Women's Health

Studies examine the prevalence, impact, and disclosure of domestic violence among women

From one-fourth to one-half of women will be victimized by intimate partner violence (IPV) in their adult lifetime. Although many abused women seek care in emergency departments (EDs), their abuse is rarely identified. Depending on IPV type, 11 to 21 percent of women are abused by more than one partner. The abuse lasts from less than 1 year to 5 years for most women; however, for 5 to 13 percent of women the duration is over 20 years, according to a new study. Women who have been victimized by IPV suffer poorer general health, inferior physical and mental health status, and greater depression and social isolation than women who have not been victims of IPV, concludes a second study. Both studies were supported by the Agency for healthcare Research and Quality (HS10909). Another AHRQ-supported study (HS11096) shows that use of computer prompts to ED physicians increases discussion of domestic violence when abused women seek care in the ED. All three studies are summarized here.

Thompson, R.S., Bonomi, A.E., Anderson, M., and others (2006, June). "Intimate partner violence: Prevalence, types, and chronicity in adult women." American Journal of Preventive Medicine 30(6), pp. 447-457.

Researchers conducted a telephone survey of a random sample of 3,429 women age 18 to 64 years who were predominantly white, educated, and employed, and who were enrolled in a large U.S. HMO from 2003 to 2005. They found that nearly half (44 percent) of women had suffered from some type of IPV in their adult lifetime (34 percent from physical/sexual abuse, and 35 percent from non-physical abuse such as anger, threats, or controlling behavior). Nearly 8 percent of women suffered from some type of IPV in the previous year and 15 percent in the past 5 years. Also, 45 percent of abused women suffered from more than one type of IPV.

Depending on IPV type, between 11 and 21 percent of women were abused by more than one partner and the median duration of abuse was less than 1 year to 5 years. However, average duration of IPV ranged from 4 years for forced sex to 8 years for controlling behavior. What's more, 15 percent of abused women were abused by 2 or more partners and 14 to 53 percent of them, depending on type of abuse, suffered from 20 or more abusive events. One-third to one-half of abused women suffered from a single episode or less than a year of physical abuse or threats, yet 5 to 13 percent of women suffered from abuse for over 20 years.

Domestic abuse was severe in many cases. Nearly two-thirds (61 percent) of abused women rated physical violence as moderately to extremely violent while the figures for forced sexual intercourse or forced sexual contact were 45 percent and 36 percent, respectively. Finally, women who were chronically exposed to a partner's threats or anger (63 percent) or cowed by controlling behavior (31 percent) rated the abuse as moderately to extremely violent. Women were more likely to suffer from domestic abuse if they were younger, had lower income, were single mothers, or had been abused as children.

Bonomi, A.E., Thompson, R.S., Anderson, M., and others (2006, June). "Intimate partner violence and women's physical, mental, and social functioning." American Journal of Preventive Medicine 30(6), pp. 458-466.

Women's physical, social, and mental functioning can decline dramatically in the wake of domestic violence. Compared with women who had never suffered from domestic abuse, women who had been abused recently (past 5 years) had much lower vitality and mental health scores, and were 2.4 times more likely to be depressed and 2.7 times more likely to be severely depressed. These women were also less likely to be socially involved, less trusting of people in the community where they resided, and reported more symptoms of poor health. Women who were abused over 5 years ago were also at increased risk for poorer health, but the effects were less pronounced.

When health effects by type of IPV were examined, women with recent physical and/or sexual IPV had substantially lower physical, social, and mental health functioning scores. They were also 4 times as likely to be severely depressed and nearly 3 times as likely to report fair or poor health. They were also less likely to be socially involved or to trust community members. Women who suffered from recent non-physical abuse (threats, put-downs, controlling behavior) had similar but less severe reduced health and functioning as victims of physical/sexual abuse.

The impact of IPV on health followed a logical time trend over a woman's adult years with more pronounced health effects associated with more recent abuse. Finally, when the association of IPV with health habits and behaviors was examined, it was found that women experiencing recent IPV were more likely to be current or former smokers or have engaged in risky behaviors and heavy or binge drinking in the past year.

Rhodes, K.V., Drum, M., Anliker, E., and others (2006, June). "Lowering the threshold for discussion of domestic violence." Archives of Internal Medicine 166, pp. 1107-1114.

Potential opportunities to intervene in cases of domestic violence (DV) are often missed, because clinicians are reluctant to bring up the issue with women they suspect may have been abused. Also, fear and shame make abused women unlikely to volunteer such information unless specifically asked. This recently published AHRQ-funded study evaluated the use of computer screening for DV. The authors found that allowing the patient to self-disclose DV risk as a part of a computer-based health risk assessment, with a prompt to the physician, increased discussions about DV between health care providers and women patients; however, it did not guarantee that DV was addressed during ED encounters.

The researchers randomized nonemergency female patients (age 18 to 65 years) who visited two EDs to two groups. One group took a self-administered computer-based health risk assessment. Depending on the women's answers, the computer prompted ED clinicians to ask women about DV. The other group received usual care. The researchers videotaped all ED visits and measured rates of DV discussion, disclosure, and services. Nearly 900 women were audiotaped and completed an exit questionnaire.

Based on their exit questionnaire, 26 percent of women in the urban ED and 21 percent in the suburban ED were currently at risk for current DV. In the urban ED, the computer prompt increased rates of DV discussion (56 vs. 45 percent of usual care visits), disclosure of DV (14 vs. 8 percent), and DV-related services provided (8 vs. 4 percent). Women at the suburban ED and those with private insurance or higher education were less likely to be asked about DV. Only half of cases (48 percent) in which ED providers received a prompt about a woman's potential DV risk led to discussions about DV. Yet both inquiries about and disclosures of abuse were associated with higher patient satisfaction with care.

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