Health status and health care use of Massachusetts women reporting partner abuse

BACKGROUND: Studies indicate that women abused by their intimate partners are at increased risk for a number of health problems and have increased rates of health care utilization. However, these findings are based mainly on studies using clinic or health plan populations. In this study, we examined the association between intimate partner abuse (IPA) and health concerns and health care utilization in a population-based sample of adult women. METHODS: We analyzed data on 2043 women aged 18 to 59 who participated in the 1998 Massachusetts Behavioral Risk Factor Surveillance System (BRFSS), a population-based health survey that included questions on IPA. IPA was defined as experiencing physical violence by, fear of, or control by an intimate partner. Consequences of IPA and self-rated health status and health care utilization of women experiencing IPA were examined. RESULTS: A total of 6.3% of Massachusetts women aged 18 to 59 reported IPA during the past year. Women experiencing IPA were more likely than other women to report depression, anxiety, sleep problems, suicidal ideation, disabilities, smoking, unwanted pregnancy, HIV testing, and condom use. Women experiencing IPA were less likely to have health insurance, but received routine health care at similar rates as other women. CONCLUSIONS: These results indicate that women in the general population experiencing IPA are at increased risk for several serious emotional and physical health concerns. Most of these women are in routine contact with health care providers. These findings also suggest that the BRFSS may provide a valuable mechanism for tracking state-based IPA prevalence rates over time.     

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.     

Help-seeking rates for intimate partner violence (IPV) among Canadian immigrant women

We examined rates of help seeking for intimate partner violence (IPV) among recent (0-9 years in Canada) and non-recent (10+ years in Canada) immigrant women. Data from a national, cross-sectional, telephone survey were used. Help-seeking variables included disclosure of IPV, reporting IPV to police, use of social services subsequent to IPV, and barriers to social service use. Recent immigrant women, compared with non-recent immigrant women, were significantly more likely to report IPV to police and less likely to use social services. Findings have important implications for prevention and detection of IPV in immigrant communities and in future research.     

Healthcare utilization and costs for women with a history of intimate partner violence

OBJECTIVE: To determine the healthcare utilization and medical care costs of women with a history of intimate partner violence (IPV) compared to women without a history of IPV. DESIGN: Longitudinal cohort study. SETTING: Mixed-model health maintenance organization. PARTICIPANTS: Over 3000 (3333) women aged 18 to 64 years with > or = 3 year's cumulative enrollment prior to the survey, at least 1 year of which was after the 18th birthday. MAIN EXPOSURE: IPV since age 18 as determined from responses to telephone interview using questions from the Behavioral Risk Factor Surveillance System and also the Women's Experience with Battering Scale. OUTCOME MEASURES: Healthcare utilization and costs (from automated data) during the time that IPV occurred and following its cessation, compared to healthcare utilization for women who did not report IPV since age 18. RESULTS: A total of 1546 women reported IPV in their lifetime; at the time of interview, IPV had ceased in 87% of women, on average 16.0 years prior to interview. Healthcare utilization was higher for all categories of service during IPV compared to women without IPV, and decreased over time after cessation of IPV. However, healthcare utilization was still 20% higher 5 years after women's abuse ceased compared to women without IPV. Adjusted annual total healthcare costs were 19% higher in women with a history of IPV (amounting to $439 annually) compared to women without IPV. Based on prevalence for IPV of 44%, the excess costs due to IPV are approximately $19.3 million per year for every 100,000 women enrollees aged 18-64. CONCLUSIONS: Women with a history of IPV had significantly higher healthcare utilization and costs, continuing long after IPV ended. Given its high prevalence, IPV has a major impact on medical care resource utilization and efforts to prevent its occurrence and consequences are clearly indicated.     

Help-Seeking Rates for Intimate Partner Violence (IPV) Among Canadian Immigrant Women

We examined rates of help seeking for intimate partner violence (IPV) among recent (0–9 years in Canada) and nonrecent (10+ years in Canada) immigrant women. Data from a national, cross-sectional, telephone survey were used. Help-seeking variables included disclosure of IPV, reporting IPV to police, use of social services subsequent to IPV, and barriers to social service use. Recent immigrant women, compared with nonrecent immigrant women, were significantly more likely to report IPV to police and less likely to use social services. Findings have important implications for prevention and detection of IPV in immigrant communities and in future research.     

