Validation and adaptation of the danger assessment-5: A brief intimate partner violence risk assessment

Forensic homicidal strangulation in women: Case series and systematic literature review

This systematic review explores women's homicidal strangulation using PRISMA method. A total of 40 Google Scholar, 26 PubMed and 4 manual searching articles were analyzed, while other sources were excluded due to lack of full texts, irrelevance, or outdated content. Review highlights gender violence as an underestimated issue and provides a socio-demographic analysis. Diagnosing strangulation can be challenging, particularly in absence of visible asphyxial signs in the external examination. Judicial authorities' collaboration and reliance on circumstantial evidence are crucial in forensic investigations. Strangulation is statistically prevalent in sexually motivated crimes and employs various methods. We reported four different strangulation cases at the Institute of Forensic Medicine, University of Palermo, to emphasize findings, forensic characteristics, and interpretation difficulties. The primary goal of this review is to shed light on homicidal strangulation's specific characteristics, given its underreported nature, and to stress the importance of mechanical asphyxia in forensic differential diagnosis. Distinguishing strangulation from other asphyxial deaths is difficult, as is identifying potential third-party involvement. This review also aims to provide key indicators that assist forensic pathologists in differentiating strangulation from other asphyxial causes of death. Future perspectives highlight the use of specific protocols, using artificial intelligence (AI), and instrumental investigations to support forensic pathologists in performing differential diagnoses and providing compatibility assessments.

Partner-Inflicted Brain Injury: Intentional, Concurrent, and Repeated Traumatic and Hypoxic Neurologic Insults

(1) Background: Traumatic brain injury (TBI) is caused from rapid head acceleration/deceleration, focal blows, blasts, penetrating forces, and/or shearing forces, whereas hypoxic-anoxic injury (HAI) is caused through oxygen deprivation events, including strangulation. Most service-seeking domestic violence (DV) survivors have prior mechanistic exposures that can lead to both injuries. At the time of our study, some evidence existed about the exposure to both injuries over the course of a survivor's lifetime from abuse sources, yet little was known about their co-occurrence to the same survivor within the same episode of physical intimate partner violence (IPV). To better understand the lived experience of service-seeking DV survivors and the context in which partner-inflicted brain injury (PIBI) is sustained, we sought to understand intentional brain injury (BI) exposures that may need to be addressed and accommodated in services. Our aims were to 1. characterize the lifetime co-occurrence of strangulation and intentional head trauma exposures from all abuse sources to the same survivor and within select physical episodes of IPV and 2. establish the lifetime prevalence of PIBI. (2) Methods: Survivors seeking DV services in the state of Ohio in the United States of America (U.S.) completed interview-administered surveys in 2019 (n = 47). Community-based participatory action approaches guided all aspects of the study development, implementation, and interpretation. (3) Results: The sample was primarily women. Over 40% reported having Medicaid, the government-provided health insurance for the poor. Half had less than a postsecondary education. Over 80% of participants presented to DV services with both intentional head trauma and strangulation exposures across their lifetime from intimate partners and other abuse sources (i.e., child abuse, family violence, peer violence, sexual assault, etc.), though not always experienced at the same time. Nearly 50% reported an experience of concurrent head trauma and strangulation in either the first or last physical IPV episode. Following a partner's attack, just over 60% reported ever having blacked out or lost consciousness-44% experienced a loss of consciousness (LOC) more than once-indicating a conservative estimate of a probable brain injury by an intimate partner. Over 80% of service-seeking DV survivors reported either a LOC or two or more alterations in consciousness (AICs) following an IPV attack and were classified as ever having a partner-inflicted brain injury. (4) Conclusions: Most service-seeking IPV survivors experience repetitive and concurrent exposures to abusive strangulation and head trauma through the life course and by intimate partners within the same violent event resulting in brain injury. We propose the use of the term partner-inflicted brain injury (PIBI) to describe the physiological disruption of normal brain functions caused by intentional, often concurrent and repeated, traumatic and hypoxic neurologic insults by an intimate partner within the context of ongoing psychological trauma, coercive control, and often past abuse exposures that could also result in chronic brain injury. We discuss CARE (Connect, Acknowledge, Respond, Evaluate), a brain-injury-aware enhancement to service delivery. CARE improved trauma-informed practices at organizations serving DV survivors because staff felt knowledgeable to address and accommodate brain injuries. Survivor behavior was then interpreted by staff as a "can't" not a "won't", and social and functional supports were offered.

