HEALTHDAY: Ob-Gyns Should Screen for Domestic Abuse: Experts

Intimate partner violence can be psychological or physical, occurs at all levels of society

By Robert Preidt

TUESDAY, Jan. 24 (HealthDay News) -- Obstetricians and gynecologists should screen all patients for intimate partner violence, including during prenatal visits, according to new recommendations from the American College of Obstetricians and Gynecologists.

In addition, ob-gyns should offer patients support, and have referral and resource information on hand to give to patients who are victims of abuse.

Intimate partner violence includes physical injury, psychological abuse, sexual assault, progressive isolation, stalking, deprivation, intimidation and reproductive coercion. The goal of these behaviors is to establish control over a partner.

The violence can occur among both heterosexual and same-sex partners and at every level of society, regardless of age, gender, income levels, race, ethnicity, religion or educational background, according to a news release from the college.

About one in four women has been physically and/or sexually assaulted by a current or former partner, and nearly 324,000 pregnant women are abused by their partners each year in the United States, researchers have found.

Intimate partner violence has been linked to poor pregnancy outcomes, including poor weight gain, infection, fetal injury, preterm delivery, low birth weight and stillbirth.

Signs and symptoms that a woman is experiencing violence include physical injuries, chronic headaches, chronic pelvic pain, irritable bowel syndrome, and recurrent vaginal infections. Violence is often linked to depression, anxiety, substance abuse, unintended pregnancy and suicide.

"Women of all ages experience intimate partner violence, but it is most prevalent among reproductive-age women," Dr. Maureen Phipps, chair of the college's Committee on Health Care for Underserved Women, said in the news release. "We have a prime opportunity to identify and help women who are being abused by incorporating this screening into our routine office visits with each and every patient."

The recommendations are published in the February issue of the journal Obstetrics & Gynecology.

SOURCE: American College of Obstetricians and Gynecologists, news release, Jan. 23, 2012

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CDC: National Intimate Partner and Sexual Violence Survey

CDC’s National Intimate Partner and Sexual Violence Survey (NISVS) is an ongoing, nationally-representative telephone survey that collects detailed information on sexual violence, stalking, and intimate partner violence victimization of adult women and men in the United States. The survey collects data on past-year experiences of violence as well as lifetime experiences of violence. The 2010 survey is the first year of the survey and provides baseline data that will be used to track trends in sexual violence, stalking and intimate partner violence. CDC developed NISVS to better describe and monitor the magnitude of these forms of violence in the United States.

Highlights of 2010 Findings

Sexual violence, stalking, and intimate partner violence are widespread in the United States. The findings in this report underscore the heavy toll of this violence, the immediate impacts of victimization, and the lifelong health consequences.

Women are disproportionally affected by sexual violence, intimate partner violence and stalking.

• 1.3 million women were raped during the year preceding the survey.
• Nearly 1 in 5 women have been raped in their lifetime while 1 in 71 men have been raped in their lifetime.
• 1 in 6 women have been stalked during their lifetime. 1 in 19 men have experienced stalking in their lifetime.
• 1 in 4 women have been the victim of severe physical violence by an intimate partner while 1 in 7 men experienced severe physical violence by an intimate partner.
• 81% of women who experienced rape, stalking or physical violence by an intimate partner reported significant short or long term impacts related to the violence experienced in this relationship such as Post-Traumatic Stress Disorder (PTSD) symptoms and injury while 35% of men report such impacts of their experiences.
• Women who had experienced rape or stalking by any perpetrator or physical violence by an intimate partner in their lifetime were more likely than women who did not experience these forms of violence to report having asthma, diabetes, and irritable bowel syndrome.
• Men and women who experienced these forms of violence were more likely to report frequent headaches, chronic pain, difficulty with sleeping, activity limitations, poor physical health and poor mental health than men and women who did not experience these forms of violence.

Female victims of intimate partner violence experienced different patterns of violence than male victims.

• Female victims experienced multiple forms of these types of violence; male victims most often experienced physical violence.

The majority of this victimization starts early in life.

• Approximately 80% of female victims experienced their first rape before the age of 25 and almost half experienced the first rape before age 18 (30% between 11-17 years old and 12% at or before the age of 10).
• About 35% of women who were raped as minors were also raped as adults compared to 14% of women without an early rape history.
• 28% of male victims of rape were first raped when they were 10 years old or younger.
  

 Summary
Overall, lifetime and one year estimates for sexual violence, stalking and intimate partner violence were alarmingly high for adult Americans; with IPV alone affecting more than 12 million people each year. Women
are disproportionately impacted. They experienced high rates of severe intimate partner violence, rape and
stalking, and long-term chronic disease and other health impacts such as PTSD symptoms. NISVS also shows that most rape and IPV is first experienced before age 24, highlighting the importance of preventing this violence before it occurs to ensure that all people can live life to their fullest potential.

