Mandatory reporting of intimate partner violence to police: views of physicians in California

OBJECTIVES: This study examined physicians' perspectives on mandatory reporting of intimate partner violence to police. METHODS: We surveyed a stratified random sample of California physicians practicing emergency, family, and internal medicine and obstetrics/gynecology. RESULTS: An estimated 59% of California primary care and emergency physicians (n = 508, 71% response rate) reported that they might not comply with the reporting law if a patient objects. Primary care physicians reported lower compliance. Most physicians agreed that the legislation has potential risks, raises ethical concerns, and may provide benefits. CONCLUSIONS: Physicians' stated noncompliance and perceived negative consequences raise the possibility that California's mandatory reporting law is problematic and ineffective.     

Child abuse - mandatory reporting requirements

All Australian states and territories have legislation that requires medical practitioners to report cases of child abuse to the appropriate child protection service. This article outlines the obligations of medical practitioners to report child abuse and highlights the differences that exist in the legislative requirements in each state and territory.     

Severity of spousal and intimate partner abuse to pregnant Hispanic women

Abuse to pregnant women can result in complications to maternal and child health. This study assessed the severity of intimate male partner abuse to Hispanic pregnant women receiving prenatal care at an urban public health department. The mean age of the 329 pregnant, abused Hispanic women was 24 years. The women had an average of eight years of education, annual incomes of less than $10,000, and most spoke only Spanish. In all, 30 percent of the women had been threatened with death, 18 percent had been threatened with a knife or gun, 80 percent had been shaken or roughly handled, 71 percent pushed or shoved, and 64 percent slapped on the face and head. Pregnant, abused Hispanic women experience abuse of sufficient severity to pose a risk to maternal and child health. Prenatal care provides a window of opportunity for routine abuse assessment and counseling for low-income, Hispanic pregnant women.     

儿童期虐待与亲密伴侣暴力关系

目的通过研究儿童期不同形式虐待与其成人后亲密伴侣暴力的关系，为家庭暴力的心理干预提供科学的理论依据。方法采用自编《新婚夫妇婚前暴力调查表》和《儿童期虐待问卷》对湖南省长沙市2个社区领取结婚证愿意接受婚前暴力调查研究的291对新婚夫妇进行调查。结果受虐组的情感虐待因子分、躯体虐待因子分及量表总分高于非受虐组；女性受虐组的躯体虐待因子分和性虐待因子分高于非受虐组；男性受虐组的情感虐待因子分、躯体虐待因子分和情感忽视因子分均高于非受虐组。但差异无统计学意义（P〉0．05）。2组间在受教育程度、职业、婚前有无同居史上差异有统计学意义（x^2=10．433，P=0．034；x^2=15．525。P=0．008；x^2=8．843。P=0．003）。结论儿童期情感虐待和躯体虐待对其成人后受虐有影响；女性儿童期躯体虐待和性虐待对其成人后受虐有影响；男性儿童期虐待对其成人后受虐无影响。亲密伴侣暴力（IPV）与受教育程度、职业、婚前同居史相关。     

The factors associated with disclosure of intimate partner abuse to clinicians

OBJECTIVE: Our goal was to identify the prevalence, determinants of, and barriers to clinician-patient communication about intimate partner abuse. STUDY DESIGN: We conducted telephone interviews with a random sample of ethnically diverse abused women. POPULATION: We included a total of 375 African American, Latina, and non-Latina white women aged 18 to 46 years with histories of intimate partner abuse who attended 1 of 3 primary care clinics in San Francisco, California, in 1997. OUTCOMES MEASURED: We measured the relevance and determinants of past communication with clinicians about abuse and barriers to communication. RESULTS: Forty-two percent (159) of the patients reported having communicated with a clinician about abuse. Significant independent predictors of communication were direct clinician questioning about abuse (odds ratio [OR]=4.6; 95% confidence interval [CI] 3.2-6.6), and African American ethnicity (OR=1.8; 95% CI, 1.1-2.9). Factors associated with lack of communication about abuse included immigrant status (OR=0.6; 95% CI, 0.3-1.0) and patient concerns about confidentiality (OR=0.7; 95% CI, 0.5-0.9). Barriers significantly associated with lack of communication were patients' perceptions that clinicians did not ask directly about abuse, beliefs that clinicians lack time and interest in discussing abuse, fears about involving police and courts, and concerns about confidentiality. CONCLUSIONS: Clinician inquiry appears to be one of the strongest determinants of communication with patients about partner abuse. Other factors that need to be addressed include patient perceptions regarding clinicians' time and interest in discussing abuse, fear of police or court involvement, and patient concerns about confidentiality.     

Maxillofacial injuries associated with intimate partner violence in women

Background  

The facial region has been the most common site of injury following violent episodes. The purpose of this study was to determine the prevalence and pattern of maxillofacial injuries associated with intimate partner violence (IPV) in women treated at a single facility in Malaysia.     

