Skip to main content

Advertisement

SpringerLink
Log in

Intimate Partner Violence Identification and Response: Time for a Change in Strategy

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND

While victims of intimate partner violence (IPV) present to health care settings for a variety of complaints; rates and predictors of case identification and intervention are unknown.

OBJECTIVE

Examine emergency department (ED) case finding and response within a known population of abused women.

DESIGN

Retrospective longitudinal cohort study.

SUBJECTS

Police-involved female victims of IPV in a semi-rural Midwestern county.

MAIN MEASURES

We linked police, prosecutor, and medical record data to examine characteristics of ED identification and response from 1999–2002; bivariate analyses and logistic regression analyses accounted for the nesting of subjects’ with multiple visits.

RESULTS

IPV victims (N = 993) generated 3,426 IPV-related police incidents (mean 3.61, median 3, range 1–17) over the 4-year study period; 785 (79%) generated 4,306 ED visits (mean 7.17, median 5, range 1–87), which occurred after the date of a documented IPV assault. Only 384 (9%) ED visits occurred within a week of a police-reported IPV incident. IPV identification in the ED was associated with higher violence severity, being childless and underinsured, more police incidents (mean: 4.2 vs 3.3), and more ED visits (mean: 10.6 vs 5.5) over the 4 years. The majority of ED visits occurring after a documented IPV incident were for medical complaints (3,378, 78.4%), and 72% of this cohort were never identified as victims of abuse. IPV identification was associated with the day of a police incident, transportation by police, self-disclosure of “domestic assault,” and chart documentation of mental health and substance abuse issues. When IPV was identified, ED staff provided legally useful documentation (86%), police contact (50%), and social worker involvement (45%), but only assessed safety in 33% of the women and referred them to victim services 25% of the time.

CONCLUSION

The majority of police-identified IPV victims frequently use the ED for health care, but are unlikely to be identified or receive any intervention in that setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. Cascardi M, Langhinrichsen J, Vivian D. Marital aggression: Impact, injury, and health correlates for husbands and wives. Arch Intern Med. 1992;152:1178–84.

    Article  PubMed  CAS  Google Scholar 

  2. Vivian D, Langhinrichsen-Rohling J. Are bi-directionally violent couples mutually victimized?: A gender-sensitive comparison. Violence Vict. 1994;9:107–24.

    PubMed  CAS  Google Scholar 

  3. Bachman R, Salzman, LE. Violence against women: Estimates from the redesigned study. Washington, DC: US Department of Justice, Bureau of Justice Statistics; 1995. BJS Publication No. 154–348.

  4. Sutherland C, Bybee D, Sullivan C. The long-term effects of battering on women's health. Women’s Health. 1998;4:41–70.

    PubMed  CAS  Google Scholar 

  5. Catalano SM. Criminal Victimization, 2004. Data from the National Crime Victimization Survey. Washington, DC: Bureau of Justice Statistics, Office of Justice Programs, US Department of Justice; 2005.

  6. Tjaden P, Thoennes N. Prevalence, incidence, and consequences of violence against women: Findings from the National Violence Against Women Survey. Washington, DC: National Institute of Justice and Centers for Disease Control and Prevention; 1998.

    Google Scholar 

  7. Stein M, Kennedy C. Major depressive and post-traumatic stress disorder comorbidity in female victims of intimate partner violence. J Affect Disorders. 2001;66:133–8.

    Article  PubMed  CAS  Google Scholar 

  8. Campbell J. Health consequences of intimate partner violence. Lancet. 2002;359:1331–6.

    Article  PubMed  Google Scholar 

  9. Coid J, Petruckevitch A, Chung W, Richardson J, Morrey S, Feder G. Abusive experiences and psychiatric morbidity in women primary care attenders. Brit J Psychiat. 2003;183:332–9.

    Article  PubMed  Google Scholar 

  10. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. Am J Prev Med. 1998;14:245–58.

