Emergency department-based study of risk factors for acute injury from domestic violence against women

Military/Civilian Risk Markers for Physical Intimate Partner Violence: A Meta-Analysis

This meta-analysis compared risk markers for perpetration of physical intimate partner violence (IPV) among military and civilian males. We also examined strength of risk markers among male and female service members. In total, 36 military studies and 334 civilian studies, which reported 883 effect sizes, were included in the analyses. Results revealed more similarities than differences in risk markers for IPV among military and civilian males and among military males and females. Of the risk markers examined, relationship satisfaction and alcohol problems were significantly stronger risk markers for IPV among civilian males compared to military males. Perpetrating emotional abuse was a significantly stronger risk marker for IPV perpetration among military females compared to military males. Recommendations for IPV prevention and intervention are discussed.

Risk Factors for Physical Injury Among Women Assaulted by Current or Former Spouses

This study examined risk factors for physical injuries resulting from partner violence using data from the Canadian Violence Against Women Survey. Multivariate results indicated that experiencing violence before the union, having a partner who was drinking at the time of the assault, having children who witnessed the assault, experiencing previous violence by the same partner, fearing one's life was in danger, and experiencing high levels of emotional abuse were related to an increased risk of both minor and severe injuries. Both models had good predictive value: 80% concordance rate when predicting minor injuries and 90% concordance rate when predicting severe injuries. Knowledge of a woman's status on these risk factors would allow public health practitioners to intervene with battered women more effectively to prevent injuries.

A survey on spousal abuse of 500 victims in Iran

Spousal abuse is a serious social problem, which includes a variety of physical, emotional, and sexual violence. Many studies conducted on this subject in different countries show that the actual severity of this problem is far greater than it seems at first glance. Because legal medical centers are the main places where victims are referred, 500 abused victims who were directed to these centers during 2012 were asked to fill out preplanned forms and the collected data were analyzed using analytic methods. The results showed that the average age of the women was 32 years, and their husbands' average age was 36 years. Most of the women had high school diplomas and they were living with their husbands and children. Most of the subjects were housekeepers and had married through their own choice and personal interest. In most of the cases, the initial instance of physical abuse occurred in the first year after marriage, and the head and face were the most frequently injured parts of their body. In a high percentage of cases, the partner was drunk, addicted, or had a history of mental illness. A significant relationship was found between alcohol and drug abuse with domestic violence in this study.

The violence triad and common single precipitants to psychiatric patient assaults on staff: 16-year analysis of the Assaulted Staff Action Program

Psychiatric patient assaults are a serious community health hazard. Risk management strategies to identify common single precipitants have had limited value and this limitation has resulted in the emergence of multiple determinant studies. This 16-year retrospective study of assault precipitants in one, public sector mental health-care system assessed single common, immediate precipitants; the multiple clinical precipitants of history of violence, personal victimization, and substance use disorder (the violence triad); and both combined. Denial of services, acute psychoses, and excess sensory stimulation were the most common single precipitants. The multicomponent violence triad yielded greater association with subsequent assault than single precipitants. The combination of the violence triad and single precipitants did not yield statistically significant greater associations. Discussion of the clinical risk management implication, and methodological issues are presented.