Violent Partners or a Specific Class of Offenders? A Criminal Career Approach to Understanding Men Involved in Intimate Partner Sexual Violence

The current study investigates the criminal career of individuals involved in intimate partner sexual violence (IPSV). Specifically, the goal is to determine whether men who engage in IPSV can be distinguished from those who engage in intimate partner non sexual violence (IPNSV) only and whether criminal trajectories in the resulting subgroup are heterogeneous. The sample comes from a Canadian database including a total of 12,458 individuals involved in IPSV and 32,474 individuals involved in IPNSV). Bivariate and multivariate analyses are performed to examine the differences in the two groups while latent profile analysis allows examining the heterogeneity of characteristics of men who engaged in IPSV. Findings indicate that the criminal career of men who engage in IPSV follows a pattern that is clearly distinct from that of men who engage in IPNSV only and is more specialized in terms of sexual offenses. Results also show that the criminal trajectories followed by the men who engage in IPSV are heterogeneous. Four profiles of different trajectories were identified. Both theoretical and practical implications are discussed.

Factors Associated with Non-Fatal Strangulation Victimization in Intimate Relationships: A Meta-Analysis

Intimate partner violence (IPV) is a public health crisis across the globe, and one particular act of IPV, non-fatal strangulation, warrants serious attention. Non-fatal strangulation is a risk factor for intimate partner homicide (IPH) and can create long-term negative mental and physical health consequences. In this meta-analysis, we sought to examine factors associated with non-fatal strangulation victimization among women to help inform education and assessment efforts. Using database searches and Boolean search terms, a total of 16 studies met the inclusion criteria. A total of 16 factors that were found in at least two unique studies were examined. The strongest associated factors included physical IPV victimization, physical injury, IPH, and sexual IPV victimization. Other significant associated factors included lower education, anxiety symptoms, perceived risk of harm, post-traumatic stress symptoms, depressive symptoms, stalking victimization, and identifying as a Black woman. Experiencing childhood trauma, the length of the relationship, age, substance use, and identifying as Hispanic were not significantly related to strangulation victimization by an intimate partner. Education and assessment implications are discussed.

Intimate partner violence: A clinical update

ABSTRACT

Intimate partner violence (IPV) is a significant public health issue associated with substantial morbidity and mortality. NPs are ideally positioned to screen for and intervene in IPV, thereby mitigating the health risks IPV carries for women, infants, and young children. Safety planning and appropriate referrals to community-based resources are critical components of addressing IPV.

Unpacking Multiagency Structured Professional Judgment Risk Assessments for Family Violence

Assessing the risk for future harm is a crucial task for agencies managing Family Violence (FV) cases. The Integrated Safety Response (ISR) is a multiagency collaboration of such agencies operating in two areas of New Zealand, and one of the first steps in their process is to perform a risk assessment. However, in these assessments, it is unclear whether the factors ISR triage team members select are the basis for their overall risk categorization (low, medium, or high), and if those factors are risk factors (i.e., empirical predictors of outcomes). Therefore, in this study we documented the factors ISR triage teams recorded during their risk assessments for 842 FV cases and examined the relationship of those factors with the risk categories. We then investigated whether those factors and the risk categories were indeed capable of predicting FV-related outcomes (recurrence and physical recurrence). We found most of the triage teams' recorded factors were associated with the risk categories, but fewer than half of the factors were associated with FV-related outcomes. Moreover, the risk categories predicted FV-related outcomes better than chance, but their predictive ability varied across subgroups, performing poorly for aggressors who were Māori or women, and for non-intimate partner cases. We concluded that the ISR triage teams' risk assessment protocol may benefit from increased structure and validation.

Incidence and risk factors of intimate partner violence among patients with gynaecological cancer in China

AIM

The aim of this study is to examine the incidence and risk factors for intimate partner violence (IPV) among patients with gynaecological cancer.

DESIGN

A cross-sectional study design was employed.

METHODS

Patients with gynaecological cancer were recruited from a tertiary hospital in Shandong, China. Eligible patients completed a survey including questions regarding their demographic and cancer-related characteristics, IPV experience and dyadic coping.

RESULTS

A total of 429 patients were surveyed, 31% of them reported previous experiences with IPV, and negotiation was the most common type reported. The following variables were associated with IPV: a husband, wife and child/children family structure; a husband, wife, child/children and parent-in-law family structure; an annual household income ≥¥50,000 ($7207); and a similar or greater income earned by the patient than by her partner.

