Addressing intimate partner violence with male patients: a review and introduction of pilot guidelines

Health care utilization, mental disorders and behavioural disorders among perpetrators of intimate partner homicide in 2000-2016: A registry-based case-control study from Sweden

Little is known about intimate partner homicide (IPH) perpetrator´s healthcare contacts and mental health problems before the killing. The aim was to compare male and female IPH perpetrators with matched controls from the general population by analysing differences in healthcare utilization and mental and behavioural disorders. This study includes 48 males and 10 females who perpetrated IPH between 2000 and 2016 in the Västra Götaland Region of Sweden. Controls (n = 458) were randomly selected from the general population and matched for sex, birth year and residential area. Data were retrieved from the Swedish National Patient Register and the Western Swedish Healthcare Register. Mental and behavioural disorders were classified according to ICD-10 (F00-F99). The Mann-Whitney U test was used to test for differences in health care utilization and mental and behavioural disorders. Compared to their controls, male perpetrators had more registered contacts with primary care ≤ 30 (p = < .001) and ≤ 365 days (p = .019), respectively, before the homicide; with specialist outpatient care ≤ 30 (p = < .001) and ≤ 365 days (p = < .001), respectively, before the homicide: and with inpatient care ≤ 30 (p = < .001) and ≤ 365 days (p = .024), respectively, before the homicide. Female perpetrators had more specialized outpatient care (p = .040) and inpatient care (p = .003) contacts ≤ 365 days before the homicide, compared to controls. Male perpetrators had at least one mental or behavioral disorder diagnosed in any studied healthcare setting except in inpatient care ≤ 30 days before homicide. Female perpetrators had more mental health disorders diagnosed in specialized outpatient care ≤ 365 days before the homicide (p < .001). Perpetrators had more healthcare contacts and mental disorders one year and one month prior to the homicide compared to their controls. Health care professionals should obtain necessary skills in routinely enquiring about intimate partner violence perpetration.

Screening for Intimate Partner Violence Experience and Use in the Veterans Health Administration

Importance

The practice of screening women for intimate partner violence (IPV) in health care settings has been a critical part of responding to this major public health problem. Yet, IPV prevention would be enhanced with detection efforts that extend beyond screening for IPV experiences to identifying those who use violence in relationships as well.

Objective

To determine rates of IPV experiences and use (ie, among perpetrators of IPV) and factors associated with disclosures among adult patients seeking mental health services at the Veterans Health Administration.

Design, Setting, and Participants

This cross-sectional study used electronic medical record data drawn from a quality improvement initiative at 5 Veterans Health Administration medical centers conducted between November 2021 and February 2022 to examine IPV disclosures following concurrent screening for IPV experience and use. Participants included patients engaged in mental health services. Data were analyzed in April and May 2023.

Exposure

Mental health clinicians were trained to screen for IPV experience and use concurrently and instructed to screen all patients encountered through routine mental health care visits during a 3-month period.

Main Outcomes and Measures

Outcomes of interest were past-year prevalence of IPV use and experience, sociodemographic characteristics, and clinical diagnoses among screened patients.

Results

A total of 200 patients were offered IPV screening. Of 155 participants (mean [SD] age, 52.45 [15.65] years; 124 [80.0%] men) with completed screenings, 74 (47.7%) denied past-year IPV experience and use, 76 (49.0%) endorsed past-year IPV experience, and 72 (46.4%) endorsed past-year IPV use, including 67 participants (43.2%) who reported IPV experience and use concurrently; only 9 participants (5.8%) endorsed unidirectional IPV experiences and 5 participants (3.2%) endorsed unidirectional IPV use. Patients who reported past-year IPV experience and use were younger than those who denied IPV (experience: mean difference, -7.34 [95% CI, 2.51-12.17] years; use: mean difference, -7.20 [95% CI, 2.40-12.00] years). Patients with a posttraumatic stress disorder diagnosis were more likely to report IPV use (43 patients [59.7%]) than those without a posttraumatic stress disorder diagnosis (29 patients [40.3%]; odds ratio, 2.14; [95% CI, 1.12-4.06]). No other demographic characteristics or clinical diagnoses were associated with IPV use or experience.