Padrões de violência domiciliar associada ao uso de álcool no Brasil

OBJETIVO: Analisar as situações de violência domiciliar ocorridas com o agressor sob efeito do álcool. MÉTODOS: Foi realizado um levantamento domiciliar que incluiu as 108 cidades brasileiras com mais de 200 mil habitantes em 2005. A amostragem foi por conglomerados, estratificada, probabilística e autoponderada, obtida em três estágios de seleção: setores censitários, domicílios e respondentes (população entre 12-65 anos de idade). O instrumento utilizado para obtenção dos dados foi o Substance Abuse and Mental Health Services Administration, com perguntas sobre dados sociodemográficos e uso de drogas psicotrópicas. RESULTADOS: Foram pesquisados 7.939 domicílios. Em 33,5% foi relatado histórico de violência domiciliar, sendo 17,1% com agressores alcoolizados. Os tipos de violência em associação com uso de álcool mais freqüentes foram: discussões direcionadas a pessoas do domicílio (81,8%), escândalos não direcionados a alguém específico (70,9%), ameaça de agressão física (39,5%) e de quebra de objetos (38,7%), agressões físicas (27,8%), com armas (5,5%) e abuso sexual (3,2%). Mais da metade dos agressores era morador do domicílio, 88,8% deles do sexo masculino. A maioria das vítimas era do sexo feminino (63,9%); 33,9% eram esposas e 18,2% filhos. Quanto às reincidências, 14,1% dos casos perduraram por período entre um a cinco anos e em 14,3% ultrapassaram uma década. A maior parte das vítimas (86%) e dos agressores (77,9%) não procurou por ajuda em serviço de saúde e/ou delegacia. CONCLUSÕES: Além da alta proporção de domicílios brasileiros com histórico de violência com agressores alcoolizados, as agressões apresentaram várias especificidades. A baixa procura por ajuda em serviços de saúde/segurança indica a importância da detecção ativa de casos de violência domiciliar.

An epidemiologic comparison of injuries presenting to a pediatric emergency department and local urgent care facilities

PROBLEM

The objective of this study was to compare the epidemiology of injuries presenting to emergency department (ED) and urgent care (UC) facilities of a single, NEISS-affiliated hospital.

METHOD

Patient medical records (n=36,811) were used to compare injury incidence, injury characteristics, and demographic characteristics between the ED, on-site UC, and off-site UC during 2006.

RESULTS

ED presentations were more likely to be open wounds and motor vehicle-related compared to on-site UC presentations. ED presentations were more likely to be system wide/late effects, be made by an African American, or be paid through Medicaid compared to off-site UC presentations. On-site UC presentations were more likely to be made by an African American or be paid through Medicaid compared to off-site UC presentations.

DISCUSSION

ED and UC injury characteristics and patient demographics differ. With no nationally-representative UC injury surveillance, current research likely underestimates injury incidence and presents skewed profiles.

IMPACT ON INDUSTRY

This article adds insight into the generalizability of ED-based injury surveillance to UC injuries.

Angry wives, abusive husbands: relationship between domestic violence and psychosocial variables

BACKGROUND

A small number of studies conducted in Pakistan have shown high rates of domestic violence. None of the studies, however, discussed associated psychosocial factors. We interviewed a group of women to look at violence and associated psychosocial factors. We wanted to see if self-esteem, quality of relationships, social support, stressful life events, psychiatric symptoms, and different measures of anger were associated with domestic violence.

METHODOLOGY

In a cross-sectional survey of women presenting to primary care physicians, we used Women's Experience with Battering and Domestic Abuse Checklist to measure domestic violence. The Relationship Assessment Scale, Oslo Social Support Scale, State Trait Anger Inventory, and Evaluative Belief Scale were used to look at the correlates of violence. We used the information in a regression model to identify independent predictors of violence in this sample.

RESULTS

More than half of the women reported experiencing battering and/or violence. Women in abusive relationships reported unhappiness with their intimate relationships and had high scores on 1 subscale of anger. Living in extended families was protective against violence.

CONCLUSIONS

We were able to replicate findings that women in abusive relationships are not satisfied with the relationships with their partners. Living in extended families was protective against violence. Community studies may provide a better design to look at the association between abuse and poverty, literacy, self-esteem, and social support.

Opinions of married women about potential causes and triggers of intimate partner violence against women. A cross-sectional investigation in an Iranian city

Background

Population-based perception studies on potential causes and triggers of intimate partner violence against women (IPVAW) may enlighten context-relevant primary preventive actions in settings where data are limited. This study, conducted in one specific city, deals with married women's opinions concerning potential causes and triggers of IPVAW and seeks to highlight areas of consensus and divergence in the views.

Methods

A convenient sample of women aged 25–45 years and married for at least 5 years was consecutively recruited in the 48 public health centres of Kermanshah city, where free health services are provided to mothers and children under 6 years old. Respondents were individually interviewed on site by trained and experienced female interviewers (response rate 94.3%). A structured pilot-tested questionnaire was used that consisted mainly of closed questions about individual assessment of the extent to which various items could be regarded as a potential cause, a potential trigger or a potential consequence of IPVAW. Individual item frequencies were compiled and the association between socio-demographic attributes of the spouses and also respondents' prior exposure to violence and women answers was explored.