PATIENT OR PUBLIC CONTRIBUTION

IPV in patients with gynaecological cancer is investigated in this study.

Evaluating Measures of Intimate Partner Violence Using Consensus-Based Standards of Validity

The assessment of intimate partner violence (IPV) by mental health, medical, and criminal justice practitioners occurs routinely. The validity of the assessment instrument they use impacts practitioners' ability to judge ongoing risk, establish the type of IPV occurring, protect potential victims, and intervene effectively. Yet, there is no known compendium of existing assessment measures. The purpose of this article is threefold: (1) to present a systematic review of measures used to identify or predict IPV, (2) to determine which of these measures have psychometric evidence to support their use, and (3) to determine whether any existing measure is capable of differentiating between situational couple violence and intimate terrorism. A systematic search was conducted using PsycINFO, PsycARTICLES, PubMed, and MEDLINE. Studies on the reliability or validity of specific measures of IPV were included, regardless of format, length, discipline, or type of IPV assessed. A total of 222 studies, on the psychometric properties of 87 unique measures, met our a priori criteria and were included in the review. We described the reliability and validity of the 87 measures. We rated the measures based on the Consensus-based Standards for the Selection of Health Measurement Instruments-revised criteria and other established validity criteria, which allowed us to generate a list of recommended measures. We also discussed measures designed to differentiate IPV types. We conclude by describing the strengths and weaknesses of existing measures and by suggesting new avenues for researchers to enhance the assessment of IPV.

Relationship Health and Intimate Partner Violence in Integrated Primary Care: Individual Characteristics and Preferences for Relationship Support across Risk Levels

This study explores differences in characteristics and relationship treatment preferences across different levels of intimate partner violence (IPV) among Veterans Affairs (VA) primary care patients. In Fall 2019, we sent a mail-in survey assessing relationship healthcare needs to N = 299 Veterans randomly sampled from 20 northeastern VA primary care clinics (oversampling female and younger Veterans). We compared those reporting past year use or experience of physical/sexual aggression, threats/coercion, or injury (Severe IPV; 21%), to those only reporting yelling and screaming (Verbal Conflict; 51%), and denying any IPV (No IPV; 28%). Participants across groups desired 2-6 sessions of face-to-face support for couples' health and communication. No IPV participants were older and had preferred treatment in primary care. The Verbal Conflict and Severe IPV groups were both flagged by IPV screens and had similar interest in couple treatment and relationship evaluation. The Severe IPV group had higher rates of harms (e.g., depression, alcohol use disorder, relationship dissatisfaction, fear of partner) and higher interest in addressing safety outside of VA. Exploratory analyses suggested differences based on use vs. experience of Severe IPV. Findings highlight ways integrated primary care teams can differentiate services to address dissatisfaction and conflict while facilitating referrals for Severe IPV.

A Comprehensive Analysis of Factors Associated with Intimate Partner Femicide: A Systematic Review

There has been a growing concern about violence against women by intimate partners due to its incidence and severity. This type of violence is a severe problem that has taken the lives of thousands of women worldwide and is expected to continue in the future. A limited amount of research exclusively considers factors related only to these women's deaths. Most focus on deaths of both men and women in an intimate partnership and do not provide precise results on the phenomenon under study. The necessity for an actual synthesis of factors linked solely to women's deaths in heterosexual relationships is key to a comprehensive knowledge of that case. This could assist in identifying high-risk cases by professionals involving an interdisciplinary approach. The study's objective is to systematically review the factors associated with these deaths. Twenty-four studies found inclusion criteria extracted from seven databases (Dialnet, Web of Science, Pubmed, Criminal Justice, Psychology and Behavioral Science Collection, Academic Search Ultimate, and APA Psyarticles). The review was carried out under the PRISMA guidelines' standards. The studies' quality assessment complies with the MMAT guidelines. Findings revealed that there are specific factors of the aggressor, victim, partner's relationship, and environment associated with women's deaths. The results have implications for predicting and preventing women's deaths, providing scientific knowledge applied to develop public action programs, guidelines, and reforms.