Conclusions and Relevance

In this cross-sectional study of IPV rates and associated factors, screening for IPV found high rates of both IPV experience and use among patients receiving mental health care. These findings highlight the benefit of screening for IPV experience and use concurrently across gender and age. Additionally, the associations found between PTSD and IPV use underscore the importance of strengthening and developing additional targeted treatment for IPV.

Intimate partner violence after cancer diagnosis: an SOS call

PURPOSE

The aim of the present study was to measure the frequency and types of IPV among patients with cancer and evaluate risk factors.

METHODS

The study was a cross-sectional, questionnaire-based study, conducted between January and April 2022, including 141 patients treated with cancer regardless of gender, site, or stage. We developed the study questionnaire by adapting items from the "WHO multi-country questionnaire on violence against women" and "The Women's Experiences with Battering Scale." Odds ratio (OR) and spearman tests were performed to assess the impact of several factors associated with the reported IPV.

RESULTS

Median age was 50 years old, 38.3% were male cancer patients. IPV prevalence was 24.8%, we observed 5 cases of torture (3%). The most common forms of violence were placing severe restriction on certain types of food and clothing in 21%, psychological violence in 20%, exposing intimate information about the patient health status to others in 17%, ignoration in 13.5%, putting restrictions on visiting friends or families in 9.2%, verbal assault in 9.2%, physical violence in 7.9%, and 7.1% racist conducts. Financial violence was rare in 4.3%. There was no difference in the incidence of IPV between man and women. We observed a significant correlation between IPV prevalence and disease stage (19.1% M0 vs 34.6% M1, p=0.04, OR=2.2 [1-4.8]), patient's educational level (48.5% vs 17.6%, p=0.01, OR= 4.4 [1.8-10.2]), and being under ongoing cancer therapy (11.4% vs 30.9%, p=0.013, OR=3.4 [1.2-9.7]) CONCLUSION: Patients were shown to be victims of several forms of IPV regardless of gender.

Asking the Right Questions: Screening Men for Partner Violence

With lifetime intimate partner violence (IPV) victimization rates for self-identified men between 14% and 20%, and an expanding understanding of gender as a nonbinary construct, practitioners in some clinical environments have expressed interest in screening all patients for IPV. Yet, few IPV screening instruments have been validated for use in nonfemale populations. This research tests the appropriateness and acceptability of a screening instrument developed for use with women.A literature review was completed to determine the current state of research into IPV screening practices tailored to men. Next, cognitive interviews were conducted to test a 9-question IPV screening instrument with men considered at average and elevated risk for experiencing partner violence. Participants were read the questions aloud and asked about item comprehension and question appropriateness and acceptability.The literature review uncovered no published reports describing routine clinic based IPV screening of men, and only two screening instruments had been validated with men. Twenty men participated in cognitive interviews from a variety of settings in a large urban center. All participants accurately described the intended meaning of each question and verified the appropriateness of asking the questions.This work addresses the gap in research on routine IPV screening with men, building on efforts to screen individuals and support improved health and response to violence to those across the gender spectrum.

A Comparative Assessment of Intimate Partner Violence Perpetration among Male Military Personnel and Civil Servants in Ibadan, Nigeria

The mode of training and work of the military personnel is different from that of civil servants and may affect their relationships with their intimate partners. This study assessed and compared the prevalence and correlates of self-reported Intimate Partner Violence (IPV) perpetration against female partners by male military personnel and civil servants in Ibadan, south-western Nigeria. A cross sectional survey of 1240 respondents, comprising 631 military personnel and 609 civilians, was conducted using a multistage sampling technique. A self-administered questionnaire was used to collect data on the respondents' characteristics and the different types of IPV perpetrated by them. Chi square test was used to compare the proportions of the different types of IPV perpetration and logistic regression analysis was used to determine the predictors of IPV perpetration in the two study groups. Military personnel reported significantly more IPV such as physical abuse, psychological abuse and controlling behaviors than the civil servants. Childhood exposure to inter-parental IPV and history of physical fight with another woman significantly increased the odds of perpetration of each type and any form of IPV in the two populations after controlling for other variables. Military personnel were significantly more likely to perpetrate any form of IPV than the civil servants. IPV was prevalent in both groups but was more among the military personnel. There is a need for multidisciplinary interventions such as psycho-education and conflict management skills to address violence against female intimate partners especially among the military population in Nigeria.