Results

For most factors covered, women mainly "agreed" or "agreed very much" about their potential as a trigger or a cause of IPVAW; agreements were stronger for individual-related potential causes. Generally, women's socio-demographic characteristics and prior victimisation did not much affect the opinions they expressed. For some triggers however, women's own occupation and their husband's educational level affected how much in agreement they were.

Conclusion

The women interviewed consider that most potential causes and triggers proposed may, at some point in a relationship, engender IPVAW. In the main, their views are not much altered by their own and their husbands' socioeconomic position or their prior victimisation. It remains to be seen whether married men and, for that matter, even women married for a shorter duration or from other settings will answer in a similar manner.

Are alcohol problems linked with an increase in depressive symptoms in abused, inner-city African American women?

OBJECTIVE

Little is known regarding the link between intimate partner violence (IPV), alcohol problems (AP), and depression in inner-city African American women. We sought to investigate whether abused inner-city African American women reporting AP endorsed more depressive symptoms compared to women reporting either AP or IPV or reporting neither.

METHOD

Participants for this cross-sectional study were 361 African American women seeking medical care at a large public hospital. Measurements included the Index of Spouse Abuse, Michigan Alcoholism Screening Test, and the Brief Symptom Index-Depression Subscale to assess IPV, AP, and depressive symptoms, respectively. Based on IPV and AP status, participants were assigned to one of four non-hierarchical risk groups: (i) low or no IPV, no AP; (ii) high IPV alone; (iii) AP alone; or (iv) both high IPV and AP. Additive effect of high levels of IPV and AP on outcome were assessed using logistic regression techniques.

RESULTS

Thirty percent reported high IPV levels, and 18% had AP. Compared with participants reporting both no AP and low or no IPV, those reporting either high IPV levels or AP reported moderate to severe depressive symptoms 4 times more often (p < .001). Women reporting high IPV and AP endorsed moderate to severe depressive symptoms 8 times more often than women reporting neither (p < .001).

CONCLUSIONS

Among inner-city, African American women, depressive symptoms are highest among those reporting both high IPV levels and AP. Health care systems serving similar communities should implement a systematic approach to identifying IPV, AP, and depression in patients.

Musculoskeletal Manifestations of Physical Abuse After Intimate Partner Violence

BACKGROUND

Domestic violence is the most common cause of nonfatal injury to women in the United States, with an estimated cost of $50 billion annually. Little is known about the spectrum of musculoskeletal injuries in victims of domestic violence. We examined the characteristics of abused women, the prevalence of musculoskeletal injuries, and the variables associated with increasing frequency of physical violence against women.

METHODS

We identified all female survivors of intimate partner violence who were referred to the Minnesota Domestic Abuse Program from January 1, 2002, through December 31, 2003. Characteristics of each woman's background, abuse history, and injuries were obtained by a trained program therapist in an in-depth, 2-hour intake interview. Specific data forms were completed for each interview. Five forms of experienced abuse were explored (physical, emotional, psychological, sexual, and financial). Injuries were subcategorized as (1) head and neck, (2) musculoskeletal, (3) chest, (4) abdomen, and (5) skin (integumentary system). We conducted regression analyses to determine factors associated with the frequency of physical abuse.

RESULTS

Of 270 potentially eligible women, 263 (97%) with complete records were included. Women were commonly Caucasian (62%) in their third decade of life with one or more children (87%). A history of abuse was recalled by over half of the women (54%). The most prevalent forms of abuse were emotional (84%), psychological (68%), physical (43%), sexual (41%), and financial (38%). Child protective services were concomitantly involved in half of the women living in abusive relationships. Among those women who reported physical abuse, 36% sought medical attention. We identified 144 injuries in 218 physically abused women. Head and neck injuries were the most prevalent after intimate partner violence (40%). Musculoskeletal injuries were the second most common manifestation of intimate partner violence (28%). The spectrum of injuries included sprains (n = 21 injuries), fracture/dislocations (n = 17 injuries), and foot injuries (n = 2 injuries). Our analysis identified seven variables associated with increasing physical abuse frequency. These included (1) younger age (p = 0.04); (2) shorter length of relationship (p = 0.049); (3) emotional abuse (p = 0.02); (4) psychological abuse (p = 0.003); (5) sexual abuse (p = 0.004); (6) drug dependency (p = 0.05); and (7) alcohol dependency (p = 0.045).

