Intimate partner violence — the hidden burden is commonThere is a chronic condition that as many as 44% of women have experienced. It adversely affects their physical and mental health. Screening for it is inadequate, and interventions are unclear. Two articles from Group Health Cooperative in Seattle and two commentaries in the June issue of the American Journal of Preventive Medicine examine intimate partner violence (IPV) and make recommendations for next steps in addressing this issue.
With colleagues from Harborview Injury Prevention and Research Center and the University of Washington, Group Health researchers evaluated the prevalence, timing, and severity of IPV in women, and the association between IPV and women's health and health behaviors.
In the first research article, Robert S. Thompson, MD, and colleagues found that IPV was not only highly prevalent (up to 44% of the more than 3,400 women said they experienced IPV as an adult) but also chronic, lasting more than 5 years and in some cases more than 20 years. Most abused women experienced more than one type of IPV: for example, physical IPV and verbal threats. In addition, the severity of abuse was rated as moderately or extremely violent in 30% to 60% of reports, depending on the type of IPV.
"A picture emerges of both physical and non-physical IPV as very common, chronic, intergenerational, and present in highly overlapping forms," according to Thompson, senior investigator at Group Health Center for Health Studies. He and his coauthors conclude:
- The time has arrived to mount and evaluate major interventions in day-to-day medical practice, as they and others have proposed.
- These efforts could employ universal routine questioning coupled with links to institutional and community services, so the practitioner's fear of opening Pandora's Box is adequately addressed.
- Many women want to answer questions addressing IPV, so the potential negative effects of asking about IPV seem exaggerated.
Amy E. Bonomi, PhD, MPH, research associate at Group Health Center for Health Studies, is the lead author of the second research article. She and her coauthors reported that rates of depression, physical symptoms, and social isolation were significantly higher in women who experienced IPV compared to women who never experienced IPV. Exposure to physical and/or sexual IPV in the past five years had the strongest adverse health effects for women. The longer women were exposed to IPV, the worse their health outcomes: This had not been shown before.
"In light of these findings and those from previous studies, it is critical to focus on strategies for the primary and secondary prevention of IPV that can be used not only in healthcare settings but also in other individual, community, and social arenas," says Bonomi.
These findings provide "the additional challenge for us in the preventive medicine and public health communities to advocacy and action to prevent IPV," Ann L. Coker, PhD, of the University of Texas Health Science Center, in Houston, writes in the accompanying editorial. "Identifying IPV and intervening to reduce the mental, physical, and social consequences of IPV must become a health priority so that providers can competently care for women, children, families, and communities."
James S. Marks, MD, MPH, senior vice president of the Robert Wood Johnson Foundation, in Princeton, NJ, considers it unlikely that the 44% figure is an overestimate. "A primary challenge in studying IPV has been the understanding that prevalence rates likely underestimate this public health problem because of the stigma and shame associated with it," he writes in his commentary introducing the two research articles.
The introductory article is "Does a Failure to Count Mean It Fails to Count? Addressing Intimate Partner Violence" by James S. Marks, MD, MPH, and Elaine F. Cassidy, PhD. The first article, on IPV incidence, is "Intimate Partner Violence--Prevalence, Types, and Chronicity in Adult Women" by Robert S. Thompson, MD; Amy E. Bonomi, PhD, MPH; Melissa Anderson, MS; Robert Reid, MD, PhD; Jane Dimer, MD; David Carrell, PhD; and Frederick P. Rivara, MD, MPH. The paper analyzing health effects is "Intimate Partner Violence and Women's Physical, Mental, and Social Functioning" by Amy E. Bonomi, PhD, MPH; Robert S. Thompson, MD; Melissa Anderson, MS; Robert J. Reid, MD, PhD; David Carrell, PhD; Jane A. Dimer, MD; and Frederick P. Rivara, MD, MPH. The final article suggesting future efforts against IPV is "Preventing IPV: How We Will Rise to This Challenge" by Ann L. Coker, PhD. These appear in the American Journal of Preventive Medicine, Volume 30, Issue 6 (June 2006).
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