Intimate Partner Violence and the Utilization of Maternal Health Care Services in Nigeria

Our aim in this study is to examine the association between women's lifetime experiences of physical, sexual, and emotional intimate partner violence (IPV) and the use of maternal health care services. We used data from the 2008 Nigeria Demographic and Health Survey. Analysis was based on responses from 17,476 women (for antenatal care [ANC]) and 17,412 (for delivery assisted by a skilled health provider) who had had deliveries in the 5 years preceding the survey. We found an overall IPV prevalence rate of 33.4%. Physical IPV was associated with low use of ANC. Emotionally abused women were less likely to use delivery assistance from skilled health care providers. Based on our findings, we suggest the importance of designing interventions to address the health care needs of women who have experienced violence from their partners.     

Frequency and correlates of intimate partner violence by type: physical, sexual, and psychological battering

OBJECTIVES: This study estimated the frequency and correlates of intimate partner violence by type (physical, sexual, battering, or emotional abuse) among women seeking primary health care. METHODS: Women aged 18 to 65 years who attended family practice clinics in 1997 and 1998 took part. Participation included a brief in-clinic survey assessing intimate partner violence. Multiple polytomous logistic regression was used to assess correlates of partner violence by type. RESULTS: Of 1401 eligible women surveyed, 772 (55.1%) had experienced some type of intimate partner violence in a current, most recent, or past intimate relationship with a male partner; 20.2% were currently experiencing intimate partner violence. Among those who had experienced partner violence in any relationship, 77.3% experienced physical or sexual violence, and 22.7% experienced nonphysical abuse. Alcohol and/or drug abuse by the male partner was the strongest correlate of violence. CONCLUSIONS: Partner substance abuse and intimate partner violence in the woman's family of origin were strong risk factors for experiencing violence. Efforts to universally screen for partner violence and to effectively intervene to reduce the impact of such violence on women's lives must be a public health priority.     

Considering HIV risk and intimate partner violence among older women of color: a descriptive analysis

This study describes the types of intimate partner violence (IPV) and sexual HIV-risk factors reported by a sample of 139 African American and Latina women ages 50 and older receiving care in outpatient clinics of an urban medical center. Additionally, we obtained estimates of the associations between experiencing IPV in a primary heterosexual relationship and the following HIV-risk behaviors among our sample of older minority women: (a) having multiple sexual partners, (b) STD history, (c) partner-related risk (i.e., having a partner who has multiple sexual partners, is HIV-infected, injecting drugs, and/or has an STD), and (d) self-perception of risk for HIV infection. Results indicate that many of these women are engaged in sexual risk behaviors, and such behaviors are associated with increased likelihood of IPV for this cohort. Implications for health care professionals are discussed.     

Intimate partner violence and substance abuse among minority women receiving care from an inner-city emergency department.

A woman's drug and alcohol use has been found to increase her risk of experiencing intimate partner violence (IPV). OBJECTIVE: The study describes the rates of lifetime and current IPV among women awaiting care in an emergency department and explores the association between IPV and having a drug abuse problem, and IPV and having an alcohol abuse problem, after controlling for demographic factors and history of childhood victimization. METHODS: Face-to-face interviews were conducted with 143 low-level triaged women recruited from an inner-city emergency department. RESULTS: Nearly one-half reported ever experiencing IPV, and over 18% reported IPV during the year before the interview. A higher proportion of abused women reported a history of regular crack, cocaine, or heroin use and visiting shooting galleries or crack houses. Participants who were physically abused by their partner during the past year (15%, n = 21) were more likely than nonabused women (85%, n = 122) to report higher scores on the Alcohol Use Disorders Identification Test (AUDIT) (4.9 vs. 2.4), a measure of alcohol-related problems, and the Drug Abuse Severity Test (DAST) (3.0 vs. 1.3), a measure of drug-related problems. Sexually abused women (6%, n = 9) were more likely than their counterparts (94%, n = 134) to have significantly higher AUDIT scores (6.4 vs. 2.5). The findings have implications for how the intersecting public health problems of IPV and substance abuse should be taken into consideration in research and patient care protocols in emergency departments.     

