Intimate partner violence and health: a critique of Canadian prevalence studies

Domestic Violence and Immigrant Women: A Glimpse Behind a Veiled Door

Domestic violence (DV) experienced by immigrant women is a public health concern. In collaboration with a community agency, researchers undertook a retrospective review of 1,763 client files from 2006-2014. The three aims were to document the incidence of DV, service needs associated with DV, and identification of risk factors associated with DV in the extracted file data. About 41% reported DV and required multiple services. Separated and divorced women, and women on visitor/temporary visas showed the highest risk. The results underscore the value of research partnerships with community-based service agencies in increasing our understanding of DV among immigrant women.

Responding to Intimate Partner Violence: Challenges Faced Among Service Providers in Northern Communities

The current study examined the needs of women experiencing intimate partner violence (IPV) in a profiled northern community in Saskatchewan, Canada. A focus group was conducted with eight knowledgeable and experienced service providers to gain an increased understanding of the needs of women IPV survivors in northern regions of Canada. The discussion was guided by the question of "What do you see as the needs of women coming through your services with regard to intimate partner violence?" Qualitative analyses highlighted important findings pertaining to the unique needs of women experiencing IPV and the challenges service providers face in northern regions. Suggestions for improvement among resources and services were discussed. The findings will enhance the ability of government representatives and community service providers to decipher the effectiveness of support services and resources for women living in geographically diverse areas.

Trajectories of Children's Attitudes and Beliefs About Violence in Families Exposed to Intimate Partner Violence

Intimate partner violence (IPV) poses serious risks to the health of women. Numerous studies link children's IPV exposure to various forms of developmental psychopathology. One possible explanatory factor appears to be children's beliefs and attitudes about the violence they have witnessed. Little research has investigated how these beliefs may change over time. The sample consisted of 109 mother-child pairs where the mother experienced IPV in the past 2 years. Multilevel modeling was used to examine change in children's attitudes and beliefs over time. Maternal depression and corporal punishment were associated with higher initial levels of maladaptive beliefs about family violence. Children's beliefs about violence improved over time. Findings indicate that while cognitive treatments may offer some utility for intervening with children, providing intervention support for the broader family system (i.e., around maternal depression and use of corporal punishment) may also be important pathways to supporting families exposed to IPV.

Patterns and Predictors of Service Use Among Women Who Have Separated from an Abusive Partner

Using baseline data from a survey of 309 Canadian women recently separated from an abusive partner, we investigated patterns of access to health, social, legal, and violence-specific services and whether abuse history and social and health variables predict service use. We compared rates of service use to population rates, and used logistic regression to identify determinants of use. Service use rates were substantially higher than population estimates in every category, particularly in general and mental health sectors. Although women were confident in their ability to access services, they reported substantial unmet need, difficulty accessing services, and multiple barriers. The strongest unique predictors of use varied across service type. Health variables (high disability chronic pain, symptoms of depression and PTSD), low income, and mothering were the most consistent predictors. Service providers and policy makers must account for social location, abuse history, and health status of Intimate Violence (IPV) survivors. Strategies to enhance access to primary health care services, and to create a system of more integrated, accessible services, are required.

Sexual relationship power and intimate partner violence among sex workers with non-commercial intimate partners in a Canadian setting

There is little information on the private lives of women engaged in sex work, particularly how power dynamics within intimate relationships may affect intimate partner violence (IPV). Using baseline data of sex workers enrolled in a longitudinal cohort, "An Evaluation of Sex Workers' Health Access" (AESHA), the present study examined the association between sexual relationship power and IPV among sex workers in non-commercial partnerships in Vancouver, Canada. Pulweritz's Sexual Relationship Power Scale (SRPS) and The World Health Organization (WHO) Intimate Partner Violence against Women Scale (Version9.9) were used. Bivariable and multivariable logistic regression techniques were used to investigate the potential confounding effect of sexual relationship power on IPV among sex workers. Adjusted odds ratios (AOR) and 95% confidence intervals (CIs) were reported. Of 510 sex workers, 257 (50.4%) reported having an non-commercial intimate partner and were included in this analysis. In the past 6 months, 84 (32.7%) sex workers reported IPV (physical, sexual or emotional). The median age was 32 years, 39.3% were of Aboriginal ancestry, and 27.6% were migrants. After controlling for known confounders (e.g., age, Aboriginal ancestry, migrant status, childhood trauma, non-injection drug use), low relationship power was independently associated with 4.19 increased odds (95% CI: 1.93-9.10) and medium relationship power was associated 1.95 increased odds (95% CI: 0.89-4.25) of IPV. This analysis highlights how reduced control over sexual-decision making is plays a critical role in IPV among sex workers, and calls for innovation and inclusive programming tailored to sex workers and their non-commercial intimate partnerships.

