Doctors urged to screen women for domestic abuse

By Monte Morin, Los Angeles Times

January 21, 2013, 8:02 p.m.

 

Asking standard questions of female patients of childbearing age shows a 'moderate net benefit' and little risk, a federal advisory panel says.

Women of childbearing age should undergo screening for domestic violence and other forms of abuse while visiting their doctor or clinic, according to a recommendation published online Monday by an influential panel of medical experts that advises the federal government.

 

That recommendation, published in the Annals of Internal Medicine, marks a significant change from 2004 when the U.S. Preventive Services Task Force found insufficient evidence to support screenings for so-called intimate partner violence, or IPV.

 

Now, citing new evidence, the task force said that screening women for IPV with a list of standard questions showed a "moderate net benefit," while the risks associated with disclosing abuse were small.

"The bottom line is that more research is needed on how primary-care clinicians can effectively screen and protect all populations, including older and vulnerable adults, middle-aged women, men and children from abuse and violence," said Dr. David Grossman, a Seattle pediatrician and task force member.

The guidelines apply only to women aged 14 to 46 who do not show obvious signs of physical or sexual abuse that would otherwise prompt questions from healthcare providers. Though the report acknowledged that women of childbearing age were not the only people who suffered abuse at the hands of former or current intimate partners, evidence was still insufficient to recommend broader screenings, the authors said.If abuse is confirmed, physicians should provide patients with, or refer them to, intervention services, the panel said. Such services include counseling, home visits, information cards, community service referrals and mentor programs.

 

In a separate draft statement addressing child maltreatment, task force members said there wasn't enough evidence to recommend how clinicians could prevent abuse among children who lacked obvious symptoms.

 

Intimate partner violence includes physical violence, sexual abuse, psychological abuse, stalking and reproductive coercion — intimidation that increases the risk of unplanned pregnancy. The Centers for Disease Control and Preventionestimates that nearly 31% of women and 26% of men have experienced IPV in their lifetimes. Immediate health consequences include injury, death, sexually transmitted diseases, unintended pregnancy, psychological distress and premature births.

 

Screening for domestic violence is recommended by the American Congress of Obstetricians and Gynecologists for women of all ages. Other organizations, such as the American Medical Assn., encourage physicians to inquire about abuse in all patients as part of medical history, but do not recommend a specific screening format or list of questions.

 

Monday's recommendation by the task force could possibly steer organizations toward adopting a more standardized protocol, according to some healthcare providers.

 

"This is very significant," said Eric Ferrero, a Planned Parenthood spokesman who was not involved in the study. "It's just good practice to know a patient's health history, and we have been conducting screenings for a number of years. Hopefully, with this recommendation, it will be done more broadly."

In the case of Planned Parenthood, which treats about 3 million patients in 800 facilities, IPV screenings were sometimes the first time that patients spoke of or even acknowledged abuse, Ferrero said. "We know, at least anecdotally, that this first discussion has led some women to leave an abusive relationship."

 

The task force recommendation was based on a review of dozens of studies and interviews with more than 30,000 people. Screenings were conducted several ways. Some women were questioned face to face by their healthcare provider and others performed self-screenings, answering questions on either a computer or a printed questionnaire.

monte.morin@latimes.com

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

HealthDay

Copyright (c) 2012 HealthDay. All rights reserved.

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.

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
Copyright © 2011 HealthDay. All rights reserved.

Mental Health Consequences of Intimate Partner Abuse

Mindy B Mechanic; Terri L Weaver; Patricia A Resick;

California State University, Fullerton, CA, USA.

Battered women are exposed to multiple forms of intimate partner abuse. This article explores the independent contributions of physical violence, sexual coercion, psychological abuse, and stalking on symptoms of posttraumatic stress disorder (PTSD) and depression among a sample of 413 severely battered, help-seeking women. The authors test the unique effects of psychological abuse and stalking on mental health outcomes, after controlling for physical violence, injuries, and sexual coercion. Mean scores for the sample fall into the moderate to severe range for PTSD and within the moderate category for depression scores. Hierarchical regressions test the unique effects of stalking and psychological abuse, after controlling for physical violence, injuries, and sexual coercion. Psychological abuse and stalking contribute uniquely to the prediction of PTSD and depression symptoms, even after controlling for the effects of physical violence, injuries, and sexual coercion. Results highlight the importance of examining multiple dimensions of intimate partner abuse.

PMID: 18535306 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/18535306?ordinalpos=76&itool=EntrezSystem2.PEntrez....