Intimate partner violence: what are physicians' perceptions?

BACKGROUND: Intimate partner violence (IPV) is common in primary care; 11% to 22% of women experienced physical abuse in the past year. Older women experience IPV as well, but it is often undetected. This study examined primary care providers' awareness about IPV in older women, including their screening practices and management. METHODS: Interviews and focus groups were conducted with 44 primary care providers. Thematic analysis was used to identify common themes. RESULTS: Providers fell along a continuum of thoroughness for identifying and managing IPV in older women, ranging from suboptimal to thorough identification of IPV and suboptimal to thorough management of the patient. In addition to the barriers commonly reported about IPV screening in younger women, providers described limited understanding of the diagnoses commonly associated with IPV, frustration with older women's unwillingness to disclose problems and ask for help, and limited community services that accommodate older women with IPV. Providers recommended that communities sponsor public awareness campaigns about IPV as a problem for all women and that aging and IPV agencies work together. CONCLUSIONS: Continued provider training about IPV should include information on identifying older victims and appropriate management options. Participants stressed the importance of community efforts to raise awareness and improve resources available for older women who are victims of IPV.     

Gay men and intimate partner violence: a gender analysis

Though intimate partner violence (IPV) is predominately understood as a women's health issue most often emerging within heterosexual relationships, there is increasing recognition of the existence of male victims of IPV. In this qualitative study we explored connections between masculinities and IPV among gay men. The findings show how recognising IPV was based on an array of participant experiences, including the emotional, physical and sexual abuse inflicted by their partner, which in turn led to three processes. Normalising and concealing violence referred to the participants’ complicity in accepting violence as part of their relationship and their reluctance to disclose that they were victims of IPV. Realising a way out included the participants’ understandings that the triggers for, and patterns of, IPV would best be quelled by leaving the relationship. Nurturing recovery detailed the strategies employed by participants to mend and sustain their wellbeing in the aftermath of leaving an abusive relationship. In terms of masculinities and men's health research, the findings reveal the limits of idealising hegemonic masculinities and gender relations as heterosexual, while highlighting a plurality of gay masculinities and the need for IPV support services that bridge the divide between male and female as well as between homosexual and heterosexual.     

Physically Abused Pregnant Women's Perceptions About the Quality of Their Relationships with Their Male Partners

SUMMARY

Objectives. Most studies of pregnant victims of intimate partner violence have focused on the violent behaviors, without examining other potentially important dimensions of the relationships. This research studies pregnant abuse victims to examine the frequency of violent behaviors occurring during pregnancy, how women characterize the quality of their relationships, and the association between violence frequency and women's perceptions concerning the overall quality of their relationships.

Methods. Eighty-one women who were physically abused by intimate partners during pregnancy were interviewed. Information was collected concerning the women's: experiences of partner violence during pregnancy; perceptions of other aspects of the quality of their relationships; and sociodemographic characteristics.

Results. The most frequent type of violent behavior occurring during pregnancy was verbal aggression, followed by minor violence, and then severe violence. Men perpetrated each type of violent behavior at significantly higher rates than did their female partners. In general, the women were quite negative in their characterizations of many dimensions of their relationships, as well as in their perceptions concerning the overall quality of their relationships, with women who had been victims of more frequent violence being significantly more likely to characterize their relationships as being of lower overall quality (OR = 3.5, 95% CI = 1.4–8.7).

Conclusions. Prenatal care providers are encouraged to screen their patients for intimate partner violence, and to work with others in their community to assure that women in abusive situations are offered appropriate services/interventions including safe and feasible alternatives to staying in unsatisfactory relationships with abusive partners.     