    Article  PubMed  CAS  Google Scholar 

  11. Coker A, Davis KE, Arias I, et al. Physical and mental health effects of intimate partner violence for men and women. Am J Prev Med. 2002;23:260–8.

    Article  PubMed  Google Scholar 

  12. Abbott J, Johnson R, Koziol-McLain J, Lowenstein SR. Domestic violence against women: Incidence and prevalence in an emergency department population. JAMA. 1995;273:1763–7.

    Article  PubMed  CAS  Google Scholar 

  13. McCloskey LA, Lichter E, Ganz ML, et al. Intimate partner violence and patient screening across medical specialties. Acad Emerg Med. 2005;12:712–22.

    Article  PubMed  Google Scholar 

  14. Neilson HD, Nygren P, McInerney Y, Klein J. Screening women and elderly adults for family and intimate partner violence: A review of the evidence for the US Preventive Services Task Force. Ann Intern Med. 2004;140:387–96.

    Google Scholar 

  15. American College of Obstetricians and Gynecologists. ACOG issues technical bulletin on domestic violence. http://www.acog.org/departments/dept_notice.cfm?recno=17&bulletin=585, accessed, 2-7-11

  16. Violence position paper: American Academy of Family Physicians Website. http://www.aafp.org/online/en/home/policy/policies/v/violencepositionpaper.html accessed, 2-7-11

  17. American Association of Pediatrics Website http://aappolicy.aappublications.org/misc/Identifying_and_Responding_to_Domestic_Violence.dtl., accessed 2-7-11

  18. The Joint Commission Accreditation Program: Hospital: Provision of care, treatment, and services, 2008. Joint Commission Website. http://www.jointcommission.org/AccreditationPrograms/Hospitals/. Accessed September 23, 2008.

  19. MacMillan HL, Wathen CN with the Canadian Task Force on Preventive Health Care. Prevention and Treatment of Violence Against Women. In: Systematic Review & Recommendations. London, Ontario: Canadian Task Force; 2001. CTFPHC Technical Report No. 01–4.

  20. United States Preventive Services Task Force (USPSTF). Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: Recommendation statement. Ann Intern Med. 2004;140:554–6.

    Google Scholar 

  21. MacMillan HL, Wathen CN, Jamieson E, et al. Screening for intimate partner violence in health care settings: A randomized trial. JAMA. 2009;302:493–501.

    Article  PubMed  CAS  Google Scholar 

  22. Kothari C, Rhodes KV. Missed opportunities: Emergency department visits by police-identified victims of intimate partner violence. Ann Emerg Med. 2006;47:190–9.

    Article  PubMed  Google Scholar 

  23. Rhodes KV, Frankel R, Levinthal N, Prenoveau E, Bailey J, Levinson W.“You’re not a victim of domestic violence, are you?” Ann Intern Med. 2007;147:620–7.

    PubMed  Google Scholar 

  24. Houry D, Feldhaus K, Peery B, et al. A positive domestic violence screen predicts future domestic violence. J Interper Violence. 2004;19:955–66.

    Article  Google Scholar 

  25. Moracco KE, Cole TB. Preventing intimate partner violence: Screening is not enough. JAMA. 2009;302:568–70.

    Article  PubMed  CAS  Google Scholar 

  26. Rhodes KV, Drum M, Anliker EA, Frankel R, Howes DS, Levinson W. Lowering the threshold for discussions of domestic violence: A randomized controlled trial of computer screening. Arch Intern Med. 2006;165:1–8.

    Google Scholar 

  27. Gerbert B, Abercrombie P, Caspers N, Love C, Bronstone A. How health care providers help battered women: The survivor’s perspective. Women Health. 1999;29:115–35.

    PubMed  CAS  Google Scholar 

  28. Bien TH, Miller WR, Tonigan JS. Brief interventions for alcohol problems: A review. Addiction. 1993;88:315–35.

    Article  PubMed  CAS  Google Scholar 

  29. World Health Organization Brief Intervention Study Group (WHOBISG). Cross-national trial of brief interventions with heavy drinkers. Am J Public Health. 1996;86:948–55.

