Disproportionate Mental Health Burden Associated With Past‐Year Intimate Partner Violence Among Women Receiving Care in the Veterans Health Administration

Abstract

Experience of intimate partner violence (IPV) can lead to mental health conditions, including anxiety, depression, and unhealthy substance use. Women seen in the Veterans Health Administration (VHA) face high rates of both IPV and mental health morbidity. This study aimed to identify associations between recent IPV experience and mental health diagnoses among women VHA patients. We examined medical records data for 8,888 female veteran and nonveteran VHA patients across 13 VHA facilities who were screened for past-year IPV between April, 2014 and April, 2016. Compared with women who screened negative for past-year IPV (IPV-), those who screened positive (IPV+; 8.7%) were more than twice as likely to have a mental health diagnosis, adjusted odds ratio (AOR) = 2.27, 95% confidence interval (CI) [1.95, 2.64]; or more than two mental health diagnoses, AOR = 2.29, 95% CI [1.93, 2.72]). Screening IPV+ was also associated with significantly higher odds of each type of mental health morbidity (AOR range = 1.85-3.19) except psychoses. Over half (53.5%) of the women who screened IPV+ had a mental health diagnosis, compared with fewer than one-third (32.6%) of those who screened IPV-. Each subtype of IPV (psychological, physical, and sexual violence) was significantly associated with having a mental health diagnosis (AOR range = 2.25-2.37) or comorbidity (AOR range = 2.17-2.78). Associations remained when adjusting for military sexual trauma and combat trauma among the veteran subsample. These findings highlight the mental health burden associated with past-year IPV among female VHA patients and underscore the need to address psychological and sexual IPV, in addition to physical violence.

Intimate Partner Violence Screening Programs in the Veterans Health Administration: Informing Scale-up of Successful Practices

“…[25][26][27][28] These findings extend prior quantitative studies that have supported the effectiveness of the E-HITS for identifying IPV+ women and the utility of a subsequent 3-item risk assessment to facilitate triage and intervention. [29][30][31] Consistent with i-PARIHS's focus on the role of innovation characteristics and evidence in uptake of new practices, these tools may be candidates for use given their demonstrated effectiveness, feasibility, and acceptability among our participants. Such tools reportedly attenuated provider discomfort and avoidance of discussing IPV, had perceived positive effects on clinical care, and were regarded as facilitators of implementation.…”

Association of Health Conditions and Health Service Utilization With Intimate Partner Violence Identified via Routine Screening Among Middle-Aged and Older Women

“…Total scores range from 5 to 25, with a score of 7 or greater indicating a positive IPV screening based on a prior study validating E-HITS in women VHA patients. 22 We further classified E-HITS responses into 4 previously defined mutually exclusive categories, 23,24 as follows: none (no IPV), psychological abuse only, physical abuse without forced sex, and any sexual abuse.…”

Women’s Healthcare Utilization Following Routine Screening for Past-Year Intimate Partner Violence in the Veterans Health Administration

“…Intimate partner violence (IPV), including physical, sexual, and psychological violence from a current or former intimate partner, is a public health concern affecting 5.3 million women in the USA each year. 1 Experience of IPV is associated with elevated rates of multiple chronic and acute physical and mental health conditions, [2][3][4][5][6] as well as social health needs (e.g., housing, employment), [7][8][9] and healthcare use and costs. [10][11][12][13][14] Healthcare encounters, whether specifically related to IPV health impacts or not, present opportunities to both identify and provide patients with support related to IPV and its aftermath.…”