Physically abused pregnant women's perceptions about the quality of their relationships with their male partners

OBJECTIVES: Most studies of pregnant victims of intimate partner violence have focused on the violent behaviors, without examining other potentially important dimensions of the relationships. This research studies pregnant abuse victims to examine the frequency of violent behaviors occurring during pregnancy, how women characterize the quality of their relationships, and the association between violence frequency and women's perceptions concerning the overall quality of their relationships. METHODS: Eighty-one women who were physically abused by intimate partners during pregnancy were interviewed. Information was collected concerning the women's: experiences of partner violence during pregnancy; perceptions of other aspects of the quality of their relationships; and sociodemographic characteristics. RESULTS: The most frequent type of violent behavior occurring during pregnancy was verbal aggression, followed by minor violence, and then severe violence. Men perpetrated each type of violent behavior at significantly higher rates than did their female partners. In general, the women were quite negative in their characterizations of many dimensions of their relationships, as well as in their perceptions concerning the overall quality of their relationships, with women who had been victims of more frequent violence being significantly more likely to characterize their relationships as being of lower overall quality (OR = 3.5, 95% CI = 1.4-8.7). CONCLUSIONS: Prenatal care providers are encouraged to screen their patients for intimate partner violence, and to work with others in their community to assure that women in abusive situations are offered appropriate services/interventions including safe and feasible alternatives to staying in unsatisfactory relationships with abusive partners.     

How do women in Spain deal with an abusive relationship?

OBJECTIVES: To determine the different responses adopted by women in Spain who are victims of intimate partner violence (IPV); identify the different sociodemographic profiles associated with each response; analyse the factors contributing to adopting a response; and study the association between the different types of response and the different types of IPV. DESIGN: Cross sectional study. SETTING: 23 volunteer general practices in Spain. PARTICIPANTS: 1402 randomly selected women. MAIN OUTCOME MEASURE: Women's response to IPV: none, partner separation, reporting the case to the police, seeking help from healthcare professionals and seeking help from associations for battered women. RESULTS: Lifetime prevalence of any type of IPV (physical, psychological, and/or sexual) was 32%. Sixty three per cent of abused women took some kind of action to overcome IPV. Women who separated from their partners were mostly younger, with a smaller number of children and higher income and educational levels, compared with those abused women who reported the abuse to the police or sought help from healthcare professionals or associations for battered women. Independent factors associated with presenting a response to IPV were: being separated/divorced/widowed, having social support, having experienced IPV frequently, and having experienced physical and psychological abuse (compared with psychological abuse alone). Women who experienced the three types of abuse were also more likely to respond to violence. CONCLUSIONS: Identifying the factors that have an influence on the response adopted by abused women allows us to better understand the support needed by them to abandon an abusive relationship.     

Intimate partner violence and the power of love: A qualitative systematic review

Abstract

Intimate partner violence (IPV) is a crime encompassing physical, psychological, financial, emotional, and sexual abuse by a current or former partner. The presence of love in abusive relationships tends to be marginalized in healthcare discourses. The authors' aim in this qualitative systematic literature review was to explore the interplay between IPV and romantic love and their impacts on women. The review provides a rare (but much needed) explanation and acknowledgement that love does sometimes exist in abusive relationships. These insights will assist healthcare workers in offering empathic care to women, based on understandings of the complex and highly unsettled nature of love in abusive relationships.     

Missed opportunities: intimate partner violence in family practice settings

BACKGROUND: For women experiencing partner violence, women health care visits represent opportunities for physicians and patients to address intimate partner violence (IPV), a significant health threat for women. OBJECTIVES: The objectives were to estimate rates of physician documentation of IPV in medical records; characterize IPV+ women most likely to have IPV documented; and determine whether IPV screening increased IPV documentation. METHODS: Subjects were women ages 18-65 receiving primary care in two large family practice clinics. All were screened for IPV by study staff using a modified Index of Spouse Abuse and the Women's Experience with Battering scales. We selected and abstracted medical records for all women experiencing current IPV (N = 144) and a random sample of women never experiencing IPV (N = 147). RESULTS: Of 144 women screened as currently experiencing IPV, 14.7% were documented. Women most likely to have IPV documented were Caucasian, with higher WEB scores, and more likely to have an event that could trigger posttraumatic stress syndrome. Although the majority (41/56) of women currently in physically violent relationships did not plan to disclose IPV, those disclosing were significantly more likely to have IPV documented and documentation occurred after screening for 60% of women experiencing IPV. CONCLUSION: IPV screening increased documentation. IPV screening can provide the opportunity for patients to disclose IPV. Physicians then have the opportunity to compassionately connect patients with appropriate resources.     

