A predictive model to help identify intimate partner violence based on diagnoses and phone calls

Tools for the identification of victims of domestic abuse and modern slavery in remote services: A systematic review

OBJECTIVE

To explore the technology-based tools available for supporting the identification of victims of domestic abuse and modern slavery in remote services and consider the benefits and challenges posed by the existing tools.

METHODS

We searched six academic databases. Studies were considered for inclusion if they were published in English between 2000 and 2023. The QuADS quality appraisal tool was used to assess the methodological quality of included studies. A narrative synthesis was conducted using the convergent integrated approach.

RESULTS

Twenty-four studies were included, of which two were professional guidelines; each reported on a distinct technology-based tool for remote services. All tools related to domestic abuse and 21 focused on screening for intimate partner violence among young and mid-life women (18-65) in high-income countries. The review did not identify tools that support the identification of victims of modern slavery. We identified eight common themes of tool strengths, highlighting that the remote approach to screening was practical, acceptable to victims, and, in some circumstances, elicited better outcomes than face-to-face approaches. Five themes pointed to tool challenges, such as concerns around privacy and safety, and the inability of computerised tools to provide empathy and emotional support.

CONCLUSIONS

Available technology-based tools may support the identification of victims of domestic abuse by health and social care practitioners in remote services. However, it is important to be mindful of the limitations of such tools and the effects individuals' screening preferences can have on outcomes. Future research should focus on developing tools to support the identification of victims of modern slavery, as well as empirically validating tools for screening during remote consultations.

Marriage as a Protective Factor Against Intimate Partner Violence Suffered by Women. Exploring Mechanisms

Research has consistently found that married women experienced less intimate partner violence (IPV) than cohabiting ones. However, most existing studies focus on the incidence of IPV as a binary indicator, while the severity of that exposure or the different types of violence has been largely ignored. This article begins to address these issues with a multivariate approach, for some Latin American countries. The study reports that married women suffered less violence than cohabiting women for each singular type of violence, even after controlling by education, age, locality, wealth, and personal violence history. This article proposes a novel mechanism that helps to explain these findings: marriage would provide a framework that fosters investment in the quality of the couple's relationship, thus preventing IPV. The estimates on the couple's investments support these predictions.

Measuring the hidden burden of violence: use of explicit and proxy codes in Minnesota injury hospitalizations, 2004-2014

PURPOSE

Commonly-used violence surveillance systems are biased towards certain populations due to overreporting or over-scrutinized. Hospital discharge data may offer a more representative view of violence, through use of proxy codes, i.e. diagnosis of injuries correlated with violence. The goals of this paper are to compare the trends in violence in Minnesota, and associations of county-level demographic characteristics with violence rates, measured through explicitly diagnosed violence and proxy codes. It is an exploration of how certain sub-populations are overrepresented in traditional surveillance systems.

METHODS

Using Minnesota hospital discharge data linked with census data from 2004 to 2014, this study examined the distribution and time trends of explicit, proxy, and combined (proxy and explicit) codes for child abuse, intimate partner violence (IPV), and elder abuse. The associations between county-level risk factors (e.g., poverty) and county violence rates were estimated using negative binomial regression models with generalized estimation equations to account for clustering over time.

RESULTS

The main finding was that the patterns of county-level violence differed depending on whether one used explicit or proxy codes. In particular, explicit codes suggested that child abuse and IPV trends were flat or decreased slightly from 2004 to 2014, while proxy codes suggested the opposite. Elder abuse increased during this timeframe for both explicit and proxy codes, but more dramatically when using proxy codes. In regard to the associations between county level characteristics and each violence subtype, previously identified county-level risk factors were more strongly related to explicitly-identified violence than to proxy-identified violence. Given the larger number of proxy-identified cases as compared with explicit-identified violence cases, the trends and associations of combined codes align more closely with proxy codes, especially for elder abuse and IPV.

CONCLUSIONS

Violence surveillance utilizing hospital discharge data, and particularly proxy codes, may add important information that traditional surveillance misses. Most importantly, explicit and proxy codes indicate different associations with county sociodemographic characteristics. Future research should examine hospital discharge data for violence identification to validate proxy codes that can be utilized to help to identify the hidden burden of violence.

Victims of family violence identified in emergency care: Comparisons of mental health and somatic diagnoses with other victims of interpersonal violence by a retrospective chart review

Family violence is a global health problem incurring significant costs to both individuals and health care systems. However, family violence as a cause of trauma and other health issues is often unidentified in patients attending emergency care. Better understanding of the risk factors associated with family violence could improve the identification and treatment of victimized patients in health care settings. Little longitudinal research exists on the mental and somatic health of family violence victims currently identified in EDs and little is known about how victims of family violence differ from other help-seeking victims of interpersonal violence. A total of 345 patients were identified as victims of interpersonal violence in a mid-size Finnish ED during the period 2011–2014. A retrospective chart review was conducted to analyze their mental and somatic health two years before and two years after identification. Victims of family violence were most likely women and they were significantly older than other victim groups. Victims of family violence also presented the most varied health symptoms both before and after identification, although differences between victim groups were not as clear as in previous studies comparing victims of family violence with non-victims. Comparison with previous data demonstrated that family violence was severely under-identified at the study site, further increasing the likelihood of family violence victims revisiting health care services. More attention should thus be paid to the identification and treatment of family violence in emergency care and other health care settings.

