Intimate Partner Violence

 


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Am Fam Physician. 2016 Oct 15;94(8):646-651.

  Patient information: See related handout on intimate partner violence.

Related editorial: Beyond Identificatiom of Patients Experiencing Intimate Partner Violence.

Author disclosure: No relevant financial affiliations.

Intimate partner violence (IPV) is a prevalent worldwide health problem, affecting women more commonly than men. IPV is underreported and underrecognized by health care professionals. Even when IPV is recognized, it remains an underaddressed issue. In addition to physical injury and death, IPV causes significant physical and psychiatric health problems commonly treated by family physicians. The U.S. Preventive Services Task Force recommends screening all female patients of childbearing age for IPV. There are several brief screening tools that have been proven effective at detecting IPV and that can be used in the office setting. Identification of IPV allows the physician to provide better care and improves health outcomes for the survivor. Family physician offices should provide patients with local and national resources. Thorough documentation of injuries sustained from abuse is critical. Although caring for patients unready to leave an abusive relationship may be challenging for the physician, continuous, supportive care improves patient outcomes.

Intimate partner violence (IPV) is a prevalent worldwide health problem, affecting women more commonly than men. It can include physical, emotional, sexual, and financial abuse, as well as control over contraception or pregnancy and medical care. IPV occurs in heterosexual and same-sex relationships. Patients who are being abused exhibit chronic physical and emotional symptoms in addition to injuries sustained as a result of physical and sexual violence. They are also at risk of death from homicide. IPV is largely underrecognized and underaddressed as a health issue. The World Health Organization has released guidelines to help physicians respond to IPV in women.1

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

All women of childbearing age should be screened for IPV. There is a low risk of negative effects from screening.

A

15, 16

Women who screen positive for IPV should receive intervention services.

C

15, 18, 26

There are multiple screening tools effective for IPV (Table 2).

C

15, 17, 21


IPV = intimate partner violence.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

All women of childbearing age should be screened for IPV. There is a low risk of negative effects from screening.

A

15, 16

Women who screen positive for IPV should receive intervention services.

C

15, 18, 26

There are multiple screening tools effective for IPV (Table 2).

C

15, 17, 21


IPV = intimate partner violence.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

Epidemiology

Because IPV is underreported, estimating true prevalence is difficult. Conservative estimates indicate that 20% to 30% of women in the United States have experienced IPV in their lifetime.24 More than 10% of female college students have reported unwanted sexual intercourse with a partner.2 IPV tends to be repetitive, with an escalation in frequency and severity over time.3 Homicide is a common consequence of IPV, resulting in more than 1,000 deaths in the United States each year.4,5 The initial episode of IPV usually occurs before 25 years of age.6

Factors that increase the risk of IPV include alcohol consumption, psychiatric illness, a history of violent relationships in childhood, and academic and financial underachievement.3,6,7

Studies have found higher rates of IPV in Native American and Alaska Native women.6 Immigrants have higher rates of IPV, but it is much less likely to be reported or recognized in this population.8 It is also common in same-sex relationships, among transgender women,9 and among women who are survivors of human trafficking.8 The incidence of IPV in men appears to be less than in women, but IPV is more likely to be under-reported in men.3,10

Acute and Chronic Health Outcomes

IPV can lead to acute health outcomes, including acute physical injury and homicide, as well as chronic health burdens. Table 1 lists short- and long-term health outcomes in women who are abused.2,11,12 IPV

The Authors

show all author info

DANIEL DICOLA, MD, is a clinical associate professor of family and community medicine at Thomas Jefferson University's Sidney Kimmel Medical College in Philadelphia, Pa., and is an attending physician at the Excela Health Family Medicine Residency in Latrobe, Pa....

ELIZABETH SPAAR, DO, is a physician in Pittsburgh, Pa.

Address correspondence to Daniel DiCola, MD, Sidney Kimmel Medical College, Thomas Jefferson University, 1 Mellon Way, Latrobe, PA 15650 (e-mail: ddicola@excelahealth.org). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. World Health Organization. Responding to intimate partner violence and sexual violence against women. 2013. http://www.who.int/reproductivehealth/publications/violence/9789241548595/en/. Accessed May 19, 2015....

2. Chang JC. Intimate partner violence: how you can help female survivors. Cleve Clin J Med. 2014;81(7):439–446.

3. Carmo R, Grams A, Magalhães T. Men as victims of intimate partner violence. J Forensic Leg Med. 2011;18(8):355–359.

4. Stöckl H, Devries K, Rotstein A, et al. The global prevalence of intimate partner homicide: a systematic review. Lancet. 2013;382(9895):859–865.

5. Violence Policy Center. When men murder women: an analysis of 2010 Homicide Data. September 2012. http://www.vpc.org/studies/wmmw2012.pdf. Accessed April 15, 2015.