Child Abuse,Risk in Male Partner Selection,and Intimate Partner Violence Victimization of Women of the European Union

The revictimization of women during the life cycle has attracted the interest of many researchers in recent years. In this study, we examined the relationship between the experience of child abuse and the subsequent victimization by a male partner in adulthood. Specifically, we proposed that childhood abuse experiences negatively affect the development of healthy interpersonal relationships in adulthood. Thus, some female victims of child abuse are more likely to select potentially abusive intimate male partners. Data from 23,863 heterosexual women from the 28 countries of the European Union who were living with their partners at the time of the study were used. We investigated the association between child abuse, partner’s adherence to traditional gender roles, and general violence and intimate partner violence (IPV) against women. Multilevel structural equation modeling (MSEM) results indicated that child abuse is positively related to the partner’s traditional gender role and general violence, which in turn predict IPV. Countries’ level of human development was found to affect this process. We found support for the hypothesis that child abuse is related to IPV partially because it influences partner selection in adulthood. Thus, when they become adults, girls abused in childhood tend to select partners who are either traditional or generally violent. There is a persistent influence of social structural conditions (i.e., country’s human development) throughout this process.     

Intimate partner abuse of women: identification of victims in medical practice

Intimate partner abuse is world-wide much more prevalent than often suspected. Three female patients consulted their family doctor with a variety of complaints. A 53-year-old woman, mother of three grown-up children, and divorced a year ago, sought help after four days, for a large infected wound of her right hand. A 32-year-old single mother of a 2-year-old girl asked the practice assistant for an iteration of a tranquillizer because of tension headache. A 36-year-old divorced mother of three sons was sent by her company doctor to ask for a referral to a psychiatrist because of chronic fatigue. All three women appeared to have been severely abused by their partners, recently or in the past, and were reluctant to disclose the abuse. Two women were regular visitors of doctor's offices with diverse unspecific complaints. The third woman was a victim of sexual abuse as a child and was severely depressed. Active asking about experiences of intimate partner abuse helped these women to disclose the real nature of their problem. Important effect is that abused women can accept help and experience support to improve their situation. Doctors should suspect intimate partner abuse more often in patients who are heavy medical consumers, depressed or victims of sexual abuse in childhood. Single and divorced mothers can hide a history of abuse. Doctors should ask clear and specific questions about relationships and listen without passing judgement so as to help women to disclose abuse.     

An examination of intimate partner violence in rural communities: results from a hospital emergency department study from Southwest United States

Intimate partner violence (IPV) affects women disproportionately, women being 5-8 times more likely than men to be victimized by their intimates. Women in abusive relationships use a disproportionate share of health care services, including more visits to the emergency departments. Female clients from two hospital emergency departments in the rural Southwest were recruited and administered semistructured interviews. Study findings indicate the prevalence and pervasiveness of IPV among study participants and illustrate the significant effects of and predictive nature of three factors associated with abuse in the past to current IPV.     

What do abused women expect from their family physicians? A qualitative study among women in shelter homes

OBJECTIVE: To gain insight into the needs and expectations of abused women in shelter homes, with regard to family physicians. METHODS: Twelve women in two shelter homes were interviewed. The interview focused on women's experiences and expectations of family physicians regarding the abuse situation. RESULTS: Eight women did not disclose intimate partner abuse to their family physicians. The main reasons were shame and fear of retaliation. Six women suffered from extreme controlling behavior by their partners, which made it impossible to seek help. Four women were not aware of the relationship between abuse by a partner and physical symptoms. Women mainly wanted a solution for physical problems and were ambivalent about help to tackle their problems with abuse. The majority of the women found the family physician's attitude of great importance and considered it a task of the family physician to provide assistance. CONCLUSION: Although the family physician did not play an important role in solving the problems for victims of intimate partner abuse living in shelter homes, an open and empathic attitude was of great importance to these women. Women also expressed the need for assistance by their physician and emphasized that it was important to keep asking about partner abuse, even in case of denial.     