It's (Not) Over: Relationship Instability and Recovery Between Victims and Detained Domestic Abusers

We used an innovative data set involving audio-recorded conversations between abusers and victims to explore the interactional patterns that occur within violent relationships, following severe violence and the abuser's detainment. Using micro-level conversational data, our analysis sequenced the hopes/desires that victims and abusers expressed around their expectations for continuing or discontinuing a connection with each other. Conversations commonly included an expressed statement to end the relationship. Although it was common for both victims and abusers to express hope of ending the relationship, victims were most likely to initiate this desire. In response, abusers used multiple strategies to regain connection, including 1) challenging the victim, 2) declaring love or a desire to continue the relationship, 3) appealing for sympathy or help from the victim, and 4) mirroring or accepting the victim's desire to end the relationship (when other strategies were unsuccessful). Abusers' responses served to cultivate additional conflict in the relationship while at the same time maintained communication and facilitated relationship recovery following threats of dissolution. These findings contribute to an increased theoretical understanding of the dynamics of domestic violence in the sensitive period involving the couple's physical separation.

Integrating intimate partner violence assessment and intervention into healthcare in the United States: a systems approach

The Institute of Medicine, United States Preventive Services Task Force (USPSTF), and national healthcare organizations recommend screening and counseling for intimate partner violence (IPV) within the US healthcare setting. The Affordable Care Act includes screening and brief counseling for IPV as part of required free preventive services for women. Thus, IPV screening and counseling must be implemented safely and effectively throughout the healthcare delivery system. Health professional education is one strategy for increasing screening and counseling in healthcare settings, but studies on improving screening and counseling for other health conditions highlight the critical role of making changes within the healthcare delivery system to drive desired improvements in clinician screening practices and health outcomes. This article outlines a systems approach to the implementation of IPV screening and counseling, with a focus on integrated health and advocacy service delivery to support identification and interventions, use of electronic health record (EHR) tools, and cross-sector partnerships. Practice and policy recommendations include (1) ensuring staff and clinician training in effective, client-centered IPV assessment that connects patients to support and services regardless of disclosure; (2) supporting enhancement of EHRs to prompt appropriate clinical care for IPV and facilitate capturing more detailed and standardized IPV data; and (3) integrating IPV care into quality and meaningful use measures. Research directions include studies across various health settings and populations, development of quality measures and patient-centered outcomes, and tests of multilevel approaches to improve the uptake and consistent implementation of evidence-informed IPV screening and counseling guidelines.

Predictors of intimate partner violence in a sample of multiethnic urban young adults

The purpose of the present study was to investigate risk and protective factors for intimate partner violence (IPV) victimization in a high-risk sample of predominantly minority young adults from low-income urban communities. Participants were 1,130 individuals (57.9% women) ages 21 to 26 who participated in a telephone interview assessing IPV victimization, violence-related behaviors, and sexual behaviors. Results indicated that about 20.9% of participants reported experiencing one or more IPV incidents in their lifetime. Based on previous research, we examined lifetime violence, lifetime number of sexual partners, number of children, education, and religious service attendance as predictors of IPV. Results from a multivariate logistic regression showed that lifetime violence-related behaviors, number of lifetime sexual partners, and number of children were significant risk factors for IPV. The link between children and IPV risk: (a) was moderated by education for women and men and (b) was stronger for women (vs. men). These findings suggest that training for coping with stress and anger, endorsement of safe sex practices, and greater support for education may be effective strategies for preventing and reducing IPV among high-risk populations.

Sexual infidelity as trigger for intimate partner violence

BACKGROUND

We conducted a qualitative study to examine acute, situational factors and chronic stressors that triggered severe intimate partner violence (IPV) in women.

METHODS

Our sample consisted of 17 heterosexual couples, where the male was in detention for IPV and made telephone calls to his female victim. We used up to 4 hours of telephone conversational data for each couple to examine the couple's understanding of (1) acute triggers for the violent event and (2) chronic stressors that created the underlying context for violence. Grounded theory guided our robust, iterative data analysis involving audiotape review, narrative summation, and thematic organization.

RESULTS

Consistently across couples, violence was acutely triggered by accusations of infidelity, typically within the context of alcohol or drug use. Victims sustained significant injury, including severe head trauma (some resulting in hospitalization/surgery), bite wounds, strangulation complications, and lost pregnancy. Chronic relationship stressors evident across couples included ongoing anxiety about infidelity, preoccupation with heterosexual gender roles and religious expectations, drug and alcohol use, and mental health concerns (depression, anxiety, and suicide ideation/attempts).

CONCLUSIONS

Disseminated models feature jealousy as a strategy used by perpetrators to control IPV victims and as a red flag for homicidal behavior. Our findings significantly extend this notion by indicating that infidelity concerns, a specific form of jealousy, were the immediate trigger for both the acute violent episode and resulting injuries to victims and were persistently raised by both perpetrators and victims as an ongoing relationship stressor.