He Said, She Said: Comparing Men's and Women's Descriptions of Men's Partner Violence

More than one in three women and one in four men in the United States report victimization by intimate partner violence. Women and men often disagree about the frequency or severity of violent acts, and researchers have proposed various reasons for discordant reports. Using daily surveys and qualitative interviews, we compared men's and women's reports about men's partner aggression and examined language they used to describe their experiences. Fifteen heterosexual couples in violent relationships completed an 8-week study that involved daily telephone surveys about violent behaviors and household environment; baseline and end-of-study surveys addressing predictors and outcomes of violence; and qualitative end-of-study interviews to provide perspective about their relationships. Most participants were Latinos with low income. Relationship length was 5.5 years, median. In daily surveys, both partners reported similar frequencies of men's physical violence (4% of days), but men reported more physical violence by women than women did (8% vs. 3% of days). The qualitative analysts compared men's and women's accounts of male-to-female violence and observed gender-specific variations in style of reporting. Men used indirect language to describe their violent behavior, implied definitions of abuse, and justified their aggression. These findings have implications for clinical guidelines to screen and intervene with victims and perpetrators of intimate partner violence in primary care and emergency settings. Future research should focus on perpetrators of violence and examine effective ways for health care providers to identify and manage their care.

Brief Intimate Partner Violence Perpetration Screening Tools: A Scoping Review

Recent research findings indicate that patients are willing to disclose their use of violence to health-care providers if asked. Health-care providers have a unique opportunity to screen their patients for intimate partner violence (IPV) perpetration; however, given the time constraints and limited personnel within medical offices and emergency-care facilities, instrument brevity is critically important. The development and evaluation of tools to screen for IPV perpetration in health-care settings, particularly brief instruments, is limited by the lack of adequate guidelines, clear institutional policies for screening, and reviews of the available literature. Given the need for validated measurement tools, we assessed the psychometric properties of measurement tools designed to quickly detect IPV perpetration by conducting a scoping review. Our search identified five measures meeting eligibility requirements. Inclusion criteria required that study information be published in a peer-reviewed journal, be published in English or Spanish languages, contain 10 or less items, report psychometric testing results, require no additional information, and be designed to detect IPV perpetration. We searched subject-specific databases and the bibliographies of relevant publications to identify studies. As part of appraising and synthesizing the evidence, we found most measures to have good reliability and validity. Most measures contained 2-5 items. Most studies were conducted in the United States and utilized an adequate sample size. There were considerable differences in how each of the measures determined a positive or negative screening. Gaps in the literature and areas for future research pertained to sample diversity, invariance testing, and practice guidelines for implementation.

A scoping review of recommendations in the English language on conducting research with trauma-exposed populations since publication of the Belmont report; thematic review of existing recommendations on research with trauma-exposed populations

OBJECTIVE

To identify recommendations for conducting public health research with trauma-exposed populations.

METHODS

Researchers searched Embase, PubMed, Scopus, Web of Science, Open Grey, and Google Scholar for recommendations. Trauma that causes psychological impact was our exposure of interest and we excluded clinical articles on treating physical trauma. We reviewed titles and abstracts of 8,070 articles and full text of 300 articles. We analyzed recommendations with thematic analysis, generated questions from the existing pool of recommendations, and then summarized select gaps.

RESULTS

We abstracted recommendations from 145 articles in five categories: community benefit, participant benefit, safety, researcher well-being, and recommendations for conduct of trauma research.

CONCLUSIONS

Gold standards to guide the conduct of trauma-informed public health research do not yet exist. The literature suggests participation in trauma research is not inherently harmful, and current recommendations concern using research to benefit communities and participants, protecting participants and researchers from harm, and improving professional practice. As public health researchers increasingly analyze trauma as a determinant of health, gold standards for the conduct of trauma-informed public health research would be appropriate and timely.