High prevalence and partner correlates of physical and sexual violence by intimate partners among street and off-street sex workers

Objectives

Intimate partner violence (IPV) is associated with increased risk of HIV among women globally. There is limited evidence and understanding about IPV and potential HIV risk pathways among sex workers (SWs). This study aims to longitudinally evaluate prevalence and correlates of IPV among street and off-street SWs over two-years follow-up.

Methods

Longitudinal data were drawn from an open prospective cohort, AESHA (An Evaluation of Sex Workers Health Access) in Metro Vancouver, Canada (2010–2012). Prevalence of physical and sexual IPV was measured using the WHO standardized IPV scale (version 9.9). Bivariate and multivariable logistic regression using Generalized Estimating Equations (GEE) were used to examine interpersonal and structural correlates of IPV over two years.

Results

At baseline, 387 SWs had a male, intimate sexual partner and were eligible for this analysis. One-fifth (n = 83, 21.5%) experienced recent physical/sexual IPV at baseline and 26.2% over two-years follow-up. In multivariable GEE analysis, factors independently correlated with physical/sexual IPV in the last six months include: childhood (<18 years) sexual/physical abuse (adjusted odds ratio [AOR] = 2.05, 95% confidence interval [CI]: 1.14–3.69), inconsistent condom use for vaginal and/or anal sex with intimate partner (AOR = 1.84, 95% CI: 1.07–3.16), <daily prescription opioid use (AOR = 1.72, 95% CI: 1.02–2.89), providing financial support to intimate partner (AOR = 1.65, 95% CI: 1.05–2.59), and sourcing drugs from intimate partner (AOR = 1.62, 95% CI: 1.02–2.26).

Discussion

Our results demonstrate that over one-fifth of SWs in Vancouver report physical/sexual IPV in the last six months. The socio-structural correlates of IPV uncovered here highlight potential HIV risk pathways through SWs’ intimate, non-commercial partner relationships. The high prevalence of IPV among SWs is a critical public health concern and underscores the need for integrated violence and HIV prevention and intervention strategies tailored to this key population.

How many Slovenian family practice attendees are victims of intimate partner violence? A re-evaluation cross-sectional study report

Background

Intimate partner violence (IPV) can be considered a leading public health problem affecting approximately 50% of women during the course of their lifetimes. This study was carried out with the aim of re-testing the prevalence data and providing sufficient grounds for decision-makers in family medicine in Slovenia to adopt much-needed protocols for IPV management in the field.

Methods

In January 2012, every tenth general practitioner (GP) registered in Slovenia, of a total of 958, was invited to participate in a multi-centre cross-sectional study, and 9.4% of them, working in 90 family practices, agreed to participate. From February 1 to March 1, 2012, they asked every fifth family practice attendee aged 18 years and above, regardless of gender, to participate in the study. The short version of Domestic Violence Exposure Questionnaire was administered to 2572 patients.

Results

In the sample, there were more women (62.9% (n = 1617)). The average age of all the participants was 49.0 ± 16.1 years. Of 2572 participants (95.3% response rate), 17.1% people had been exposed to either emotional or both physical and emotional abuse. The prevalence of psychological violence was 10.3%, and that of concurrent physical and psychological abuse 6.8%, with all the patients exposed to physical IPV disclosing concurrent psychological violence. Female gender and previous formal divorce were risk factors identified in all three multivariate logistic regression models. The odds of concurrent physical and psychological and either type of IPV exposure in patients were lessened by an age of 65 years or above. The odds for either type of IPV were also lower in single people, while in concurrent physical and psychological IPV exposure, living in urban settings acted as a protective factor.

Conclusions

In Slovenian family practice attendees, an IPV exposure prevalence of approximately 17% should be considered a valid estimation.

Prevalence of abuse and violence before, during, and after pregnancy in a national sample of Canadian women

OBJECTIVES

We describe the prevalence of abuse before, during, and after pregnancy among a national population-based sample of Canadian new mothers.

METHODS

We estimated prevalence, frequency, and timing of physical and sexual abuse, identified category of perpetrator, and examined the distribution of abuse by social and demographic characteristics in a weighted sample of 76,500 (unweighted sample = 6421) Canadian mothers interviewed postpartum for the Maternity Experiences Survey (2006-2007).