Use of medical care, police assistance, and restraining orders by women reporting intimate partner violence--Massachusetts, 1996-1997

Approximately 1.5 million women in the United States are physically or sexually assaulted by an intimate partner (IP) each year (1). The Woman Abuse Tracking in Clinics and Hospitals (WATCH) Project at the Massachusetts Department of Public Health analyzed data from the 1996 and 1997 Behavioral Risk Factor Surveillance System (BRFSS) in Massachusetts to 1) estimate the percentage of women aged 18-59 years experiencing intimate partner violence (IPV) who used medical care, police assistance, and restraining orders during the preceding 5 years, 2) determine where women experiencing IPV went for medical care, and 3) examine the overlap in use of these three services. This report describes the results of these analyses, which indicate that a higher percentage of women aged 18-59 years use police assistance rather than obtain a restraining order or seek medical care.     

On a life-saving mission: Nurses' willingness to encounter with intimate partner abuse

The main purpose of this qualitative study was to explore in depth selected expert nurses' experiences of the phenomenon of violence against women and the nurses' roles as health care providers to those women. The authors adopted a grounded theory method and produced an emerging theory comprising two key themes: nurses' personal perceptions toward intimate partner violence and nurses' feeling equipped to intervene. The findings showed that violence against women existed in a small local community and raised pitfalls caused by nurses' knowing the inhabitants. Furthermore, the findings indicate the devotion of nurses and the importance of their role in the care of battered women and the sharing of knowledge. Thus, the nurses compensate for a lack of training through personal maturity and security within the social context.     

Pregnancy counselling clinic: a questionnaire survey of intimate partner abuse

CONTEXT: Intimate partner abuse has a significant and detrimental impact on the mental and physical health of a woman. Physical abuse is often associated with sexual abuse. OBJECTIVE: To examine the prevalence and nature of physical and sexual partner abuse experienced by women who request a termination of pregnancy (TOP). DESIGN: Quantitative data collection using an anonymous, self-completed questionnaire. SETTING: A pregnancy counselling clinic located within a large district general hospital in the north west of England. PARTICIPANTS: A sample of 312 women attending the clinic. RESULTS: Three hundred and twelve questionnaires were returned (96.7% response rate). The prevalence rate of intimate partner abuse at some stage in the woman's life was 35.1%; 19.5% had experienced actual physical abuse in the past year; and 3.7% had experienced forced sexual intercourse in the past year. Of the latter, in over half of the cases, this may have resulted in the current pregnancy. A total of 6.6% of women in this study are currently living in fear. DISCUSSION: The anonymity of the survey and the method of implementation encouraged an excellent response rate. The prevalence of physical abuse was higher than that reported in previous studies, however the prevalence of sexual abuse was lower. Up to 2% of requests for TOP could have been due to recent forced sexual intercourse. CONCLUSIONS: Many women requesting a TOP have been, or still are, in violent relationships. Some women may attend with an unwanted conception following sexual assault by their current or previous intimate partner.     

Adding insult to injury: intimate partner violence among women and men reporting activity limitations

PURPOSE: Women with activity limitations (ALs) are at risk for Intimate partner violence (IPV). This study examined IPV in men versus women with ALs. METHODS: Data from the Canadian 1999 General Social Survey compared physical, sexual, emotional, and financial IPV from a current/expartner in 5 years for men and women with ALs compared with those without ALs. Logistic regression examined sex differences in IPV among those with ALs, adjusting for sociodemographic factors. RESULTS: Rates of physical (11.9% versus 7.8%; p < 0.0001), sexual (3.5% versus 1.4%; p < 0.0001), emotional (27.1% versus 17.7%; p < 0.0001), and financial (7.5% versus 3.4%; p < 0.0001) IPV were greater in women with compared with without ALs. A similar pattern was seen for men, with greater rates of physical (9.2% versus 6.6%; p = 0.006), emotional (22.6% versus 18.2%; p = 0.002), and financial (2.6% versus 1.4%; p = 0.005) IPV in men with ALs than men without ALs. Risk factors for IPV included younger age, being divorced/separated or single, and having lower income and poorer health. Women with ALs were more likely than men to experience any IPV (29.1% versus 24.9%) and more severe and more incidents of IPV. In multivariable analysis, women were no longer at greater risk for "any IPV" after adjusting for sociodemographic variables (odds ratio = 1.09; 95% confidence interval, 0.88-1.36). CONCLUSION: This is the first study to document IPV rates in men with ALs. Women with ALs were more likely to be divorced/separated, living in poverty, and in poorer health than men with ALs. These factors accounted for sex differences in IPV rates.     