Accounting for Multiple Nonfatal Strangulation in Intimate Partner Violence Risk Assessment

Nonfatal strangulation is a prevalent, underreported, and dangerous form of intimate partner violence (IPV). It is particularly important to assess for strangulation among abused women as this form of violence may not leave visible injury. The most severe negative physical and mental health consequences of strangulation appear to be dose-related, with those strangled multiple times or to the point of altered consciousness at higher risk of negative sequelae. This research examines the relationship between multiple strangulation, loss of consciousness due to strangulation, and risk of future near-fatal violence to modify the Danger Assessment (DA) and the Danger Assessment for Immigrant women (DA-I), IPV risk assessments intended to predict near-fatal and fatal violence in intimate relationships. Data from one study (n = 619) were used to modify the DA to include an item on multiple strangulation or loss of consciousness due to strangulation. Data from an independent validation sample (n = 389) were then used to examine the predictive validity of the updated DA and DA-I. The updated version of the DA predicts near-fatal violence at 7-8 months follow-up significantly better than the original DA. Adding multiple strangulation or loss of consciousness to the DA-I increased the predictive validity slightly, but not significantly. The DA and DA-I are intended to be used as a collaboration between IPV survivors and advocates as tools for education and intervention. Whether or not an IPV survivor has been strangled, she should be educated about the dangerous nature of strangulation and the need for medical intervention should her partner use strangulation against her. This evidence-based adaptation of the DA and DA-I may assist practitioners to assess for and intervene in dangerous IPV cases.

Intimate partner violence victimization and perpetration as precursors to suicide

It remains unclear how often and under what circumstances intimate partner violence (IPV) precedes suicide. Available research on IPV and suicide focuses largely on homicide-suicide, which is a rare event (<2% of suicides). We focus instead on single suicides (i.e., suicides unconnected to other violent deaths), which are the most common type of fatal violence in the US.

Unfortunately, information about IPV circumstances is often unavailable for suicides. To address this gap, we sought to identify the proportion of single suicides that were preceded by IPV in North Carolina (NC), to describe the prevalence of IPV victimization and perpetration as precursors to suicide, and to explore how IPV-related suicides differ from other suicides. We used data from the NC Violent Death Reporting System (2010–2017, n = 9682 single suicides) and hand-reviewed textual data for a subset of cases (n = 2440) to document IPV circumstances.

We had robust inter-rater reliability (Kappa: 0.73) and identified n = 439 IPV-related suicides. Most were males who had perpetrated nonfatal IPV (n = 319, 72.7%) prior to dying by suicide. Our findings suggest that IPV was a precursor for at least 4.5% of single suicides.

Next, we conducted logistic regression analyses by sex comparing IPV-related suicides to other suicides. For both men and women, IPV was more common when the person who died by suicide had recently disclosed suicidal intent, was younger, used a firearm, and was involved with the criminal legal system, even after controlling for covariates. We also found sex-specific correlates for IPV circumstances in suicide.

Combined with homicide-suicide data (reported elsewhere), IPV is likely associated with 6.1% or more of suicides overall. Results suggest clear missed opportunities to intervene for this unique subpopulation, such as suicide screening and referral in IPV settings (e.g., batterer intervention programs, Family Justice Centers) that is tailored by sex.

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Intimate partner violence is a precipitating factor for 4.5% of single suicides.

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Most IPV-related single suicides were of men who perpetrated nonfatal IPV.

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Decedents in IPV-related suicides often used a firearm and disclosed intent.

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Integrated prevention strategies to target both IPV and suicide may be appropriate.

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When combined with homicide-suicide data, IPV influences 6.1% of suicides overall.

Risk Assessment Instruments for Intimate Partner Femicide: A Systematic Review

Intimate partner violence is a severe problem that has taken the lives of thousands of women worldwide, and it is bound to continue in the future. Numerous risk assessment instruments have been developed to identify and intervene in high-risk cases. However, a synthesis of specific instruments for severe violence against women by male partners has not been identified. This type of violence has specific characteristics compared to other forms of intimate partner violence, requiring individualized attention. A systematic review of the literature has been conducted to summarize the intimate partner homicide risk assessment instruments applied to this population. It has been carried out with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. The search strategy yielded a total of 1,156 studies, and only 33 studies met eligibility criteria and were included in the review. The data of these studies were extracted, analyzed, and presented on study characteristics (country and year, sample, data sources, purpose of the studies) and main findings (a brief description of the instruments, risk factor items, psychometric properties). The results indicate that the Danger Assessment, the Danger Assessment for Immigrants, the Danger Assessment for Law Enforcement, the Danger Assessment-5, the Taiwan Intimate Partner Violence Danger Assessment, the Severe Intimate Partner Risk Prediction Scale, The Lethality Screen, and the H-Scale are specific risk assessment instruments for predicting homicide and attempted homicide. There are differences in the number and content of risk assessment items, but most of them include the evidence's critical factors associated with homicide. Validity and reliability scores of these instruments vary, being consistency and accuracy medium-high for estimating homicide. Finally, implications for prediction and prevention are noted, and future research directions are discussed.