CONCLUSIONS

Among women presenting to a domestic violence therapy program seeking counseling, head and neck and musculoskeletal injuries were most common. Frequency of physical abuse was most likely to be associated with younger women who are in short-term relationships, have chemical and alcohol dependency, and concomitant emotional, psychological, and sexual abuse. Recognizing musculoskeletal injuries in women as a potential result of intimate partner violence is warranted. Identifying children exposed to abusive situations may further alert treating surgeons to the potential for intimate partner violence in the mother.

Support for emergency department screening for intimate partner violence depends on perceived risk

Emergency department (ED) screening for intimate partner violence (IPV) faces logistic difficulties and has uncertain efficacy. We surveyed 146 ED visitors and 108 ED care providers to compare their support for ED IPV screening in three hypothetical scenarios of varying IPV risk. Visitor support for screening was 5 times higher for the high-risk (86%) than for the low-risk (17%) scenario. Providers showed significantly more support for the need for ED IPV screening than visitors. Controlling for confounding by gender, race, experience with IPV, hospital, and marital status did not affect comparisons between groups. These responses indicate greater support for IPV screening in the ED for high-risk than for low-risk cases, particularly among visitors.

Alcohol and intimate partner violence: do we have enough information to act?

BACKGROUND

Male alcohol consumption is one of the accepted risk factors for intimate partner violence. The aim of this study is to assess the magnitude of the association between male alcohol consumption and intimate partner violence against women and the quality of the evidence of published papers exploring this relationship empirically.

METHODS

Systematic review and meta-analysis of quantitative studies (1966-2004). Eight databases from Social and Behavioural Sciences, Clinical Medicine, and Life Sciences were reviewed. Studies with available 2 x 2 table or odds ratio were analysed using meta-analytic techniques.

RESULTS

A total of 22 studies fulfilled the inclusion criteria for the systematic review: 14 (63.6%) were cross-sectional studies, 6 (27.3%) case-series, 2 (9.1%) case-control studies. Ten studies analysed the relationship between alcohol and violence as their primary hypothesis and only two used a direct measure of alcohol consumption. Of them, 11 papers were included in the meta-analysis. The overall pooled odds ratio was 4.57 (95% confidence limits 3.30-6.35), but a high degree of heterogeneity was observed. The magnitude of the effect was inversely associated with the year of publication. The biggest odds ratios were obtained in the studies with the smallest sample sizes.

CONCLUSIONS

The evidence about the relationship between alcohol consumption and intimate partner violence is of low quality in the study designs and maybe biased by publication of positive results. Currently there is not enough empirical evidence to support preventive policies based on male alcohol consumption as a risk factor in the particular case of intimate partner violence.

The roles of victim and perpetrator alcohol use in intimate partner violence outcomes

Alcohol use increases the risk of intimate partner violence (IPV), yet little research has examined its role in victimization outcomes (e.g., physical injury, police reporting). This study examined the roles of perpetrator and victim incident-specific alcohol use in IPV outcomes. The sample included 501 men and 1,756 women who had experienced an IPV physical assault. Logistic regression analyses showed that after controlling for relevant covariates, women whose partners had been drinking were significantly more likely to be injured than were women whose partners had not been drinking. A woman's own alcohol use was unrelated to victimization outcomes. Men were significantly more likely to report the incident if their partners had been drinking but were marginally less likely to report if they had been drinking. Findings suggest that perpetrators' incident-specific alcohol use is important in understanding which victims are most likely to be injured and report the incident to the police.

