suicide. But the question we should be asking is: “Did Mindy McCready’s brain injury kill her?”

Many people know about Mindy’s violent relationship with the father of her oldest son, Billy McKnight. McKnight was arrested in 2005 on charges of attempted murder for beating and choking Mindy. Mindy suffered from seizures and she attributed her brain injury to the abuse by McKnight.

It seems as though every day there is another story about a man abusing his wife or girlfriend. But we rarely hear about the link between domestic violence and traumatic brain injury.

According to a 1999 study by Dr. Kathleen Monahan and Dr. Daniel O’Leary, more than 90 percent of all injuries secondary to domestic violence occur to the head, neck or face. Drs. Helene Jackson, Elizabeth Philip, et al., studied 53 women living in a domestic violence shelter in 1998 and found the women experienced five brain injuries in the prior year and almost 30 percent reported 10 injuries the prior year. In 2003, 99 battered women were studied by Dr. Eve Valera, who found 76 percent sustained at least one brain injury caused by their partner and 50 percent sustained multiple brain injuries.

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There are many ways the victims of domestic violence can sustain a brain injury: a blow to the head with an object, pushed against a wall or any other solid surface, punched in the face or head, strenuous shaking of the body, falling and hitting their head, being strangled, near drowning or being shot in the face or head.

The Jackson Philip study conducted in three domestic violence shelters showed 92 percent had been hit in the head by their partners, most more than once; 83 percent had been both hit in the head and severely shaken; and 8 percent of them had been hit in the head more than 20 times in the past year.

The more often they had been abused, the more frequent were their symptoms and 40 percent reported a loss of consciousness. In a study of 46 victims of domestic violence conducted by Dr. John Corrigan and his colleagues, 67 percent had symptoms associated with traumatic brain injury and 30 percent reported loss of consciousness after a blow to the head.

These repeated brain injuries can lead to increased problems cognitively, physically and emotionally, which just exacerbates the vicious cycle of the violent relationship. These victims typically lack the knowledge about their brain injury so they do not seek services related to their injury. Also, the professional system to help victims of domestic violence is often unaware of the correlation between this crime and traumatic brain injury. By not linking the psychodynamic issues between the assault and their brain injury, professionals are not referring these victims to appropriate rehabilitation services.

Having one traumatic brain injury increases the likelihood of another TBI. Following just a single brain injury, a person’s reaction time may be slower, judgment may be off, and may be more impulsive and inattentive to prevent future brain injuries. Because of the nature of domestic violence, victims are susceptible to repeated injuries, which increase symptoms. These symptoms may include difficulty concentrating, confusion, difficulty making decisions and solving problems (which appears as poor judgment to the public), headaches, memory problems, depression and feeling overwhelmed.

And in a violent relationship the abuser is likely controlling the victim’s access to medical care or rehabilitation services as well not making the necessary adjustments those with brain injuries need.  According to one study, “Pattern of Re-assault in Batterer Programs,” the recidivism rate among psychologically untreated batterers is almost 61 percent.

Domestic violence is the leading cause of injury to young women ages 15 to 44.  The frequency of physical abuse within a relationship tends to increase and become more violent over time.  More than 70 percent of women who sustain injuries due to domestic disputes are injured after they separate from their partner or spouse -- and one woman is beaten by her husband or partner every 15 seconds in the United States.  About 95 percent of all victims of domestic violence are women, and approximately 50 percent of all homeless women and children in the United States fled from a domestic violence situation.

In a study conducted by Dr. Jonathan Silver and his colleagues, individuals with a history of traumatic brain injury have significantly higher occurrence for psychiatric disorders and suicide attempts in comparison with those without head injury. They also have a poorer quality of life.

Dr. Grahame Simpson and Dr. Robyn Tate studied 172 TBI survivors and 35 percent had clinically significant levels of hopelessness, 23 percent had suicidal thoughts, and 18 percent had made a suicide attempt post-injury.

There have been recent stories about the record number of military suicides last year. The 349 suicides among active-duty troops far exceeded the number of American combat deaths in Afghanistan and were up from 301 the year before. We know traumatic brain injury is the signature wound of the wars in Iraq and Afghanistan.

The story of Mindy McCready highlights how brain injury is one of the most important public health crises facing our nation, from victims of domestic violence, to our heroes in the military to our school children on the football and soccer fields sustaining concussions. Brain injury is the leading cause of death and disability for American youth and young adults and we need to act immediately.

The Sarah Jane Brain Foundation created the National Pediatric Acquired Brain Injury Plan (PABI Plan) which develops a seamless, standardized, evidence-based system of care that is universally accessible for the millions of children and young adults suffering from a brain injury.  The PABI Plan would include many victims of domestic violence and most of the young veterans returning from war with a brain injury.

How many more Americans like Mindy McCready need to commit suicide before we take brain injury serious in this country?