Pregnant Victims of Intimate Partner Homicide in the National Violent Death Reporting System Database, 2003-2014: A Descriptive Analysis

Intimate partner homicide (IPH) is a leading cause of maternal mortality in the United States. However, very little information exists as to the circumstantial factors associated with IPH during pregnancy. We conducted a descriptive study of the demographic characteristics, psychosocial service engagement, and crises experiences (i.e., life and relationship stressors) among pregnant and nonpregnant victims to understand what differences, if any, exist in their risk profile for IPH. Data from the Centers for Disease Control and Prevention's National Violent Death Reporting System (NVDRS) were used for this study. The NVDRS is a national opt-in tracking system of all violent deaths in the United States. Pregnant victims (N = 293) were significantly more likely to be 5 years younger than nonpregnant victims, African American, and never married. Pregnant victims were more likely to be seen in the emergency room following the fatal incident. Nonpregnant victims (N = 2,089) were significantly more likely to have suspected alcohol use at the time of their death. In strictly proportional terms, we also observed higher rates of mental health problems, a history of mental health treatment, and a reported history of intimate partner violence (IPV), crisis, or family problems among nonpregnant victims. A wider range of IPH-related risk factors (e.g. substance abuse) need to be included IPV assessments. Future studies should seek to develop effective interventions to prevent IPH, particularly among reproductive aged women.

Barriers to help-seeking among intimate partner violence survivors with opioid use disorder

Intimate partner violence is common among people with opioid use disorder (OUD), but little research has focussed on identifying barriers survivors with OUD face when trying to leave an abusive relationship. Semi-structured interviews were conducted with 40 postpartum women with OUD. Interview questions were designed to identify barriers to help-seeking and facilitators and supports that have helped survivors make positive changes. Qualitative data were coded and analyzed, using a phenomenological approach to develop emerging themes. Most participants were white, 24-29 years old, single, unemployed, Medicaid insured, and used medications for OUD. All participants (n = 40, 100%) shared that a current or past partner physically, sexually, emotionally, or verbally abused them. Participants identified multiple barriers to help-seeking including abusive partner control of money and resources, fear of retaliatory violence, and concerns related to police and child welfare. Participants also described supports that helped them make positive changes, including being treated with care and support from domestic violence shelters and treatment programs. Finally, survivors offered suggestions for ways providers can better meet survivors' needs. Clinicians and policymakers should prioritize overcoming multiple barriers to service access and engagement faced by survivors and their children.

What is the role of firearms in nonfatal intimate partner violence? Findings from civil protective order case data

BACKGROUND

Perpetrators of intimate partner violence (IPV) use firearms to injure, scare, and manipulate their partners. Abusers who have a firearm in their homes are more likely to threaten and/or kill their partner. To date, however, limited research documents the nature of IPV perpetrator firearm access or the prevalence of nonfatal firearm abuse behaviors.

METHODS

Federal law restricts firearm access for IPV perpetrators in qualifying domestic violence protective order (DVPO) cases and information about firearms should be disclosed during the DVPO process. We used secondary data from civil DVPO cases (n = 406) in North Carolina that were collected using a representative sampling strategy. Data were from DVPO case files and structured DVPO hearing observations. We conducted a content analysis to record IPV perpetrator access to guns and reported firearm abuse behaviors. We used a linear regression analysis to determine whether IPV perpetrator gun access was associated with higher levels of reported abuse. We also examined factors associated with perpetration of nonfatal firearm abuse.

RESULTS

We found evidence of perpetrator firearm access in nearly half of all cases (46%, n = 108). Controlling for covariates, gun access was significantly associated with higher levels of reported IPV (b = 0.5, p < .001). Firearm abuse was reported in nearly one out of four cases (23.1%, n = 101), and often entailed spoken threats, displaying a gun, or holding a partner at gun point. The only factors associated with firearm abuse in the multivariate models were related to English language speaking/fluency.

