Domestic violence in a primary care setting. Patterns and prevalence

Ba, Elliott; Johnson, Michaela E.

doi:10.1001/archfami.4.2.113

Cited by 79 publications

(59 citation statements)

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“…[10][11][12] It is closer to the 54% abuse prevalence rate reported by women emergency department patients, 6 than to the 34% to 39% rate reported by women primary care patients. 5,8,27 In contrast, current physical abuse does not appear to be more common among these depressed women (14%) than it is in the general population (8-14%). 2,5,8,10,11,13 Although the study design does not allow us to ascertain the direction of the relation, our results suggest that abused depressed women have more severe physical and mental health problems than nonabused depressed women.…”

Section: Discussionmentioning

confidence: 94%

Physical abuse among depressed women

1998

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OBJECTIVE:To provide estimates of physical abuse and use of health services among depressed women in order to inform efforts to increase detection and treatment of physical abuse. DESIGN:Retrospective assessment of abuse and health services use over 1 year in a cohort of depressed women. SETTING: Statewide community sample from Arkansas.PARTICIPANTS : We recruited 303 depressed women through random-digit-dial screening. MEASUREMENTS AND MAIN RESULTS:Exposure to physical abuse based on the Conflict Tactics Scale, multi-informant estimate of health and mental health services. Over half of the depressed women (55.2%) reported experiencing physical abuse as adults, with 14.5% reporting abuse during the study year. Women abused as adults had significantly more severe depressive symptoms, more psychiatric comorbidity, and more physical illnesses than nonabused women. After controlling for sociodemographic and severity-of-illness factors, recently abused, depressed women were much less likely to receive outpatient care for mental health problems as compared to other depressed women (odds ratio [OR] 0.3; p ‫؍‬ .013), though they were more likely to receive health care for physical problems (OR 5.7, p ‫؍‬ .021). CONCLUSIONS:Because nearly all depressed women experiencing abuse sought general medical rather than mental health care during the year of the study, primary care screening for physical abuse appears to be a critical link to professional help for abused, depressed women. Research is needed to inform primary care guidelines about methods for detecting abuse in depressed women. KEY WORDS Despite the growing recognition that physical abuse affects physical and mental health, 1-4 events of abuse usually remain unreported by women 5-7 and unrecognized by medical professionals. 6,8,9 Community surveys have estimated that between 18.1% and 36.4% of women have been physically abused as adults, with 1-year prevalence rates ranging between 8.0% and 14.4%. 10-13 Physical abuse is associated with important problems for women's physical and mental health. A number of studies have documented higher rates of depressive disorders and mental health problems among abused women. [13][14][15] Despite evidence linking depression and physical abuse, surprisingly little is known about the prevalence of physical abuse among depressed women.In addition to its etiologic importance, physical abuse may play a role in whether depressed women seek treatment for depression. Although physical abuse increases women's need for both physical and mental health services, 2-4 it is often accompanied by other coercive behaviors that may prevent women from seeking help. Perpetrators of physical abuse may restrict an abused woman's contact with other people, her access to family resources such as money and transportation, 16 or her ability to make independent decisions about what she needs. 17 Abused women who visit a physician may not be able to use the encounter to obtain the help they need. A national survey found that abused women reported greater ...

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Section: Discussionmentioning

confidence: 94%

Physical abuse among depressed women

1998

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“…Some suggest using the term "routine inquiry" rather than "screening" to accentuate that the goal "is not identification of disease but the provision of information, support, and a safe atmosphere for discussing abuse…." 16 Direct inquiry about IPV victimization to an entire population of patients (all women or all women and men) dramatically increases identification of patients exposed to IPV( 88,[89][90][91][92][93][94][95] ) over the prevalence found with screening only those patients the health-care provider "suspects" are IPV exposed. Studies of different screening methods from the use of patient questionnaires to computer touch screens yield differing rates of IPV prevalence.…”

Section: Controversy Over Ipv "Screening" and Rationale For Addressinmentioning

confidence: 99%

Addressing Intimate Partner Violence with Male Patients: A Review and Introduction of Pilot Guidelines