Patient and provider barriers, facilitators, and implementation preferences of intimate partner violence perpetration screening

BACKGROUND

The substantial prevalence and consequences of intimate partner violence (IPV) underscore the need for effective healthcare response in the way of screening and follow up care. Despite growing evidence regarding perspectives on healthcare-based screening for IPV experiences (i.e., victimization), there is an extremely limited evidence-base to inform practice and policy for detecting IPV use (i.e., perpetration). This study identified barriers, facilitators, and implementation preferences among United States (US) Veterans Health Administration (VHA) patients and providers for IPV use screening.

METHODS

We conducted qualitative interviews with patients enrolled in VHA healthcare (N = 10) and focus groups with VHA providers across professional disciplines (N = 29). Data was analyzed using thematic and content analyses.

RESULTS

Qualitative analysis revealed convergence between patients' and providers' beliefs regarding key factors for IPV use screening, including the importance of a strong rapport, clear and comprehensive processes and procedures, universal implementation of screening, and a self-report screening tool that assesses for both IPV use and experiences concurrently.

CONCLUSIONS

Findings provide foundational information regarding patient and provider barriers, facilitators, and preferences for IPV use screening that can inform clinical practice and next steps in this important but understudied aspect of healthcare.

Prevalence of Intimate Partner Violence and Beliefs About Partner Violence Screening Among Young Men

PURPOSE

Few clinical guidelines focus on how physicians can identify intimate partner violence (IPV) perpetration or victimization among male patients, and little is known of men's experiences and beliefs regarding screening in health care settings. Our objective was to determine prevalence of men's experiences with IPV screening in health care settings and associations with men's beliefs regarding health care clinician identification of IPV.

METHODS

Using a cross-sectional online survey of a nationally representative sample of 916 men aged 18-35 years, we conducted survey-weighted descriptive analyses to determine IPV prevalence, screening experiences and beliefs, and multivariate logistic regression to examine associations of demographics, IPV perpetration, and IPV victimization with men's screening experiences and beliefs.

RESULTS

Of 916 men surveyed, 19% reported perpetration and 27% reported victimization in relationship with current or previous spouse/partner, 90% believed health care clinicians should ask about perpetration, 92% believed health care clinicians should ask about victimization, but only 11% had been asked about perpetration and 13% about victimization. Beliefs regarding IPV were associated with African American non-Hispanic race, IPV perpetration, and IPV victimization. Experiences being asked about IPV were associated with educational attainment and IPV perpetration.

CONCLUSIONS

Among young US men, 9 in 10 support IPV identification by health care clinicians, nearly 1 in 5 report using IPV, but only about 1 in 10 report health care clinicians asking about IPV. These represent missed opportunities for health care IPV identification. Beliefs and experiences regarding health care IPV identification vary by race, education, and men's IPV perpetration and victimization. These disparities can inform tailored health care identification approaches.

Interventions in Health Settings for Male Perpetrators or Victims of Intimate Partner Violence

BACKGROUND

Intimate partner violence (IPV) is common in patients attending health-care services and is associated with a range of health problems. The majority of IPV perpetrators are men, and a substantial minority of men are victims, yet health-care professionals have little evidence or guidance on how to respond to male patients who perpetrate or experience violence in their intimate relationships.

METHODS

We conducted a systematic review to determine the effectiveness of interventions for male perpetrators or victims of IPV in health settings. Online databases, reference lists, Google Scholar, and gray literature were searched, and inclusion/exclusion criteria were applied. Narrative synthesis methods were used due to the heterogeneity of study types and outcome measures.

RESULTS

Fourteen studies describing 10 interventions met our inclusion criteria: nine randomized controlled trials, four cohort studies, and one case-control study. Interventions were predominantly therapeutic in nature and many were conducted in alcohol treatment settings.

CONCLUSION

Overall, the evidence for effectiveness of interventions in health-care settings was weak, although IPV interventions conducted concurrently with alcohol treatment show some promise. More work is urgently needed in health-care services to determine what interventions might be effective, and in what settings, to improve the response to male perpetrators or victims of IPV.