CONCLUSIONS

Gun access should be considered an indicator for severe IPV. We must ensure that existing legal mechanisms to identify and restrict abuser access to firearms are fully implemented and enforced. Firearm abuse often manifests as non-physical coercive control which is traumatic and has the potential to escalate to homicide, even in the absence of past physical violence.

Women's Experiences of Sexual Violence in Intimate Relationships: Applying a New Taxonomy

How do women describe their experiences of sexual violence in their intimate relationships? In answering this question, the present article builds upon a newly developed taxonomy of intimate partner sexual violence (IPSV). Women with past or present intimate partner violence experience (N = 28) were recruited from a domestic violence program and the community at large. Data were collected with semistructured, in-person interviews, audio recorded, and transcribed. As defined by the taxonomy, 27 women (96%) experienced intimate partner sexual abuse; 19 (68%) experienced intimate partner sexual coercion; 14 (50%) experienced intimate partner sexual assault; and two (7%) experienced intimate partner-forced sexual activity. Intimate partner sexual abuse was central to women's experiences of IPSV. Common categories of sexual abuse were having sex outside of the relationship, controlling reproductive decisions, degrading with sexual criticism and insults, refusing communication, denying pleasure, and withholding sex. The types of IPSV did not typically occur in isolation; the taxonomy revealed a grouping pattern, with intimate partner sexual assault and intimate partner sexual coercion co-occurring with sexual abuse. Understanding the different types of IPSV as a comprehensive mechanism of sexual control is a meaningful way to conceptualize sexual violence in intimate relationships. The expanded taxonomy provides a useful therapeutic tool in helping women share and heal from these experiences.

Examining Relationship and Abuse Tactics Associated with Nonfatal Strangulation Experiences Before and After a Protective Order

Nonfatal strangulation is associated with significant physical harm and lethal violence. The overall objective of this study was to examine relationship and abuse tactics for women with (n = 369) and without (n = 276) nonfatal strangulation experiences the year before, and the year after, a civil protective order (PO) against an abusive (ex)partner was obtained. Furthermore, this study sought to examine which abuse tactics, including nonfatal strangulation, were associated with mental health status at follow-up. In the year before the PO, 57% of women experienced nonfatal strangulation and 12.4% experienced nonfatal strangulation in the year after the PO by their abusive (ex)partner. Those with nonfatal strangulation experiences in the year before the PO were 3.5 times more likely to experience nonfatal strangulation after the PO. Additionally, death threats in the year before the PO as well as having spent any time in the relationship with the abuser after the PO were uniquely associated with post-PO nonfatal strangulation. Furthermore, abuser control tactics and severe violence after the PO were significantly associated with mental health status at follow-up after controlling for baseline mental health status. Study results also suggest that those with nonfatal strangulation experiences may have an especially difficult time initiating and maintaining separation from abusive partners. Results suggest that there are specific risk factors to consider in tailoring PO protections, safety supports, and resources for those with prior nonfatal strangulation experiences.

United States ED Visits by Adult Women for Nonfatal Intimate Partner Strangulation, 2006 to 2014: Prevalence and Associated Characteristics

INTRODUCTION

Nonfatal intimate partner strangulation poses significant acute and long-term morbidity risks and also heightens women's risk for future femicide. The lifetime prevalence of nonfatal intimate partner strangulation has been estimated to be approximately 10%, or 11 million women, in the general United States population. Given the potential for significant health risks and serious consequences of strangulation, this study adds to the limited literature by estimating prevalence and describing the associated characteristics of strangulation-related visits among United States ED visits by adult women after intimate partner violence.

METHODS

Prevalence estimation as well as simple and multivariable logistic regression analyses were completed using data from the Nationwide Emergency Department Sample spanning the years 2006 to 2014.

RESULTS

The prevalence of strangulation codes was estimated at 1.2% of all intimate partner violence visits. Adjusting for visits, hospital characteristics, and visit year, higher odds of strangulation were noted in younger women, metropolitan hospitals, level I/II trauma centers, and non-Northeast regions. Increases in strangulation events among intimate partner violence-related visits in recent years were also observed.

DISCUSSION

A relatively low prevalence may reflect an underestimate of true nonfatal intimate partner strangulation visits owing to coding or a very low rate of ED visits for this issue. Higher odds of strangulation among intimate partner violence visits by women in more recent years may be due to increased recognition and documentation by frontline clinicians and coding teams. Continued research is needed to further inform clinical, postcare, and social policy efforts.