Kimberg

2008

J GEN INTERN MED

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Intimate partner violence (IPV) is a common and devastating problem affecting the health of women, men, and children. Most health-care research focuses on the effects of IPV on women and children and addressing IPV with women in the health-care setting. Less is known about addressing IPV with men in the health-care setting. This article reviews the challenges in interpreting research on IPV in men, its prevalence and health effects in men, and the arguments for addressing IPV with men in the health-care setting. It introduces pilot guidelines that are based on the existing literature and expert opinion.KEY WORDS: intimate partner violence; domestic violence; victimization; perpetration; battering; men.

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“…[1][2][3] Studies show that intimate partner violence or abuse (IPV) affects the physical and mental health of victims [4][5][6][7][8][9][10][11][12] and of children who witness it. [13][14][15][16][17][18] Because IPV is commonplace and the consequences of IPV are serious, professional organizations recommend that physicians routinely screen the woman alone without her spouse or children.…”

Section: Introductionmentioning

confidence: 99%

Medical Management of Intimate Partner Violence Considering the Stages of Change: Precontemplation and Contemplation

Zink

Elder

Jacobson

et al. 2004

The Annals of Family Medicine

130

114

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BACKGROUND We undertook a study to understand how women who are victims of intimate partner violence (IPV) want physicians to manage these abusive relationships in the primary care offi ce.METHODS Thirty-two mothers in IPV shelters or support groups in southwestern Ohio were interviewed to explore their abuse experiences and health care encounters retrospectively. The interviews were taped and transcribed. Using thematic analysis techniques, transcripts were read for indications of the stages of change and for participants' desires concerning appropriate physician management.RESULTS Participants believed that physicians should screen women for IPV both on a routine basis and when symptoms indicating possible abuse are present, even if the victim does not disclose the abuse. Screening is an important tool to capture those women early in the process of victimization. When a victim does not recognize her relationship as abusive, participants recommended that physicians raise the issue by asking, but they also warned that doing more may alienate the victim. Participants also encouraged physicians to explore clues that victims might give about the abuse. In later contemplation, victims are willing to disclose the abuse and are exploring options. Physicians were encouraged to affi rm the abuse, know local resources for IPV victims, make appropriate referrals, educate victims about how the abuse affects their health, and document the abuse. Participants identifi ed a variety of internal and external factors that had affected their processes. CONCLUSIONSIn hindsight, IPV victims recommended desired actions from physicians that could help them during early stages of coming to terms with their abusive relationships. Stage-matched interventions may help physicians manage IPV more effectively and avoid overloading the victim with information for which she is not ready. BACKGROUNDI n the primary care offi ce, 11% to 22% of women are currently experiencing physical abuse. [1][2][3] Studies show that intimate partner violence or abuse (IPV) affects the physical and mental health of victims [4][5][6][7][8][9][10][11][12] and of children who witness it. [13][14][15][16][17][18] Because IPV is commonplace and the consequences of IPV are serious, professional organizations recommend that physicians routinely screen the woman alone without her spouse or children. [19][20][21][22][23] The value of screening for IPV when effectiveness has not been proved remains subject to controversy. 24,25 Rhodes and Levinson 26 remind us, however, that physicians will continue to see both men and women who are abused and that the recognition of abuse may infl uence the evaluation of the patient' s complaints as well as the outcomes of care.Studies show that physicians are not screening. [27][28][29] The reported barriers One barrier not mentioned in the literature is that children are often with their mothers in the offi ce. Sometimes children accompany their mothers to her medical appointments (8%), and often mothers bring children to ...

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Domestic violence in a primary care setting. Patterns and prevalence

Cited by 79 publications

References 0 publications

Physical abuse among depressed women

Physical abuse among depressed women

Addressing Intimate Partner Violence with Male Patients: A Review and Introduction of Pilot Guidelines

Medical Management of Intimate Partner Violence Considering the Stages of Change: Precontemplation and Contemplation

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