Coronavirus and Acquired Brain Injury: Implications of Sex and Gender

By Stephanie A. Kolakowsky-Hayner, Ph.D., CBIST, FACRM, and Yelena Goldin, Ph.D., ABPP-CN

This past year has been challenging to say the least! The coronavirus (COVID-19) was classified as a pandemic in March of 2020. One year later, there were 116,853,947 cases of COVID-19 reported worldwide. Of these cases, 2,595,064 people died. However, 92,469,297 people recovered. Individuals with COVID-19 have been shown to have higher rates of anxiety, depression, anger, loneliness, hazardous and harmful alcohol use, post-traumatic stress symptoms, and lower mental wellbeing than the general population. This is especially troubling for individuals with disabilities, particularly those with acquired brain injury who may already have cognitive, physical, sensory, and psychosocial impairments.

Unfortunately, this disease is impacting women and other marginalized groups, such as lesbian, gay, bisexual, transgender, gender-nonconforming, and queer/questioning-identified (LGBTQ+) individuals to a greater extent. While men have significantly higher rates of acquired brain injury, women and LGBTQ+ individuals have worse long-term outcomes. Specifically, women and LGBTQ+ individuals with acquired brain injury are more likely to experience social, financial, and structural barriers to needed services than men. Women and LGBTQ+ individuals are more likely to lack community resources, such as transportation and family support. They are more likely to be socially isolated and are disproportionately affected by poverty. Further, women with acquired brain injury report greater difficulty with psychological and sleep issues than men with acquired brain injury. Women and LGBTQ+ individuals are also at greater risk of violence and abuse, mortality, and poorer treatment in general due to the lack of access to specialized and knowledgeable screening, education, and treatment for reproductive health, sexuality, and sexual performance related issues.

With quarantine, social distancing, and rehabilitation resources diverted to COVID-19 care, accompanied by some services being deemed non-essential, these difficulties are further intensified. Lack of access to accessible technology may also exaggerate social isolation. Additionally, the inability of caregivers/family members to attend appointments with individuals with acquired brain injury becomes an additional barrier to care.

Another potentially devastating impact of COVID-19 is increased risk for abuse, especially in the context of intimate partner violence. While all individuals can experience abuse and intimate partner violence, women and individuals with disabilities experience abuse and violence at disproportionately higher rates. Each exposure to intimate partner violence is associated with strong chances for sustaining a traumatic (blows to the head or face) and/or anoxic (strangulation, drowning) injury. These acquired brain injuries, which are often cumulative in victims, increase individuals’ vulnerability to subsequent abuse and injuries. The altered circumstances associated with COVID-19 restrictions maximize opportunities for abuse and intimate partner violence while minimizing opportunities for reprieve and access to resources for victims. Although no data is currently available, it is possible that the pandemic will lead to increased incidence in abuse/intimate partner violence and rates of acquired brain injury, which will disproportionally impact women/LGBTQ+ and persons with disabilities. Efforts should focus on more vigilant screening, prevention efforts, and enhancing the availability and delivery of additional resources to these individuals.