Persistence and Potential Lethality in Intimate Partner Violence: Evaluating the Concurrent and Predictive Validity of a Dual Risk Assessment Protocol

This study seeks to determine the concurrent and predictive validity of a dual risk assessment protocol. It combines the risk of persistence in intimate partner violence (IPV) measured via the Domestic Violence Screening Instrument-Revised (DVSI-R) with supplemental items from the Danger Risk Assessment (DRA) bearing on the risk of potential lethality. We further test whether this assessment protocol reproduces disparities by race and ethnicity found in the larger population. Using a sample of 4,665 IPV male defendants with a female victim, analyses support both types of criterion validity. The DRA risk score is associated with felony charges, incarceration at the initial arrest, and the frequency of subsequent dangerous behavior. Results also suggest minimal predictive bias or disparate impact by race and ethnicity. Incorporating supplemental items bearing on potential lethality risk adds important information concerning the risk management strategies of those involved in IPV.

Critical call for hospital-based domestic violence intervention: The Davis Challenge

BACKGROUND

Fifty percent of women killed in intimate partner violence (IPV) were seen by a health care provider within a year of their death. As guest speaker to Virginia Commonwealth University Trauma Center (VCU-TC), Dr. James Davis (Western Trauma Association past president) challenged VCU-TC to develop a hospital-based IPV program. This research examines the development and impact of an integrated hospital/VCU-TC-based IPV program.

METHODS

The IPV survey was carried out to determine need for training and screening. Hospital forensic nurse examiners case logs were evaluated to determine IPV prevalence. An integrated IPV program-Project Empower was developed, consisting of staff education, patient screening, victim crisis fund, and interdisciplinary sexual assault/domestic violence intervention team. Between 2014 and 2018, patients admitted with an IPV consult to Project Empower were entered into a secure database capturing demographics, mechanisms, income data, and social determinants of risk. Program feasibility was evaluated on patient engagement via screening and case management. Program impact was evaluated on crisis intervention, safety planning, and community referral.

RESULTS

Forensic nurse examiner data and IPV survey evaluation noted 20% IPV prevalence and lack of IPV screening and training. The IPV patients (N = 799) were women (90%), unmarried (79%) and African-American (60%). Primary mechanisms were firearm (44%) or stabbing (34%). Survivors were perpetrated by a cohabiting (42%) or dating partner (18%). Monthly income averaged US $622. Forty percent had no health insurance. Advocates provided 62% case management. Survivors received victim crisis funds (16%), safety planning (68%), crisis intervention (78%), sexual and domestic violence education (83%), and community referral (83%). Within 5 years, 35 (4%) were reinjured and seen in the emergency department. Thirty-one (4%) were readmitted for IPV-related injuries. Two deaths were attributed to IPV.

CONCLUSION

Critical call for hospital-based IPV intervention programs as a priority for trauma centers to adopt cannot be underestimated but can be answered in a comprehensive integrated model.

LEVEL OF EVIDENCE

Therapeutic, level I.

Linking partner violence survivors to supportive services: impact of the M Health Community Network project on healthcare utilization

BACKGROUND

Intimate partner violence (IPV) is associated with adverse health effects and increased healthcare utilization. Systems-level interventions have been shown to be effective in identifying and referring survivors but little is known about how these strategies impact future utilization. The objective of this study is to examine the impact of a systems-level response on healthcare utilization among patients screening positive for IPV from November 2016 to February 2019 in a large multi-specialty outpatient health system in the Midwest.

METHODS

Using electronic health record (EHR) data, we identified patients who screened positive for IPV (N = 756) and categorized their response as accepted printed material (N = 116), accepted direct referrals (N = 85), declined both (N = 271), or missing (N = 255). We used negative binomial models to model post-period utilization as a function of decision group, pre-period utilization, and clinical and demographic factors.

RESULTS

After controlling for demographic characteristics and baseline utilization, the printed materials and direct referral groups had higher utilization rates than those who declined printed materials and direct referral during the post-period for every type of service. However, these differences were only statistically significant for outpatient, behavioral health, and social work services. Specifically, the visit rate for patients receiving printed materials was two times higher (rate ratio: 2.18; 95% CI: 1.21, 3.94) for behavioral health services and three times higher (rate ratio: 3.33; 95% CI: 1.3, 8.52) for social work services compared to those who refused printed material and direct referral. For those opting for a direct referral, the visit rate was two times higher for outpatient services (rate ratio: 1.97; 95% CI: 1.13, 3.42) compared to those who refused.