Centers for Disease Control and Prevention (CDC) Releases Latest Data on Deaths

“Surveillance for Violent Deaths — National Violent Death Reporting System, 16 States, 2008,” appears in the August 26, 2011 online edition of Morbidity and Mortality Weekly Report Surveillance Summaries (MMWR). 

 

Report Highlights:

The new report compiled data on 16,138 deaths in 2008 from 16 NVDRS states. A majority of these deaths were:

• Suicides (58.7%)
• Homicide/legal intervention deaths (26.4%)
• Deaths of undetermined intent (14.5%)

NVDRS provides a comprehensive picture by combining once fragmented pieces of information from:

• Death certificates
• Coroner/medical examiner reports
• Toxicology results
• Law enforcement reports
• And other reports related to each death

Data are used to inform prevention efforts by providing a more complete understanding of the circumstances preceding deaths in these 16 states.

To Learn More:

• View an electronic copy of this document.
• Data from the NVDRS states is available online through WISQARS™ (Web-based Injury Statistics Query and Reporting System)
• About CDC’s violence prevention efforts: www.cdc.gov/violenceprevention
• Follow the CDC on Facebook: www.facebook.com/vetoviolence

ABSTRACT

HOMICIDE PATTERNS

"Escalated interpersonal conflicts with an intimate partner, a friend, or another acquaintance remained the primary preceding circumstances for homicide. These circumstances were vastly more common than random acts of violence, hate crimes, or drive by shootings. For incidents with male victims, arguments with an acquaintance other than an intimate partner most often preceded homicide. Homicides with female victims were most often a result of intimate partner violence. Similar findings were provided in previous reports and studies (7--9,21). These findings provide more evidence that homicides are most commonly perpetrated by someone known to the victim, and strategies designed to reduce interpersonal and relationship conflicts might be valuable for prevention efforts.

Homicide-followed-by-suicide (i.e., homicide-suicide) incidents continued to be rare in 2008. However, they did account for the greatest proportion of violent incidents that involved multiple deaths. Similar to other reports and previous data years, perpetrators of homicide-suicide incidents were mostly white males of mid-late adulthood (i.e., aged 35--54 years) and victims were mostly females who were either current of former intimate partners of the perpetrator (21,23,24). As expected, intimate partner problems were among the most common circumstances preceding these incidents (7--9,21); however, job/financial problems and mental health problems were two to three times more common among perpetrators in 2008 versus those in 2007.  

PREVENTION OPPORTUNITIES

NVDRS continues to show that interpersonal conflicts and relationship problems, particularly with an intimate partner, are common circumstances preceding a violent event.

 In addition to demonstrating the need to address the situational stressors highlighted in this report, prevention strategies also need to focus on community level factors. For example, changing cultural and social norms (e.g., attitudes condoning the use of violence as a means of resolving conflict) and addressing the social and economic conditions within communities that often give rise to violence (e.g., inequities with regard to the distribution of and access to resources and opportunities, social isolation and lack of connectedness among persons, families, and communities) might further help prevent violence.

CONCLUSION

Accurate, timely, and comprehensive surveillance data can be used to monitor the occurrence of violence-related fatal injuries and assist public health and other authorities in the development, implementation, and evaluation of programs and policies that reduce and prevent violent deaths and injuries at the national, state, and local levels (36,37). Continued development and expansion of NVDRS is critical to the public health and criminal justice communities at the federal, state, and local levels that work to reduce the personal, familial, and societal costs of violence. Further efforts are needed to increase the number of states participating in NVDRS, with the ultimate goal of full national representation, including all 50 states, the District of Columbia, and U.S. territories. 

CIRCUMSTANCES - Circumstances preceding fatal injury, by manner of death --- National Violent Death Reporting System, 16 states, 2008 (ABSTRACTED)

SUICIDE/UNDETERMINED

• Intimate partner problem: problems with a current or former intimate partner that appear to have contributed to the suicide.
• Other legal problem: decedent was facing civil legal problems (e.g., a child custody or civil lawsuit).
• Perpetrator of interpersonal violence in previous month: decedent perpetrated interpersonal violence (e.g., being sought by police for assault or having been issued a restraining order resulting from recent violence) during the previous month.
• Victim of interpersonal violence in previous month: decedent was the target of interpersonal violence in the past month.

 HOMICIDE

• Other argument, abuse, conflict: conflict between decedent and suspect was over something other than money, property, or drugs.
• Jealousy ("lovers' triangle"): jealousy or distress over an intimate partner's relationship or suspected relationship with another person led to the homicide.
• Intimate-partner violence--related: homicide is related to conflict between current or former intimate partners; includes the death of actual intimate partners and nonintimate partner decedents killed to cause pain to an intimate partner (e.g., child or parent).

Key STATS - Suicides

30.9% - Intimate Partner Problem - 32.2% of Males and 25.9% Females who commit suicide.