RESULTS

Prevalence of any abuse in the 2 years before the interviews was 10.9% (6% before pregnancy only, 1.4% during pregnancy only, 1% postpartum only, and 2.5% in any combination of these times). The prevalence of any abuse was higher among low-income mothers (21.2%), lone mothers (35.3%), and Aboriginal mothers (30.6%). In 52% of the cases, abuse was perpetrated by an intimate partner. Receiving information on what to do was reported by 61% of the abused mothers.

CONCLUSIONS

Large population-based studies on abuse around pregnancy can facilitate the identification of patterns of abuse and women at high risk for abuse. Before and after pregnancy may be particularly important times to monitor risk of abuse.

Variations in Women’s Help Seeking in Response to Intimate Partner Violence: Findings From a Canadian Population-Based Study

This study examined the role of sociodemographic factors and v iolence characteristics in influencing women’s use of informal and formal supports in response to intimate partner v iolence (IPV) in a national surv ey of Canadian households. A subset of female respondents in the 1999 Canadian General Social Surv ey who experienced at least one incident of physical or sexual IPV by a male current or former intimate partner was used for this analysis. Findings suggest that although there are significant sociodemographic v ariations in women’s help seeking, the largest independent predictor of women’s use of supports is fear that one’s life is in danger.

Caring for victims of intimate partner violence: a survey of Canadian emergency departments

OBJECTIVE

We sought to determine the proportion of Canadian emergency departments (EDs) that have intimate partner violence (IPV) universal screening programs and intervention policies and procedures. Of the EDs with programs, we determined what proportion had made changes in their practices during the past 10 years and since the 2003 Canadian Task Force on Preventive Health Care recommendations.

METHODS

Using the same sampling methods as a 1994 study, we mailed questionnaires to nurse managers of a stratified, random sample of 250 out of 638 (39%) Canadian EDs and followed up with a series of telephone calls.

RESULTS

Of the 250 EDs initially contacted, 6 were excluded before the surveys were mailed. The response rate was 78.3% (191/244). Sixty-one (31.9%) of the studied EDs reported the existence of IPV policies and procedures. In this group, 26 (42.6%) applied universal screening and 13 (21.3%) implemented their screening policies after the 2003 national recommendations were published. When these results were compared with those of the 1994 study, there was no difference in the proportion of EDs with IPV policies and procedures or in the proportion of EDs that applied universal screening.

CONCLUSION

Despite increased research into IPV there was no significant change between 1994 and 2004 in the existence of IPV polices or universal screening in Canadian EDs. Policies and procedures that address appropriate responses to patients exposed to IPV should be a priority, with most emphasis directed toward developing effective interventions to which women can be referred.

Who is most at risk for intimate partner violence? A Canadian population-based study

Whole population studies on intimate partner violence (IPV) have given contradictory information about prevalence and risk factors, especially concerning gender. The authors examined the 1999 Canadian General Social Survey data for gender patterns of physical, sexual, emotional, or financial IPV from a current or ex-partner. More women (8.6%) than men (7.0%, p = .001) reported partner physical abuse in general, physical IPV causing physical injury (p < .0001), sexual abuse (1.7% vs. 0.2%, p < .0001), and financial abuse (4.1% vs. 1.6%, p < .0001). There were no gender differences for partner emotional abuse. Significant risk factors after multivariate modeling for physical/sexual IPV were younger age, being divorced/separated or single, having children in the household, and poor self-rated physical health. These findings from a large, randomly generated data set further refine our understanding of the risk profile for IPV in the developed world.

Risk indicators to identify intimate partner violence in the emergency department

BACKGROUND

Intimate partner violence against women is prevalent and is associated with poor health outcomes. Understanding indicators of exposure to intimate partner violence can assist health care professionals to identify and respond to abused women. This study was undertaken to determine the strength of association between selected evidence-based risk indicators and exposure to intimate partner violence.

METHODS

In this cross-sectional study of 768 English-speaking women aged 18-64 years who presented to 2 emergency departments in Ontario, Canada, participants answered questions about risk indicators and completed the Composite Abuse Scale to determine their exposure to intimate partner violence in the past year.

RESULTS

Intimate partner violence was significantly associated with being separated, in a common-law relationship or single (odds ratio [OR] = 2.08, 95% confidence interval [CI] 1.17-3.71); scoring positive for depression (OR = 4.26, 95% CI 2.11-8.60) or somatic symptoms (OR = 4.09, 95% CI 2.18-7.67); having a male partner who was employed less than part time (OR = 5.12, 95% CI 2.46-10.64), or having a partner with an alcohol (OR = 4.36, 95% CI 2.16-8.81) or drug problem (OR = 4.63, 95% CI 1.89-11.38). Each unit increase in the number of indicators corresponded to a four-fold increase in the risk of intimate partner violence (OR = 3.92, 95% CI 3.06-5.02); women with 3 or more indicators had a greater than 50% probability of a positive score on the Composite Abuse Scale. Intimate partner violence was not associated with pregnancy status.