Intimate partner violence among midlife and older women: a descriptive analysis of women seeking medical services

Although intimate partner violence (IPV) may occur throughout a woman's life course, there has been a paucity of research on the experiences of victimization among midlife and older women. This article examines both the prevalence of IPV among a sample of women ages 50 to 64 (N=620), who were recruited at an emergency department and primary care clinics in an urban setting, and the associated factors for the subsample of these women who reported IPV (n=34). More than 5 percent of the women reported experiencing some form of abuse by their partners within the past two years. Bivariate analyses comparing victims and nonvictims indicate that higher proportions of women who reported abuse had received public assistance and had a recent history of homelessness. In addition, victims of IPV reported higher frequencies of HIV risk factors than did nonvictims, including having a partner who insisted on sex without a condom, having sex with a man they knew or suspected was an IV drug user, and experiencing symptoms or receiving a diagnosis or treatment for a sexually transmitted infection. Significantly higher percentages of abused women reported being tested for HIV and being HIV seropositive. Implications of the findings for social workers are discussed.     

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.     

Intimate partner violence from the emergency medicine perspective

BACKGROUND: The incidence of acute cases of intimate partner violence (IPV) in the Emergency Department (ED) patients is between 2 and 7.2%. Ongoing IPV may be an immediate cause of presentation for medical care, or it may not be readily apparent. Over the last two decades efforts to improve identification of IPV in the ED have been successful. METHODS: A medline literature search from 1981-2001 was performed. A review of intimate partner violence from the emergency department provider perspective is performed. A discussion of the screening/detection of intimate partner violence and the barriers to improving detection rates is provided. RESULTS: The review of the current literature shows that IPV is a frequent cause of illness or injury in patients presenting in the ED. Screening programs for intimate partner violence have shown to increase the identification of patients experiencing acute episodes of abuse and seeking treatment. The difficulty has been in sustaining the programs and improving the screening of patients. Patient, provider and systems barriers prevent adequate recognition and management of the problem. CONCLUSION: Detection of IPV in patients presenting to the ED can be improved by providing educational programs and screening tools to health care providers. Sustaining the screening programs is more difficult and requires a health care system-wide effort.     

Intimate partner violence. A survey conducted in the primary care setting

OBJECTIVES: To determine the prevalence of intimate partner violence (IPV) in a sample of women attending primary care centers for any reason and to analyze the characteristics of this violence. METHODS: A cross sectional study was performed in 23 primary care centers in three regions of Spain (Andalusia, Madrid and Valencia). The sample included 1,402 randomly selected adult women aged between 18 and 65 years attending these centers. Among the variables collected through a self-administered questionnaire were the existence of physical, emotional or sexual abuse, and its timing, duration, and frequency. RESULTS: Overall, 32% had experienced some type of IPV. By type, 7% had experienced both physical and emotional IPV, 14% had experienced emotional IPV, 3% had experienced emotional and sexual IPV, and 6% had suffered all 3 types of IPV. Among the latter, 52% had experienced abuse for more than 5 years. Women who experienced abuse in a previous relationship had a greater probability of being abused by a new intimate partner (OR = 3.30; 95% CI, 2.10-5.18). CONCLUSIONS: These results show the scale of IPV in Spain. Health professionals play an important role in IPV, as they are in a privileged position to tackle this serious public health problem.     

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.     