The disconnected self: consequences of abuse in a cohort of low-income white women living with HIV/AIDS

An infrequently acknowledged social factor influencing the health of low-income women is a history of physical/emotional abuse. In this article I address how abusive relationships influenced women's self-care practices. In this grounded theory study, vulnerability to abuse was established before diagnosis of HIV infection and promoted "lingering images" of a damaged self. The damaged self-images that grew out of abusive relationships provided a barrier to self-care. Data analysis uncovered a core category of disconnection from self-care. Experiences of being cared for, particularly the care of health professionals, offered supportive relationships that encouraged women to care for themselves through self-care practices.     

Partner violence and medical encounters: African-American women's perspectives

OBJECTIVE: To examine the relationship between intimate partner violence (IPV) victimization and patient satisfaction with medical encounters among an African-American population. DESIGN: Cross-sectional, self-administered, anonymous survey. SETTING: Community-based, primary care center. PATIENTS: Consecutive African-American women recruited from an urban health center. A total of 102 women provided sufficient information to reveal whether they were currently experiencing IPV and to allow us to assess their experiences in their most recent primary care encounter. MEASUREMENTS: Patients' perceptions of their most recent encounter using questions adopted from the Medical Interview Satisfaction Scale and Consultation Satisfaction Questionnaire. We used the Conflicts Tactics Scale, supplemented with questions measuring sexual violence and emotional abuse, to assess IPV "in the past year." RESULTS: Women who reported current IPV rated several aspects of the encounter more negatively than did women who did not report current abuse. The IPV victims were less likely to report that they felt respected and accepted during the encounter, and they provided lower ratings of the quality of communication with their providers. CONCLUSIONS: It is unclear why victims of partner violence experience medical encounters as less satisfactory. Researchers need to expand studies of medical encounters as experienced by abused women to determine whether IPV status adversely affects general medical care.     

Victims of chronic dating violence: How women's vulnerabilities link to their decisions to stay*

Abstract: This article describes relational and situational vulnerabilities that emerged from interviews with 28 women (7 Black and 21 White) who were victims of chronic abuse suffered at the hands of male dating partners. Based on a qualitative content analysis, we explore how these vulnerabilities relate to women's decisions to stay in their abusive relationships and consider the implications of racial differences that emerged. Prevention and intervention strategies that help women see themselves as active choice makers are discussed.     

Nurses’ and physicians’ attitudes about women abuse: The effects of gender and professional role

The apathy encountered by battered women when they seek help from medical and other professions has been attributed to patriarchal norms and victim‐blaming. Because of their place in the medical hierarchy this study hypothesized that: a) nurses would have more sympathetic attitudes toward battered women than physicians; and b) professional roles and not gender would explain the differences. The findings supported the first but not the second hypothesis. Nurses were less likely to believe that wife‐beating is justified and that victims are responsible for the abuse. Women, regardless of profession, were more sympathetic than men. Nurses and physicians with the most liberal attitudes about women's roles were least likely to blame victims. Those with the most intensive training on the topic held victims less responsible and were more willing to help them.     

Risk factors for femicide in abusive relationships: results from a multisite case control study

OBJECTIVES: This 11-city study sought to identify risk factors for femicide in abusive relationships. METHODS: Proxies of 220 intimate partner femicide victims identified from police or medical examiner records were interviewed, along with 343 abused control women. RESULTS: Preincident risk factors associated in multivariate analyses with increased risk of intimate partner femicide included perpetrator's access to a gun and previous threat with a weapon, perpetrator's stepchild in the home, and estrangement, especially from a controlling partner. Never living together and prior domestic violence arrest were associated with lowered risks. Significant incident factors included the victim having left for another partner and the perpetrator's use of a gun. Other significant bivariate-level risks included stalking, forced sex, and abuse during pregnancy. CONCLUSIONS: There are identifiable risk factors for intimate partner femicides.     