CONCLUSIONS

Patients receiving printed materials or direct referrals had more social work and behavioral health visits, highlighting an important outcome of the protocol. However, higher utilization rates among outpatient services and a trend toward higher utilization of other services, including the emergency department, suggest greater health service utilization is not diminished by the systems level response-at least not within a two-year time frame.

Risk-Informed Intervention: Using Intimate Partner Violence Risk Assessment within an Evidence-Based Practice Framework

Intimate partner violence (IPV) is a pervasive problem in the United States. IPV is often repetitive and may escalate; in a small number of cases, IPV leads to homicide. This article presents an evidence-based practice (EBP) model for risk-informed social work intervention with survivors and perpetrators of IPV. The EBP model combines the best available research evidence, practitioner expertise, and client self-determination to guide the most appropriate intervention. IPV risk assessment instruments provide the best available evidence of future reassault, severe reassault, or homicide. Practitioners who implement IPV risk assessment can use their expertise to adjust risk scores and to suggest risk mitigation strategies for their clients. Examples of risk-informed social work practice include the safe removal of firearms, safety planning around separation, and mitigating the negative consequences of strangulation and sexual violence. Clients ultimately use their self-determination to decide which risk reduction strategies to implement. An EBP model can be used by social workers in all areas of practice to provide risk-informed social work interventions.

Suicide and Additional Homicides Associated with Intimate Partner Homicide: North Carolina 2004-2013

Intimate partner homicide (IPH) is a critical public health and safety issue in the USA. In this study, we determine the prevalence and correlates of perpetrator suicide and additional homicides following intimate partner homicide (IPH) in a large, diverse state with high quality data. We extract IPHs from the North Carolina Violent Death Reporting System for 2004-2013 and identify suicides and other homicides that were part of the same incidents. We analyze the likelihood (in odds ration form) of perpetrator suicide and additional homicides using logistic regression analysis. Almost all IPH-suicide cases were by men with guns (86.6%). Almost one-half of IPHs committed by men with guns ended with suicide. Male-perpetrated IPH incidents averaged 1.58 deaths if a gun was used, and 1.14 deaths otherwise. It is well-known that gun access increases the chance that a violent domestic relationship will end in death. The current findings demonstrate that gun IPH is often coupled with additional killings. As suicidal batterers will not be deterred from IPH by threat of punishment, the results underline the importance of preemption by limiting batterers' access to guns.

Differentiating among Attempted, Completed, and Multiple Nonfatal Strangulation in Women Experiencing Intimate Partner Violence

PURPOSE

Because identification of intimate partner violence (IPV) in health care settings is low and strangulation increases lethality risk among women experiencing IPV, we examined the prevalence and correlates of nonfatal strangulation among 1,008 women survivors of IPV.

METHODS

Trained researchers conducted semistructured interviews with women survivors of IPV referred by police. Multinomial logistic regression examined differential correlates of attempted, completed, and multiple strangulation.

RESULTS

Interviews were conducted with 71.14% of eligible women contacted by researchers. A high proportion (79.66%) of the women interviewed experienced attempted (11.70%), completed (30.16%), or multiple (37.80%) strangulation. Each form of strangulation was independently significantly associated with sexual violence when compared with no strangulation. African American women were at increased risk of attempted (adjusted relative risk ratio [ARR], 2.02; p < .05), completed (ARR, 1.79; p < .05), and multiple strangulation (ARR, 2.62; p < .001). Compared with no strangulation, multiple strangulation was associated with more IPV injury and risk factors for homicide, including loss of consciousness (ARR, 2.95; p < .05) and miscarriage (ARR, 5.08; p < .05). Women who had lost consciousness owing to strangulation were more likely to seek medical care than those who had been strangled but had not lost consciousness (p < .01).

CONCLUSIONS

Strangulation is a prevalent form of IPV that presents significant health risks to women. Women's health practitioners are optimally positioned to identify subtle signs and symptoms of strangulation, help women to understand the delayed sequelae and potential future fatality associated with strangulation, and connect them with appropriate resources to reduce the risk of morbidity and mortality.