Accessing and Recruiting a Community-Based Sample of Men of Mexican Origin to Explore Intimate Partner Violence

INTRODUCTION

Vulnerable populations are at greater risk for the burden of disease and negative health outcomes including alcohol abuse, high-risk sexual behavior, and intimate partner violence (IPV). Moreover, health disparities experienced by vulnerable populations are mediated by socioeconomic, ethnic, and racial factors. Risk factors for IPV perpetration are exacerbated by cultural and gender norms, particularly among men of Mexican origin.

PURPOSE

To discuss research methods used in a community-based sample of men of Mexican origin and ways to overcome recruitment barriers through community engaged approaches.

DISCUSSION

Barriers can impede sampling, recruitment, and enrollment of vulnerable populations (e.g., IPV) but can be overcome. Strategies include: qualitative research methods, identifying key informants, and community engagement approaches, such as listening to the concerns of the community, incorporating the community's knowledge to inform and improve the study, and building rapport to establish trust.

CONCLUSION

Conducting research within vulnerable populations can be challenging but can be mitigated by incorporating multiple strategies. Thus, allowing researchers to gain access and valuable insight into traditionally underrepresented and understudied populations.

Accuracy and Acceptability of a Screening Tool for Identifying Intimate Partner Violence Perpetration among Women Veterans: A Pre-Implementation Evaluation

OBJECTIVES

Veterans are at heightened risk for perpetrating intimate partner violence (IPV), yet there is limited evidence to inform practice and policy for the detection of IPV perpetration. The present study evaluated the accuracy and acceptability of a potential IPV perpetration screening tool for use with women veterans.

DESIGN

A national sample of women veterans completed a 2016 web-based survey that included a modified 5-item Extended-Hurt/Insult/Threaten/Scream (Modified E-HITS) and the Revised Conflict Tactics Scales (CTS-2). Items also assessed women's perceptions of the acceptability and appropriateness of the modified E-HITS questions for use in healthcare settings. Accuracy statistics, including sensitivity and specificity, were calculated using the CTS-2 as the reference standard.

MAIN OUTCOME MEASURES

Primary measures included the Modified E-HITS (index test), CTS-2 (reference standard), and items assessing acceptability.

RESULTS

This study included 187 women, of whom 31 women veterans (16.6%) reported past-6-month IPV perpetration on the CTS-2. The Modified E-HITS demonstrated good overall accuracy (area under the curve, 0.86; 95% confidence interval, 0.78-0.94). In addition, the majority of women perceived the questions to be acceptable and appropriate.

CONCLUSIONS

Findings demonstrate that the Modified E-HITS is promising as a low-burden tool for detecting of IPV perpetration among women veterans. This tool may help the Veterans Health Administration and other health care providers detect IPV perpetration and offer appropriate referrals for comprehensive assessment and services.

Disclosing victimisation to healthcare professionals in Sweden: a constructivist grounded theory study of experiences among men exposed to interpersonal violence

OBJECTIVE

To develop a theoretical model concerning male victims' processes of disclosing experiences of victimisation to healthcare professionals in Sweden.

DESIGN

Qualitative interview study.

SETTING

Informants were recruited from the general population and a primary healthcare centre in Sweden.

PARTICIPANTS

Informants were recruited by means of theoretical sampling among respondents in a previous quantitative study. Eligible for this study were men reporting sexual, physical and/or emotional violence victimisation by any perpetrator and reporting that they either had talked to a healthcare provider about their victimisation or had wanted to do so.

METHOD

Constructivist grounded theory. 12 interviews were performed and saturation was reached after 9.

RESULTS

Several factors influencing the process of disclosing victimisation can be recognised from previous studies concerning female victims, including shame, fear of negative consequences of disclosing, specifics of the patient-provider relationship and time constraints within the healthcare system. However, this study extends previous knowledge by identifying strong negative effects of adherence to masculinity norms for victimised men and healthcare professionals on the process of disclosing. It is also emphasised that the process of disclosing cannot be separated from other, even seemingly unrelated, circumstances in the men's lives.