Partner violence and medical encounters: African-American women’s perspectives

Objective: To examine the relationship between intimate partner violence (IPV) victimization and patient satisfaction with medical encounters among an African-American population.Design: Cross-sectional, self-administered, anonymous survey.Setting: Community-based, primary care center.Patients: Consecutive African-American women recruited from an urban health center. A total of 102 women provided sufficient information to reveal whether they were currently experiencing IPV and to allow us to assess their experiences in their most recent primary care encounter.Measurements: Patients’ perceptions of their most recent encounter using questions adopted from the Medical Interview Satisfaction Scale and Consultation Satisfaction Questionnaire. We used the Conflicts Tactics Scale, supplemented with questions measuring sexual violence and emotional abuse, to assess IPV “in the past year.”Results: Women who reported current IPV rated several aspects of the encounter more negatively than did women who did not report current abuse. The IPV victims were less likely to report that they felt respected and accepted during the encounter, and they provided lower ratings of the quality of communication with their providers.Conclusions: It is unclear why victims of partner violence experience medical encounters as less satisfactory. Researchers need to expand studies of medical encounters as experienced by abused women to determine whether IPV status adversely affects general medical care.     

Role of victims' services in improving intimate partner violence screening by trained maternal and child health-care providers--Boston, Massachusetts, 1994-1995

From 1992 to 1996, approximately 1 million incidents of nonfatal intimate partner violence (IPV) occurred each year in the United States; 85% of victims were women. In 1989, pediatric research found a concurrence of victimization of mothers and their children and supported a recommendation that maternal and child health-care providers (HCPs) pursue training and advocate for increased access to services to promote the safety and well-being of mothers and their children. From 1992 to 1997, the Pediatric Family Violence Awareness Project (PFVAP), a training project for maternal and child HCPs, promoted prevention of and intervention for IPV in Massachusetts. In 1994, PFVAP conducted a pilot evaluation in two urban community health centers to determine whether HCPs trained to conduct IPV assessment would increase their screening rates of women at risk for IPV if an on-site referral service for victims was available. This report summarizes the results of the pilot project, which indicate that IPV screening rates did not increase after implementing on-site victim service.     

Physical and mental health effects of intimate partner violence for men and women

BACKGROUND: Few population-based studies have assessed the physical and mental health consequences of both psychological and physical intimate partner violence (IPV) among women or men victims. This study estimated IPV prevalence by type (physical, sexual, and psychological) and associated physical and mental health consequences among women and men. METHODS: The study analyzed data from the National Violence Against Women Survey (NVAWS) of women and men aged 18 to 65. This random-digit-dial telephone survey included questions about violent victimization and health status indicators. RESULTS: A total of 28.9% of 6790 women and 22.9% of 7122 men had experienced physical, sexual, or psychological IPV during their lifetime. Women were significantly more likely than men to experience physical or sexual IPV (relative risk [RR]=2.2, 95% confidence interval [CI]=2.1, 2.4) and abuse of power and control (RR=1.1, 95% CI=1.0, 1.2), but less likely than men to report verbal abuse alone (RR=0.8, 95% CI=0.7, 0.9). For both men and women, physical IPV victimization was associated with increased risk of current poor health; depressive symptoms; substance use; and developing a chronic disease, chronic mental illness, and injury. In general, abuse of power and control was more strongly associated with these health outcomes than was verbal abuse. When physical and psychological IPV scores were both included in logistic regression models, higher psychological IPV scores were more strongly associated with these health outcomes than were physical IPV scores. CONCLUSIONS: Both physical and psychological IPV are associated with significant physical and mental health consequences for both male and female victims.     

Loneliness and intimate partner violence:antecedents of alienation of abused women

This study explored the perceived causes of loneliness of abused women. Eighty women, victims of domestic abuse, were compared with 84 women from the general population, who have had no history of abusive relationships. A 30-item-yes/no loneliness questionnaire was utilized in order to compare the causes of loneliness in the two samples. The factors that comprise the causes of loneliness are: Personal inadequacies, Developmental deficits, Unfulfilling intimate relationships, Relocation/significant separations, and Social marginality. Results confirmed the hypothesis that abused women, indeed, perceived the causes of their loneliness significantly differently than women in the general population do. The abused women scored significantly higher on all the subscales.