Judgments about intimate partner violence: a statewide survey about immigrants

OBJECTIVES: The purpose of this research was to: (1) examine judgments about immigrants who are victims of and assailants in intimate partner violence, and (2) assess whether immigrants to the U.S., a diverse and growing population, know that intimate partner violence is illegal in the United States and their judgments about what sanctions, if any, should follow. METHODS: A random-digit-dial telephone survey was conducted in four languages with 3,679 California adults. There were roughly comparable numbers of white, black, Latino, Korean American, Vietnamese American, and other Asian American participants; 60.1% were born outside the U.S. An experimental vignette design was used to vary victim, assailant, and contextual factors about incidents of intimate partner violence and to assess respondents' judgments about the behavior and what should be done about it. Multivariate analyses were conducted to examine the independent effect of these predictor variables and characteristics of the respondents. RESULTS: Respondent judgments about whether an incident of intimate partner violence was wrong, illegal, or about what sanctions should follow were not related to nativity of either the victim or the assailant. Immigrant respondents differed from native-born respondents on two outcomes: immigrants were more likely to think that the behavior was illegal and that guns should be removed from the assailant. CONCLUSIONS: Concerns that immigrants do not know that intimate partner violence is illegal in the U.S. are largely misplaced--immigrants know it soon after their arrival in the U.S. In addition, it appears that a cultural defense regarding domestic violence is not likely to sway others.     

Women's opinions about domestic violence screening and mandatory reporting

BACKGROUND: The purpose of this paper is to describe women's opinions and policy preferences concerning domestic violence screening and mandatory reporting. METHODS: This case-control study included 202 abused women and 240 randomly selected non-abused women recruited from a large metropolitan health maintenance organization who were interviewed by telephone. Of these women, 46.6% had a college degree, 53.4% were white, and 60% had a household income of $50,000 or more. RESULTS: Forty-eight percent of the sample agreed that health care providers should routinely screen all women, with abused women 1.5 times more likely than non-abused women to support this policy. For mandatory reporting, 48% preferred that it be the woman's decision to report abuse to the police. Women thought it would be easier for abused women to get help with routine screening (86%) and mandatory reporting (73%), although concerns were raised about increased risk of abuse with both screening (43%) and reporting (52%) policies. Two thirds of the sample thought women would be less likely to tell their health care providers about abuse under a mandatory reporting policy. Interventions offered in managed care settings that would be well received, according to the women in this study, include counseling services, shelters, and confidential hotlines. CONCLUSIONS: Women expressed fears and concerns about negative consequences of routine screening and, even more so, for mandatory reporting. Domestic violence policies and protocols need to address the safety, autonomy, and confidentiality issues that concern women.     

Adverse consequences of intimate partner abuse among women in non-urban domestic violence shelters

OBJECTIVE: This study examined the health consequences of having experienced both sexual and physical abuse relative to women experiencing physical abuse but not sexual abuse. METHODS: A cross-sectional study was conducted among 203 women seeking refuge in battered women's shelters. Controlling for sociodemographics, logistic regression analyses were conducted to assess the consequences of experiencing both sexual and physical abuse. RESULTS: Compared to women experiencing physical abuse, women experiencing both sexual and physical abuse were more likely to have a history of multiple sexually transmitted diseases (STDs) in their abusive relationships, have had an STD in the past 2 months, be worried about being infected with HIV, use marijuana and alcohol to cope, attempt suicide, feel as though they had no control in their relationships, experience more episodes of physical abuse in the past 2 months, rate their abuse as more severe, and be physically threatened by their partner when they asked that condoms be used. CONCLUSIONS: Given the prevalence of adverse health outcomes, domestic violence shelters could counsel women to avoid using alcohol/drugs as a coping strategy, educate women about alternative healthy coping strategies, counsel women about methods of STD prevention that they can control, and provide STD screening and treatment.     

Barriers to screening for intimate partner violence

Background: Health care providers play a vital role in the detection of intimate partner violence among their patients. Despite the recommendations for routine intimate partner violence screening in various medical settings, health care providers do not routinely screen for intimate partner violence. The authors wanted to identify barriers to intimate partner violence screening and improve the understanding of intimate partner violence screening barriers among different health care providers. Methods: The authors conducted a systematic review to examine health care providers' perceived barriers to screening for intimate partner violence. By grouping the studies into two time periods, based on date of publication, they examined differences in the reported barriers to intimate partner violence screening over time. Results: The authors included a total of 22 studies in this review from all examined sources. Five categories of intimate partner violence screening barriers were identified: personal barriers, resource barriers, perceptions and attitudes, fears, and patient-related barriers. The most frequently reported barriers included personal discomfort with the issue, lack of knowledge, and time constraints. Provider-related barriers were reported more often than patient-related barriers. Conclusions: Barriers to screening for intimate partner violence are numerous among health care providers of various medical specialties. Increased education and training regarding intimate partner violence is necessary to address perceptions and attitudes to remove barriers that hinder intimate partner violence screening by health care providers.     

An exploratory examination of the meanings of residual injuries from intimate partner violence

The meanings attached to residual injuries resulting from intimate partner violence (IPV) may play an important role in shaping psychological distress associated with these experiences. This study explored IPV victims' personal definitions and meanings of their residual IPV-related injuries as a first step in determining the potential psychological implications. Sixteen female victims of IPV with partner violence-related residual injuries, defined as marks, scars, and other permanent changes to their bodies met in small groups of 3-5 participants. Group discussions focused on the meanings individuals associated with their most distressing residual injury and the implications of those meanings for body image, interpersonal relationships, cues for posttraumatic responses, and other emotional reactions. Findings suggested that IPV-related injuries may be connected to the IPV, IPV-related blame, and may have implications for victims' self-identity and perceived potential for future relationships.