Physical abuse against pregnant aborigines in Taiwan: prevalence and risk factors

The purpose of this study was to estimate the prevalence of, and to investigate the risk factors for physical abuse against pregnant aborigines in Taiwan. A cross-sectional survey was conducted. Aboriginal women who had just given birth in hospitals were recruited from January to December 2003. The women were interviewed with a structured questionnaire about the physical abuse and substance use experiences. Participants were 1143 aboriginal women who had just given birth in hospitals. About 175/1143 of the women (15.3%) had ever experienced physical abuse from a husband or intimate partner, and 79/1143 of the women (6.9%) had experienced it during their recent pregnancy. Multiple logistic regression analysis revealed that the women who were more likely to have been physically abused during their pregnancy were: had fewer years of education, husbands who were unemployed, with a patriarchal family situation and had alcohol, cigarette and non-prescription drug use. Based on these results, we suggest that health care professionals provide adequate support and health education, develop interventions, and use referrals in concert with routine prenatal care in order to reduce and prevent the physical abuse of aboriginal women in Taiwan.

Severe Intimate Partner Violence and Alcohol Use among Female Trauma Patients

BACKGROUND

The lifetime prevalence of intimate partner violence (IPV) among women in the United States is reported to be between 18 and 50%. One-third of female homicide victims are killed by an intimate partner and alcohol is often involved. Despite these figures, 77% of women have never been screened for IPV. Substance abuse in male partners is known to place women at risk. We examined the role of female alcohol use on rates of severe IPV. Our hypotheses were: (1) the prevalence of IPV among women seen in trauma centers is greater than that found in national surveys; (2) alcohol problems among abused women and their partners are greater than those among non-abused women; (3) females and their partners alcohol problems are each independently associated with IPV; and (4) female trauma center patients support domestic violence screening.

METHODS

An in-person survey was administered to 95 consecutive adult female trauma patients admitted to a Level I Trauma Center. The survey included questions about past-year and lifetime severe IPV, female and male partner alcohol use, and willingness to participate in IPV screening and referral. The multivariate associations of female and partner alcohol use with past-year severe IPV were assessed with logistic regression.

RESULTS

Nearly one-half (46.3%) of women reported a lifetime history of severe IPV, with 26% experiencing severe IPV in the past year. Past-year IPV was identified in 59.1% of women screening positive for drinking problems, but in only 12.7% of those screening negative for drinking problems (p = 0.001). Similarly, past-year IPV prevalence was 55.2% when the partner was a problem drinker versus 8.3% when he was not (p = 0.001). Multivariate analysis showed that female problem drinking (odds ratio [OR] = 5.8) and partner problem drinking (OR=8.9) were independent predictors of past-year severe IPV. The majority of women (90.5%) felt that it was appropriate for health care professionals to screen for IPV; 90% of women with a history of IPV thought screening was important and 71% wished a previous healthcare provider had asked them about it.

CONCLUSIONS

Female trauma patients demonstrate a higher prevalence of severe IPV than the general population. IPV rates appear to be related to both female and partner alcohol misuse. Female trauma patients endorsed IPV screening and thus should be screened for alcohol use and IPV in a way that minimizes future violence risk. Further research is needed to elucidate whether intervention for alcohol misuse has an impact on rates of IPV in this population.

A community partnership to prepare nursing students to respond to domestic violence

TOPIC

Partnership building to prepare nursing students to respond to domestic violence through service learning.

PURPOSE

To describe an innovative approach to preparing nursing students to respond to domestic violence.

SOURCES

Clinical practice and experience, published literature, partner organizations.

CONCLUSIONS

This community partnership has prepared nursing students to respond effectively and with compassion to individuals and families experiencing violence. This approach can be replicated through a service learning model to support coordinated community response to domestic violence.

Health care use by perpetrators of domestic violence

Research has demonstrated that men will admit to the perpetration of domestic violence (DV), if questioned, in the medical setting. The opportunity to identify DV perpetrators, however, also depends on the frequency of contact between health care providers and perpetrators. The purpose of this study was to determine health care use among a group of DV perpetrators. A survey was administered to 133 men enrolled in the largest community-based batterer treatment program in a metropolitan region. Of the 133 men surveyed, 56 (42%) indicated they had visited a doctor, hospital, or received some other type of medical care within the preceding 6 months. Of men reporting health care visits, the majority (41%, n = 23) indicated that the Emergency Department was the location where care was provided. These data demonstrate that Emergency Departments are often visited by DV perpetrators in this community and may be important sites for screening and intervention protocols.