CONCLUSION

Specific characteristics of male partners, relationships and women's mental health are significantly related to exposure to intimate partner violence in the past year. Identification of these indicators has implications for the clinical care of women who present to health care settings.

Factors influencing identification of and response to intimate partner violence: a survey of physicians and nurses

BACKGROUND

Intimate partner violence against women (IPV) has been identified as a serious public health problem. Although the health care system is an important site for identification and intervention, there have been challenges in determining how health care professionals can best address this issue in practice. We surveyed nurses and physicians in 2004 regarding their attitudes and behaviours with respect to IPV, including whether they routinely inquire about IPV, as well as potentially relevant barriers, facilitators, experiential, and practice-related factors.

METHODS

A modified Dillman Tailored Design approach was used to survey 1000 nurses and 1000 physicians by mail in Ontario, Canada. Respondents were randomly selected from professional directories and represented practice areas pre-identified from the literature as those most likely to care for women at the point of initial IPV disclosure: family practice, obstetrics and gynecology, emergency care, maternal/newborn care, and public health. The survey instrument had a case-based scenario followed by 43 questions asking about behaviours and resources specific to woman abuse.

RESULTS

In total, 931 questionnaires were returned; 597 by nurses (59.7% response rate) and 328 by physicians (32.8% response rate). Overall, 32% of nurses and 42% of physicians reported routinely initiating the topic of IPV in practice. Principal components analysis identified eight constructs related to whether routine inquiry was conducted: preparedness, self-confidence, professional supports, abuse inquiry, practitioner consequences of asking, comfort following disclosure, practitioner lack of control, and practice pressures. Each construct was analyzed according to a number of related issues, including clinician training and experience with woman abuse, area of practice, and type of health care provider. Preparedness emerged as a key construct related to whether respondents routinely initiated the topic of IPV.

CONCLUSION

The present study provides new insight into the factors that facilitate and impede clinicians' decisions to address the issue of IPV with their female patients. Inadequate preparation, both educational and experiential, emerged as a key barrier to routine inquiry, as did the importance of the "real world" pressures associated with the daily context of primary care practice.

The prevalence and characteristics of intimate partner violence in a community study of Chinese American women

A community probability-sampled survey was done of 181 Chinese American women to investigate the prevalence and nature of intimate partner violence (IPV) in Chinese Americans. Of participants, 42% knew a Chinese woman who had experienced IPV. Also, 14% had experienced IPV themselves in their lifetime (8% severe and 6% minor), 3% in the previous year, and 2% currently. In Chinese American women who were ever married, the lifetime prevalence of IPV was 17%. IPV resulted in physical injuries for 31% of women and affected their work and education. Exploratory analysis suggests that relationship problems and partner's alcohol use may be risk factors for IPV in this group.

[Domestic violence as a factor associated to women's health problems]

OBJECTIVE

To study the impact of intimate partner violence (IPV) on women's physical and psychological health.

DESIGN

Cross-sectional study.

SETTING

Primary care centers in 3 Andalusian provinces.

PATIENTS

A total of 425 women, aged 18 to 65 years, were recruited following the same randomisation process in 6 primary care centers.

MEASUREMENTS

A self-administered structured questionnaire for this study was used to gather the information. As well as sociodemographic variables, the instrument included questions about IPV, physical health indicators (chronic disease and type, lifetime surgeries, days in bed), psychological health (psychological morbidity, use of tranquilizers, antidepressants, pain killers, alcohol and recreational drugs), self-perceived health and social support.

RESULTS

Of 425 women, 31.5% ever experienced any type of partner violence. Women experiencing IPV were more likely to suffer a chronic disease. IPV was significantly associated with a number of adverse health outcomes, including spending more than 7 days in bed in the last three months (ORa=2.96; CI 95%, 1.00-8.76), psychological morbidity (ORa=2.68; CI 95%, 1.60-4.49) and worse self-perceived health (ORa=1.89; CI 95%, 1.04-3.43), after controlling for potential confounding variables.

CONCLUSION

This study shows that ever experiencing IPV is associated with a worse psychological and self-perceived health. Physical injuries are not the only "evidence" of the presence of IPV. Primary health care professionals are in a privileged position to help women who are abused by their partners.