    Article  Google Scholar 

  30. Glasgow RE, Whitlock EP, Eakin EG, Lichtenstein E. A brief smoking cessation intervention for women in low-income Planned Parenthood clinics. Am J Public Health. 2000;90:786–9.

    Article  PubMed  CAS  Google Scholar 

  31. Ogle RL, Baer JS. Addressing the service linkage problem: Increasing substance abuse treatment engagement using personalized feedback interventions in heavy-using female domestic violence shelter residents. J Interpers Violence. 2003;18:1311–24.

    Article  PubMed  Google Scholar 

  32. Oxman TE, Dietrich AJ, Schulberg HC. The depression care manager and mental health specialist as collaborators within primary care. Am J Geriat Psychiat. 2003;11:507–16.

    Google Scholar 

  33. Gentilello LM, Ebel BE, Wickizer TM, Salkever DS, Rivara FP. Alcohol interventions for trauma patients treated in emergency departments and hospitals: A cost benefit analysis. Ann Surg. 2005;241:541–50.

    Article  PubMed  Google Scholar 

  34. Hingson RW, Swahn MH, Sleet DA. Interventions to prevent alcohol-related injuries. In Doll L, Bonzo S, Sleet D, Mercy J, Haas E, eds. Handbook of Injury and Violence Prevention. Springer; 2006.

  35. Nilsen P, Baird J, Mello MJ. A systematic review of emergency care brief alcohol interventions for injury patients. J Subst Abuse Treat. 2008;35:184–201.

    Article  PubMed  Google Scholar 

  36. Burke P, Chapman C, Hohman M, et al. Guiding as practice: Motivational interviewing and trauma-informed work with survivors of intimate partner violence. Partner Abuse. 2010;1:92–104.

    Google Scholar 

Download references

Acknowledgments

The authors wish to thank Patricia Smith, Director, Violence Against Women Prevention Program, Michigan Department of Community Health; the Kalamazoo County Prosecutor’s Office, all members of the Community Advisory Board, the YWCA Domestic Violence Program, and the many research assistants who worked on this project. This project builds on data collected for the MEDCIIN Projects under the CDC cooperative agreement U17/CCU551067.

Conflict of Interest

None disclosed.

Research support was primarily provided by a grant from the National Institute of Justice: NIJ 2006-WG-BX-0007; additional support for investigator time was provided by NIMH K23 MH64572 (Rhodes) and K01MH75965-01 (Cerulli) and the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center (Dichter). Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice the Department of Veterans Affairs or the United States Government.

Author information

Authors and Affiliations

  1. Division of Emergency Care Policy Research, Department Of Emergency Medicine, Schools of Medicine and Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Karin V. Rhodes MD, MS

  2. Michigan State University Kalamazoo Center for Medical Studies, Kalamazoo, MI, USA

    Catherine L. Kothari MA

  3. Philadelphia VA Medical Center, Philadelphia, PA, USA

    Melissa Dichter MSW, PhD

  4. School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA

    Catherine Cerulli JD, PhD

  5. Public Research Institute, San Francisco State University, San Francisco, CA, USA

    James Wiley PhD

  6. School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA

    Steve Marcus PhD

Authors
  1. Karin V. Rhodes MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Catherine L. Kothari MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Melissa Dichter MSW, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Catherine Cerulli JD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. James Wiley PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Steve Marcus PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karin V. Rhodes MD, MS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rhodes, K.V., Kothari, C.L., Dichter, M. et al. Intimate Partner Violence Identification and Response: Time for a Change in Strategy. J GEN INTERN MED 26, 894–899 (2011). https://doi.org/10.1007/s11606-011-1662-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-011-1662-4

KEY WORDS

Search

Navigation