Improving the emergency department detection rate of domestic violence using direct questioning

The purpose of this study was to compare the domestic violence (DV) rate identified with simple direct questioning to a historical cohort of patients receiving routine emergency department (ED) care. One thousand ED charts of female patients were retrospectively reviewed. Each patient in the prospective cohort was asked five DV specific questions. The historical cohort revealed a DV prevalence rate of 0.4%. The prospective study group of 302 patients identified 11 (3.6%) patients who admitted to acute DV on direct questioning. Ten of these patients accepted help. Twenty (6.6%) were identified as probable DV and 12 (4%) admitted to past violence. The total number of victims of DV, past, present, and probable was 43 (14.2%). This increase in detection from 0.4% (4/1000) to 14.2% (43/302) is significant at p < 0.001. Only 1.3% of patients refused to participate in the DV specific questions. The conclusion of the study indicated that the use of simple, direct questioning significantly improves the detection rate of DV in the ED.

Domestic violence and the trauma surgeon

BACKGROUND

Domestic violence has become increasingly recognized as a public health problem, and was declared a national epidemic by C. Everett Koop in 1992. In the United States, 1 to million women yearly suffer injuries due to domestic violence, and 30% to 50% of female homicides are committed by a present or former partner. The majority of these murder victims had either been seen in emergency rooms for prior domestic violence-related injuries, or had reported these injuries to the police. It is estimated that 50% of all acute injuries and 21% of all injuries in women requiring urgent surgery ar the result of partner abuse.

DATA SOURCE

Medline and current literature review.

CONCLUSIONS

Health care professionals in the emergency room are an important contact with the victims of domestic violence, and timely identification and intervention can save lives. Overall, upwards of 35% of all emergency room visits by women are the result of domestic violence, whether due to acute injury, problems during pregnancy, or stress-related complaints. Unfortunately, domestic abuse is infrequently disclosed voluntarily by the patient, and often overlooked by the treating physician. Thus, the purpose of this review is to familiarize surgeons with the presentation and management of victims of this hidden epidemic.

Risk factors for injury to women from domestic violence

BACKGROUND

Domestic violence is the most common cause of nonfatal injury to women in the United States. To identify risk factors for such injuries, we examined the socioeconomic and behavioral characteristics of women who were victims of domestic violence and the men who injured them.

METHODS

We conducted a case-control study at eight large, university-affiliated emergency departments. The 256 intentionally injured women had acute injuries resulting from a physical assault by a male partner. The 659 controls were women treated for other conditions in the emergency department. Information was collected with a standardized questionnaire; no information was obtained directly from the male partners.

RESULTS

The 256 intentionally injured women had a total of 434 contusions and abrasions, 89 lacerations, and 41 fractures and dislocations. In a multivariate analysis, the characteristics of the partners that were most closely associated with an increased risk of inflicting injury as a result of domestic violence were alcohol abuse (adjusted relative risk, 3.6; 95 percent confidence interval, 2.2 to 5.9); drug use (adjusted relative risk, 3.5; 95 percent confidence interval, 2.0 to 6.4); intermittent employment (adjusted relative risk, 3.1; 95 percent confidence interval, 1.1 to 8.8); recent unemployment (adjusted relative risk, 2.7; 95 percent confidence interval, 1.2 to 6.5); having less than a high-school-graduate's education (adjusted relative risk, 2.5; 95 percent confidence interval, 1.4 to 4.4); and being a former husband, estranged husband, or former boyfriend (adjusted relative risk, 3.5; 95 percent confidence interval, 1.5 to 8.3).

CONCLUSIONS

Women at greatest risk for injury from domestic violence include those with male partners who abuse alcohol or use drugs, are unemployed or intermittently employed, have less than a high-school-graduate's education, and are former husbands, estranged husbands, or former boyfriends of the women.

Violence against women

Violence against women has received increasing public attention over the past 20 years. The past two decades have highlighted the problem of intimate partner violence as a major cause of intentional injury to women. Many of these women present themselves to emergency departments where emergency physicians have a unique opportunity to intervene.