CONCLUSIONS

The process of disclosing victimisation to healthcare professionals was a complex process involving the men's experiences of victimisation, adherence to gender norms, their life circumstances and the dynamics of the actual healthcare encounter.

Occurrence and impact of negative behaviour, including domestic violence and abuse, in men attending UK primary care health clinics: a cross-sectional survey

OBJECTIVE

To measure the experience and perpetration of negative behaviour, including domestic violence and abuse (DVA), and investigate its associations with health conditions and behaviours in men attending general practice.

DESIGN

Cross-sectional questionnaire-based study conducted between September 2010 and June 2011.

SETTING

16 general practices in the south west of England.

PARTICIPANTS

Male patients aged 18 or older, attending alone, who could read and write English. A total of 1403 of eligible patients (58%) participated in the survey and 1368 (56%) completed the questions relevant to this paper. 97% of respondents reported they were heterosexual.

MAIN OUTCOME MEASURES

Lifetime occurrence of negative behaviour consistent with DVA, perceived health impact of negative behaviours, associations with anxiety and depression symptoms, and cannabis use in the past 12 months and binge drinking.

RESULTS

22.7% (95% CI 20.2% to 24.9%) of men reported ever experiencing negative behaviour (feeling frightened, physically hurt, forced sex, ask permission) from a partner. All negative behaviours were associated with a twofold to threefold increased odds of anxiety and depression symptoms in men experiencing or perpetrating negative behaviours or both. 34.9% (95% CI 28.7% to 41.7%) of men who reported experiencing negative behaviour from a partner, and 30.8% (95% CI 23.7% to 37.8%) of men who perpetrated negative behaviours said they had been in a domestically violent or abusive relationship. No associations with problematic drinking were found; there was a weak association with cannabis use.

CONCLUSIONS

DVA is experienced or perpetrated by a large minority of men presenting to general practice, and these men were more likely to have current symptoms of depression and anxiety. Presentation of anxiety or depression to clinicians may be an indicator of male experience or perpetration of DVA victimisation.

Gender-specific research on mental illness in the emergency department: current knowledge and future directions

Mental illness is a growing, and largely unaddressed, problem for the population and for emergency department (ED) patients in particular. Extensive literature outlines sex and gender differences in mental illness' epidemiology and risk and protective factors. Few studies, however, examined sex and gender differences in screening, diagnosis, and management of mental illness in the ED setting. Our consensus group used the nominal group technique to outline major gaps in knowledge and research priorities for these areas, including the influence of violence and other risk factors on the course of mental illness for ED patients. Our consensus group urges the pursuit of this research in general and conscious use of a gender lens when conducting, analyzing, and authoring future ED-based investigations of mental illness.

Health professionals responding to men for safety (HERMES): feasibility of a general practice training intervention to improve the response to male patients who have experienced or perpetrated domestic violence and abuse

AIM

To evaluate a training intervention for general practice-based doctors and nurses in terms of the identification, documentation, and referral of male patients experiencing or perpetrating domestic violence and abuse (DVA) in four general practices in the south west of England.

BACKGROUND

Research suggests that male victims and perpetrators of DVA present to primary care clinicians to seek support for their experiences. We know that the response of primary care clinicians to women patients experiencing DVA improves from training and the establishment of referral pathways to specialist DVA services.

METHOD

The intervention consisted of a 2-h practice-based training. Outcome measures included: a pre-post, self-reported survey of staff practice; disclosures of DVA as documented in medical records pre-post (six months) intervention; semi-structured interviews with clinicians; and practice-level contact data collected by DVA specialist agencies.

RESULTS

Results show a significant increase in clinicians' self-reported preparedness to meet the needs of male patients experiencing or perpetrating DVA. There was a small increase in male patients identified within the medical records (6 pre- to 17 post-intervention) but only five of those patients made contact with a specialist DVA agency identified within the referral pathway. The training increased clinicians' confidence in responding to male patients affected by DVA. The increase in recorded identification of DVA male patients experiencing or perpetrating DVA was small and contact of those patients with a specialist DVA support service was negligible. We need to better understand male help seeking in relation to DVA, further develop interventions to increase identification of male patients experiencing or perpetrating DVA behaviours, and facilitate access to support services.