Intimate partner violence: prevalence, types, and chronicity in adult women

BACKGROUND: Most intimate partner violence (IPV) prevalence studies do not examine the relationships between IPV types and the chronicity and severity of abuse. OBJECTIVES: Delineate prevalence, chronicity, and severity of IPV among adult women. DESIGN: Retrospective cohort study conducted by telephone survey. Data were collected in 2003 to 2005 and analyzed contemporaneously. PARTICIPANTS: English-speaking women (n=3568) aged 18 to 64 years enrolled in a U.S. health maintenance organization for 3 or more years. Response rate was 56.4%. MAIN EXPOSURE: Physical, psychological, and sexual IPV were assessed using five questions from the Behavioral Risk Factor Surveillance Survey and ten items from the Women's Experience with Battering (WEB) scale. RESULTS: Most (3429) of the respondents had at least one intimate partnership as an adult. Of these, 14.7% reported IPV of any type in the past 5 years, and 45.1% of abused women experienced more than one type. Prevalence was 7.9% in the past year, while during a woman's adult lifetime, it was 44.0%. Depending on IPV type, 10.7% to 21.0% were abused by more than one partner; duration was <1 year to 5 median years; while in 5% to 13% of the instances, IPV persisted for >20 years. IPV rates were higher for younger women, women with lower income and less education, single mothers, and those who had been abused as a child. CONCLUSIONS: The high prevalence of IPV across women's lifetimes in the previous 5 years and the previous year are documented. The present investigation provides new information of IPV chronicity, severity, and the overlap of IPV types over a woman's adult life span.     

Health, Access to Health Care, and Health Care use Among Homeless Women with a History of Intimate Partner Violence

Among a sample of sheltered homeless women, we examined health, access to health care, and health care use overall and among the subgroup of participants with and without intimate partner violence (IPV). We recruited homeless women from a random sampling of shelters in New York City, and queried them on health, access to health care and health care use. Using multivariable logistic regression, we determined whether IPV was associated with past-year use of emergency, primary care and outpatient mental health services. Of the 329 participants, 31.6% reported one or more cardiovascular risk factors, 32.2% one or more sexually transmitted infections, and 32.2% any psychiatric condition. Three-fourths (73.5%) had health insurance. Health care use varied: 55.4% used emergency, 48.9% primary care, and 75.9% outpatient mental health services in the past year. Across all participants, 44.7% reported IPV. Participants with IPV compared to those without were more likely to report medical and psychiatric conditions, and be insured. Participants with IPV reported using emergency (64.4%) more than primary care (55.5%) services. History of IPV was independently associated with use of emergency (Adjusted odds ratio (AOR) 1.7, 95% CI 1.0-2.7), but not primary care (AOR 1.5, 95% CI 0.9-2.6) or outpatient mental health services (AOR 1.9, 95% CI 0.9-4.1). Across the whole sample and among the subgroup with IPV, participants used emergency more than primary care services despite being relatively highly insured. Identifying and eliminating non-financial barriers to primary care may increase reliance on primary care among this high-risk group.     

Physical partner violence and medicaid utilization and expenditures

OBJECTIVES: Little research has addressed differences in health care expenditures among women who are currently experiencing intimate partner violence (IPV) compared with those who are not. The purpose of this work is to provide estimates of direct medical expenditure for physician, drug, and hospital utilization among Medicaid-eligible women who screened as currently experiencing IPV compared with those who are not currently experiencing IPV. METHODS: In this family practice-based cross-sectional study, women were screened for current IPV using a 15-item Index of Spouse Abuse-Physical (ISA-P) between 1997 and 1998. Consents were obtained from study subjects to review Medicaid expenditure and utilization data for the same time period. RESULTS: Mean physician, hospital, and total expenditures were higher for those women with higher IPV scores compared with those who scored as not currently experiencing IPV, after adjusting for confounders. Higher IPV scores were associated with a three-fold increased risk of having a total expenditure over $5,000 (95% confidence interval [CI] 1.3, 8.4). The mean total expenditure difference between the high IPV and no IPV groups was $1,064 (95% CI $623, $1506). The adjusted risk ratio for high IPV score and the log of total Medicaid expenditures was 2.3 (95% CI 1.2, 4.4). CONCLUSIONS: Women screened as experiencing higher IPV scores had higher Medicaid expenditures compared with women not currently experiencing IPV. Early IPV assessment partnered with effective clinic or community-based interventions may help to identify IPV earlier and reduce the health impact and cost of IPV.