Intimate partner violence: Opening the door to a safer future

,; ,

doi:doi: 10.12788/jfp.0475

Behavioral Health

Intimate partner violence: Opening the door to a safer future

J Fam Pract. 2022 September;71(7):309-313 | doi: 10.12788/jfp.0475

PDF Download

References

1. CDC. National Center for Injury Prevention and Control. Preventing intimate partner violence. 2021. Accessed June 27, 2022. www.cdc.gov/violenceprevention/intimatepartnerviolence/fastfact.html

2. CDC. Black MC, Basile KC, Breiding MJ, et al. The National Intimate Partner and Sexual Violence Survey: 2010 Summary Report. Accessed June 27, 2022. www.cdc.gov/violenceprevention/pdf/nisvs_executive_summary-a.pdf

3. Chen J, Walters ML, Gilbert LK, et al. Sexual violence, stalking, and intimate partner violence by sexual orientation, United States. Psychol Violence. 2020;10:110-119. doi:10.1037/vio0000252

4. Kofman YB, Garfin DR. Home is not always a haven: the domestic violence crisis amid the COVID-19 pandemic. Psychol Trauma. 2020;12:S199-S201. doi:10.1037/tra0000866

5. Lyons M, Brewer G. Experiences of intimate partner violence during lockdown and the COVID-19 pandemic. J Fam Violence. 2021:1-9. doi:10.1007/s10896-021-00260-x

6. Parrott DJ, Halmos MB, Stappenbeck CA, et al. Intimate partner aggression during the COVID-19 pandemic: associations with stress and heavy drinking. Psychol Violence. 2021;12:95-103. doi:10.1037/vio0000395

7. CDC. National Center for Injury Prevention and Control. Costs of intimate partner violence against women in the United States. 2003. Accessed June 27, 2022. www.cdc.gov/violenceprevention/pdf/ipvbook-a.pdf

8. US Preventive Services Task Force. Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults: US Preventive Services Task Force final recommendation statement. JAMA. 2018;320:1678-1687. doi:10.1001/jama.2018.14741

9. Sprunger JG, Schumacher JA, Coffey SF, et al. It’s time to start asking all patients about intimate partner violence. J Fam Pract. 2019;68:152-161.

10. Chan CC, Chan YC, Au A, et al. Reliability and validity of the “Extended - Hurt, Insult, Threaten, Scream” (E-HITS) screening tool in detecting intimate partner violence in hospital emergency departments in Hong Kong. Hong Kong J Emerg Med. 2010;17:109-117. doi:10.1177/102490791001700202

11. Iverson KM, King MW, Gerber MR, et al. Accuracy of an intimate partner violence screening tool for female VHA patients: a replication and extension. J Trauma Stress. 2015;28:79-82. doi:10.1002/jts.21985

12. Sohal H, Eldridge S, Feder G. The sensitivity and specificity of four questions (HARK) to identify intimate partner violence: a diagnostic accuracy study in general practice. BMC Fam Pract. 2007;8:49. doi:10.1186/1471-2296-8-49

13. Sherin KM, Sinacore JM, Li X, et al. HITS: a short domestic violence screening tool for use in a family practice setting. Fam Med. 1998;30:508-512.

14. Rabin RF, Jennings JM, Campbell JC, et al. Intimate partner violence screening tools: a systematic review. Am J Prev Med. 2009;36:439-445.e4. doi:10.1016/j.amepre.2009.01.024

15. Feldhaus KM, Koziol-McLain J, Amsbury HL, et al. Accuracy of 3 brief screening questions for detecting partner violence in the emergency department. JAMA. 1997;277:1357-1361. doi:10.1001/jama.1997.03540410035027

16. Brown JB, Lent B, Schmidt G, et al. Application of the Woman Abuse Screening Tool (WAST) and WAST-short in the family practice setting. J Fam Pract. 2000;49:896-903.