27.9% - Crisis in past or impending 2 weeks - 29% Males and 24% Females

74.6% - Depression - 74.2% Males and 75.4 Females

9.3% - Anxiety - 8.4% Males and 11.4% Female

1.6% - PTSD

KEY STATS - Homicides

22.9% Married

10.2% Spouse/Intimate partner (current or former)

.8% Other intimate partner involvement

18.1% Females Age 35-44

18.7% Males Age 20-24

53.5% Black, Non-hispanic Males

50.7% White Females

52.2% Mudered at home

18.4% Intimate partner-violence-related - 7.6% Males and 51.6% Females

24.3% Assault/Homicide

KEY STATS - Undetermined Death

11.1% Intimate partner problem 

14.7% Crisis in past or impending 2 weeks

To see entire report, please visit the CDC's website.

Violence Against Women Can Take Lifelong Toll: Study Released

Research shows how rates of mental and physical illness rise, quality of life falls

By Serena Gordon
HealthDay Reporter
TUESDAY, Aug. 2 (HealthDay News) -- Women who've suffered from gender-based violence are more likely to develop anxiety disorders or other mental woes, experience physical and mental disabilities, and have worse quality of life than other women, new research shows.

Gender-based violence includes rape and other forms of sexual assault, intimate-partner violence (such as spouse abuse) and stalking.

Risks for these long-term problems rose with the intensity of abuse. For example, women who'd experienced three or four types of gender-based violence had 10 times the odds of developing an anxiety disorder than women who haven't experienced such violence, the study found. The odds of a woman who'd been subjected to such violence developing a substance abuse problem were almost six times higher than for a woman who hasn't experienced gender-based violence.

"Gender-based violence is a public health problem and occurs to many women. Women need to recognize that the social and psychological problems they are experiencing may be related to their past or current exposure to violence and not pass these reactions off to other causes," said the study's lead author, Susan Rees, a senior research fellow at the University of New South Wales in Sydney, Australia.

Results of the study are published in the Aug. 3 issue of the Journal of the American Medical Association.
In the United States, more than 20 percent of women have experienced intimate-partner violence, stalking or both. A full 17 percent have reported rape or attempted rape, according to background information in the study.

The data for Rees' study came from a national survey done in Australia on mental health and well-being. The survey included over 4,400 women between the ages of 16 and 85 years old.

In that group, 1,218 women (27 percent) reported experiencing at least one form of gender-based violence, while 139 had been exposed to three or more forms of gender-based violence.

The average age that women were first raped was 13 years old and 12 years old for sexual assault. The average age that women were beaten by a partner or stalked was 22 years old.

The more violence a woman was exposed to, the greater her risk of developing mental illnesses, according to the study.

For example, about 15 percent of women who had been subjected to one form of gender-based violence experienced post-traumatic stress disorder (PTSD). But, if women were subjected to three or more forms of gender-based violence, that number jumped to more than 56 percent, the investigators found.

Suicide rates were significantly higher for women who'd experienced gender-based violence. The average rate of attempted suicide was 1.6 percent for all women in the study, but it was 6.6 percent for women who'd experienced one form of violence, and 34.7 percent for women exposed to three or more types of violence.

Rates of physical and mental disabilities were also much higher for women who had experienced gender-based violence. These women also tended to report an impaired quality of life.

Even though the study team had expected the findings, "the extent and strength of the associations we found was surprising and very concerning," Rees said.

She noted that "the nature of gender-based violence is particularly insidious because it occurs in the very situations where the victim/survivor usually expects to enjoy conditions of safety, security and love, particularly the home."

Furthermore, this type of aggression "often occurs repeatedly, unlike other traumas such as exposure to natural disasters, so you get a compounding effect. Gender-based violence is unfortunately still largely considered a personal and private matter, making help-seeking very difficult for many women, so they rarely received the support trauma survivors need to assist recovery," Rees noted.

One U.S. expert said the findings need to be heeded closely.

"This study really demonstrated the extent of gender-based violence and the long-term consequences of violence against women," said Andrea Gielen, director of the Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health in Baltimore. "There are huge implications for health services; this is not just a one-time treatment in the ER for a broken bone. People who treat women for any health-related issues need to think about the extent that such violence can affect women," Gielen said.

Gielen added that in the United States, a measure of help is on the way. The federal government on Monday adopted recommendations from the Institute of Medicine on preventive services for women's health, and one new rule is that health care insurers must cover the cost of screening and counseling for domestic violence.
"Any woman is who experiencing gender-based violence needs to realize that there are things she can do, there are hotlines she can call, there are resources available," Gielen said. "Talking about the experience with an informed and supportive health professional is a good thing to do to move on."

More information
The U.S. Department of Health and Human Services Office on Women's Health has advice on how to help a friend who's being abused.

SOURCES: Susan Rees, Ph.D., Australian Research Council QE-11 Senior Research Fellow, Psychiatry Research and Teaching Unit, University of New South Wales, Sydney, Australia; Andrea Gielen, Sc.D., director, Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore; Aug. 3, 2011, Journal of the American Medical Association
 
Last Updated: Aug. 02, 2011
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