6. Breiding MJ, Smith SG, Basile KC, Walters ML, Chen J, Merrick MT. Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization—national intimate partner and sexual violence survey, United States, 2011. MMWR Surveill Summ. 2014;63(8):1–18.

7. Centers for Disease Control and Prevention. Intimate partner violence: risk and protective factors. http://www.cdc.gov/ViolencePrevention/intimatepartnerviolence/riskprotectivefactors.html. Accessed May 10, 2015.

8. Modi MN, Palmer S, Armstrong A. The role of Violence Against Women Act in addressing intimate partner violence: a public health issue. J Womens Health (Larchmt). 2014;23(3):253–259.

9. Ard KL, Makadon HJ. Addressing intimate partner violence in lesbian, gay, bisexual, and transgender patients. J Gen Intern Med. 2011;26(8):930–933.

10. Black MC, et al. Prevalence of sexual violence against women in 23 states and two U.S. territories, BRFSS 2005. Violence Against Women. 2014;20(5):485–499.

11. de Sousa J, Burgess W, Fanslow J. Intimate partner violence and women's reproductive health. Obstetr Gynaecol Reprod Med. 2014;24(7):195–203.

12. Pavey AR, Gorman GH, Kuehn D, Stokes TA, Hisle-Gorman E. Intimate partner violence increases adverse outcomes at birth and in early infancy. J Pediatr. 2014;165(5):1034–1039.

13. McFarlane JM, Groff JY, O'Brien JA, Watson K. Behaviors of children who are exposed and not exposed to intimate partner violence. Pediatrics. 2003;112(3 pt 1):e202–e207.

14. MacMillan HL, Wathen CN. Children's exposure to intimate partner violence. Child Adolesc Psychiatr Clin N Am. 2014;23(2):295–308, viii–ix.

15. Moyer VA. Screening for intimate partner violence and abuse of elderly and vulnerable adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;158(6):478–486.

16. U.S. Preventive Services Task Force. Intimate partner violence and abuse of elderly and vulnerable adults: screening. January 2013. http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/intimate-partner-violence-and-abuse-of-elderly-and-vulnerable-adults-screening. Accessed April 1, 2016.

17. O'Doherty LJ, Taft A, Hegarty K, Ramsay J, Davidson LL, Feder G. Screening women for intimate partner violence in healthcare settings: abridged Cochrane systematic review and meta-analysis. BMJ. 2014;348:g2913.

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19. Paranjape A, Liebschutz J. STaT: a three-question screen for intimate partner violence. J Womens Health (Larchmt). 2003;12(3):233–239.

20. Brown JB, Lent B, Brett PJ, Sas G, Pederson LL. Development of the Woman Abuse Screening Tool for use in family practice. Fam Med. 1996;28(6):422–428.

21. Rabin RF, Jennings JM, Campbell JC, Bair-Merritt MH. Intimate partner violence screening tools: a systematic review. Am J Prev Med. 2009;36(5):439–445.e4.

22. MacMillan HL, Wathen CN, Jamieson E, et al.; McMaster Violence Against Women Research Group. Approaches to screening for intimate partner violence in health care settings: a randomized trial. JAMA. 2006;296(5):530–536.

23. Friedman LS, Samet JH, Roberts MS, Hudlin M, Hans P. Inquiry about victimization experiences. A survey of patient preferences and physician practices. Arch Intern Med. 1992;152(6):1186–1190.

24. Centre for Children and Families in the Justice System. Helping children thrive. 2004. http://www.lfcc.on.ca/HCT_SWASM_7.html. Accessed April 1, 2016.

25. World Health Organization. Understanding and addressing violence against women: intimate partner violence. 2012. http://www.who.int/iris/bitstream/10665/77432/1/WHO_RHR_12.36_eng.pdf?ua=1.%25202012. Accessed February 3, 2016.

26. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 554: reproductive and sexual coercion. Obstet Gynecol. 2013;121(2 pt 1):411–415.

27. Snider C, Webster D, O'Sullivan CS, Campbell J. Intimate partner violence: development of a brief risk assessment for the emergency department. Acad Emerg Med. 2009;16(11):1208–1216.

28. Shavers CA. Intimate partner violence: a guide for primary care providers. Nurse Pract. 2013;38(12):39–46.

29. García-Moreno C, Zimmerman C, Morris-Gehring A, et al. Addressing violence against women: a call to action [published correction appears in Lancet. 2015; 385(9978):1622]. Lancet. 2015;385(9978):1685–1695.

30. Cronholm PF, Fogarty CT, Ambuel B, Harrison SL. Intimate partner violence. Am Fam Physician. 2011;83(10):1165–1172.



 

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