17. Wathen CN, Jamieson E, MacMillan HL, MVAWRG. Who is identified by screening for intimate partner violence? Womens Health Issues. 2008;18:423-432. doi:10.1016/j.whi.2008.08.003

18. Hegarty K, O’Doherty L, Taft A, et al. Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): a cluster randomised controlled trial. Lancet. 2013;382:249-258. doi: 10.1016/S0140-6736(13)60052-5

19. Correa NP, Cain CM, Bertenthal M, et al. Women’s experiences of being screened for intimate partner violence in the health care setting. Nurs Womens Health. 2020;24:185-196. doi:10.1016/j.nwh.2020.04.002

20. Chang JC, Decker MR, Moracco KE, et al. Asking about intimate partner violence: advice from female survivors to health care providers. Patient Educ Couns. 2005;59:141-147. doi:10.1016/j.pec.2004.10.008

21. Paterno MT, Draughon JE. Screening for intimate partner violence. J Midwifery Womens Health. 2016;61:370-375. doi:10.1111/jmwh.12443

22. Iverson KM, Huang K, Wells SY, et al. Women veterans’ preferences for intimate partner violence screening and response procedures within the Veterans Health Administration. Res Nurs Health. 2014;37:302-311. doi:10.1002/nur.21602

23. National Sexual Violence Research Center. Assessing patients for sexual violence: A guide for health care providers. 2011. Accessed June 28, 2022. www.nsvrc.org/publications/assessing-patients-sexual-violence-guide-health-care-providers

24. National Domestic Violence Hotline. Interactive guide to safety planning. Accessed August 22, 2022. https://www.thehotline.org/plan-for-safety/create-a-safety-plan/

Intimate partner violence (IPV) includes physical, sexual, or psychological aggression or stalking perpetrated by a current or former relationship partner.¹ IPV affects more than 12 million men and women living in the United States each year.² According to a national survey of IPV, approximately one-third (35.6%) of women and one-quarter (28.5%) of men living in the United States experience rape, physical violence, or stalking by an intimate partner during their lifetime.² Lifetime exposure to psychological IPV is even more prevalent, affecting nearly half of women and men (48.4% and 48.8%, respectively).²

Lifetime prevalence of any form of IPV is higher among women who identify as bisexual (59.8%) and lesbian (46.3%) compared with those who identify as heterosexual (37.2%); rates are comparable among men who identify as heterosexual (31.9%), bisexual (35.3%), and gay (35.1%).³ Preliminary data suggest that IPV may have increased in frequency and severity during the COVID-19 pandemic, particularly in the context of mandated shelter-in-place and stay-at-home orders.^4-6

IPV is associated with numerous negative health consequences. They include fear and concern for safety, mental health disorders such as posttraumatic stress disorder (PTSD), and physical health problems including physical injury, chronic pain, sleep disturbance, and frequent headaches.² IPV is also associated with a greater number of missed days from school and work and increased utilization of legal, health care, and housing services.^2,7 The overall annual cost of IPV against women is estimated at $5.8 billion, with health care costs accounting for approximately $4.1 billion.⁷ Family physicians can play an important role in curbing the devastating effects of IPV by screening patients and providing resources when needed.

Facilitate disclosure using screening tools and protocol

In Ms. T’s case, evidence of violence was clearly visible. However, not all instances of IPV leave physical marks. The US Preventive Services Task Force (USPSTF) recommends that all women of childbearing age be screened for IPV, whether or not they exhibit signs of violence.⁸ While the USPSTF has only published recommendations regarding screening women for IPV, there has been a recent push to screen all patients given that men also experience high rates of IPV.⁹

It’s helpful to ask questions such as: “Do arguments [with your partner] ever result in hitting, kicking, or pushing?” and “How often does your partner scream or curse at you?”

Utilize a brief screening tool. Directly ask patients about IPV; this can help reduce stigma, facilitate disclosure, and initiate the process of connecting patients to potentially lifesaving resources. The USPSTF lists several brief screening measures that can be used in primary care settings to assess exposure to IPV (TABLE 1^8,10-17). The brevity of these screening tools makes them well suited for busy physicians; cutoff scores facilitate the rapid identification of positive screens. While the USPSTF has not made specific recommendations regarding a screening interval, many studies examining the utility of these measures have reported on annual screenings.⁸ While there is limited evidence that brief screening alone leads to reductions in IPV,⁸ discussing IPV in a supportive and empathic manner and connecting patients to resources, such as supportive counseling, does have an important benefit: It can reduce symptoms of depression.¹⁸

Continue to: Screen patients in private; this protocol can help