Prevalence and Correlates of Intimate Partner Violence among Male Civil Servants in Ibadan, Nigeria

BACKGROUND

Intimate Partner violence (IPV) is one of the common forms of violence against women and is a global public health problem that transcends social, economic, religious and cultural groups. It is often perceived as a private problem or a normal part of life but it contributes greatly to morbidity and mortality.

OBJECTIVE

To assess the prevalence and correlates of intimate partner violence by male civil servants in Oyo State Secretariat Ibadan, Nigeria.

METHODS

A cross-sectional study was conducted using a multi-stage sampling technique. A total of 609 respondents completed a pre-tested self-administered questionnaire. Data were analysed using SPSS version 18 and STATA version 12. Chi-square statistic was used to test associations between categorical variables and predictors of perpetration of intimate partner violence were determined using logistic regression model at a level of statistical significance of 5%.

RESULT

The mean age was 38.8±9.9 years and about 74.5% were married. The prevalence of IPV perpetration in the 12 months preceding the study was 66.0%. The prevalence of controlling behaviour was 52.2%, psychological abuse - 31.2%, sexual violence - 23.0%, and physical violence - 11.7%. The predictors of perpetrating any form of IPV included previous history of physical fight with another woman [OR: 2.4 (95% CI: 1.30-3.40)], having a negative attitude towards wife beating [OR 2.5 [95% CI: 1.85-3.42], childhood exposure to parental IPV [OR: 2.1 (95% CI: 1.30-3.41)] and use of alcohol [OR: 1.6 (95% CI: 1.14-2.15].

CONCLUSION

The different types of IPV were prevalent among the male civil servants, despite their educational status. Strategies to stop IPV should include male education to change attitudes that encourage violence in relationships to use of non-violent conflict resolution strategies. Education should also include the dangers of alcohol abuse and involvement in physical fights.

Addressing intimate partner violence in lesbian, gay, bisexual, and transgender patients

The medical community's efforts to address intimate partner violence (IPV) have often neglected members of the lesbian, gay, bisexual, and transgender (LGBT) population. Heterosexual women are primarily targeted for IPV screening and intervention despite the similar prevalence of IPV in LGBT individuals and its detrimental health effects. Here, we highlight the burden of IPV in LGBT relationships, discuss how LGBT and heterosexual IPV differ, and outline steps clinicians can take to address IPV in their LGBT patients.

Optimal methods to screen men and women for intimate partner violence: results from an internal medicine residency continuity clinic

Contradictory data exist regarding optimal methods and instruments for intimate partner violence (IPV) screening in primary care settings. The purpose of this study was to determine the optimal method and screening instrument for IPV among men and women in a primary-care resident clinic. We conducted a cross-sectional study at an urban, academic, internal medicine residency continuity clinic in Connecticut among English or Spanish speaking adult patients. One group of patients ( n = 340) received a self-administered questionnaire (SAQ) containing the partner violence screen (PVS) and the Hurt, Insulted, Threatened or Screamed at Questionnaire (HITS). A second group (n = 126) was screened with PVS and HITS by their primary care providers during face-to-face (FTF) clinical encounters. Multivariable logistic regression models were used to determine the association between IPV prevalence and screening method (SAQ or FTF) after adjusting for socio-demographic effects. The overall IPV prevalence was 17.3% using the SAQ and 9.0% with FTF screening (p = .008). Patients receiving the SAQ were more likely to report IPV than those who were screened FTF (adjusted odds ratio [AOR]: 2.6, 95% confidence interval [CI]: 1.2-5.6). This effect persisted for women, who had a higher odds of IPV when screened through a SAQ than when screened FTF (AOR: 3.5, 95% CI: 1.4-8.6). Men did not differ in reporting IPV between methods: 11% with SAQ versus 9.4% FTF (p = .69). In internal medicine residency continuity clinics, a SAQ for IPV may result in higher disclosure and completion rates among female patients compared to FTF screening. Unique screening instruments and methods may be needed for men.