Risk factors associated with different types of intimate partner violence (IPV): an emergency department study

A Lethality Assessment Program in the Emergency Department: Program Implementation and Evaluation

INTRODUCTION

Despite routine screening for intimate partner violence and validated screening tools for lethality, intimate partner violence assessment and linkage to services remain inconsistent in health care settings. This program aimed to implement and evaluate a lethality assessment program, a nurse-led screening and prevention program for intimate partner violence homicide in an emergency department that partnered with a local community agency.

METHODS

A single group pre-post design was used to evaluate changes in knowledge of intimate partner violence and the lethality assessment program protocol and confidence in implementing the protocol among 143 registered nurses in the emergency department. Program outcomes were assessed during a 4-month post-implementation period. Focus group interviews were conducted and analyzed to identify barriers and facilitators of implementation.

RESULTS

Significant improvements in the nurses' knowledge and confidence in implementing the protocol (all P< .001) were observed. Fourteen lethality screens were completed during the 4 months, with 13 indicating high intimate partner violence homicide danger. Eight victims received 20 services (1-5/person) from the local community organization: emergency shelter, safety planning, legal aid, and domestic violence protection order. Barriers to implementation included time, privacy, training, and access to screening forms. Facilitators included champions, resources to allow for implementation, and prompts.

DISCUSSION

The lethality assessment program is a feasible protocol in a health care setting to increase intimate partner violence awareness, link high-risk intimate partner violence victims to needed services in real time, and potentially reduce intimate partner violence homicides. Programs like this are essential to address this public health concern.

Maternal Childhood Maltreatment, Internal Working Models, and Perinatal Substance Use: Is There a Role for Hyperkatifeia? A Systematic Review

The parent-infant relationship is critical for socioemotional development and is adversely impacted by perinatal substance use. This systematic review posits that the mechanisms underlying these risks to mother-infant relationships center on 3 primary processes: (1) mothers' childhood maltreatment experiences; (2) attachment styles and consequent internal working models of interpersonal relationships; and (3) perinatal substance use. Further, the review considers the role of hyperkatifeia, or hypersensitivity to negative affect which occurs when people with substance use disorders are not using substances, and which drives the negative reinforcement in addiction. The authors performed a systematic review of articles (published 2000-2022) related to these constructs and their impact on mother-infant relationships and offspring outcomes, including original clinical research articles addressing relationships between these constructs, and excluding case studies, reviews, non-human animal studies, intervention studies, studies with fewer than 30% female-sex participants, clinical guidelines, studies limited to obstetric outcomes, mechanistic/biological studies, and studies with methodological issues precluding interpretation. Overall 1844 articles were screened, 377 were selected for full text review, and data were extracted from 157 articles. Results revealed strong relationships between mothers' childhood maltreatment experiences, less optimal internal working models, and increased risk for perinatal substance use, and importantly, all of these predictors interacted with hyperkatifeia and exerted a marked impact on mother-infant relationships with less data available on offspring outcomes. These data strongly support the need for future studies addressing the additive impact of maternal childhood maltreatment experiences, suboptimal internal working models, and perinatal substance use, with hyperkatifeia as a potential moderator, and their interacting effects on mother-infant socioemotional outcomes.

2021 SAEM Consensus Conference Proceedings: Research Priorities for Developing Emergency Department Screening Tools for Social Risks and Needs

Introduction: The Emergency Department (ED) acts as a safety net for our healthcare system. While studies have shown increased prevalence of social risks and needs among ED patients, there are many outstanding questions about the validity and use of social risks and needs screening tools in the ED setting. Methods: In this paper, we present research gaps and priorities pertaining to social risks and needs screening tools used in the ED, identified through a consensus approach informed by literature review and external expert feedback as part of the 2021 SAEM Consensus Conference -- From Bedside to Policy: Advancing Social Emergency Medicine and Population Health. Results: Four overarching research gaps were identified: (1) Defining the purpose and ethical implications of ED-based screening; (2) Identifying domains of social risks and needs; (3) Developing and validating screening tools; and (4) Defining the patient population and type of screening performed. Furthermore, the following research questions were determined to be of highest priority: (1) What screening tools should be used to identify social risks and needs? (2) Should individual EDs use a national standard screening tools or customized screening tools? (3) What are the most prevalent social risks and needs in the ED? and (4) Which social risks and needs are most amenable to intervention in the ED setting? Conclusion: Answering these research questions will facilitate the use of evidence-based social risks and needs screening tools that address knowledge gaps and improve the health of our communities by better understanding the underlying determinants contributing to their presentation and health outcomes.

Association of Cannabis Use and At-Risk Alcohol Use With Intimate Partner Violence in an Urban ED Sample

INTRODUCTION

Urban ED patients have elevated rates of substance use and intimate partner violence. The purpose of this study is to describe the risk profiles for intimate partner violence among urban ED patients who report at-risk alcohol use only, cannabis use only, or both types of substance use.

METHODS

Cross-sectional survey data were collected from study participants (N = 1037; 53% female; ages 18-50) following informed consent. We measured participants' past-year at-risk drinking (women/men who had 4+/5+ drinks in a day), cannabis use, psychosocial and demographic characteristics, and past-year physical intimate partner violence (assessed with the Revised Conflict Tactics Scale). We used bivariate analysis to assess whether rates of intimate partner violence perpetration and victimization differed by type of substance use behavior. Multivariate logistic regression models were estimated for each intimate partner violence outcome. All analyses were stratified by gender.

RESULTS

Rates of intimate partner violence differed significantly by type of substance use behavior and were highest among those who reported both at-risk drinking and cannabis use. Multivariate analysis showed that women who reported at-risk drinking only, cannabis use only, or both types of substance use had increased odds for intimate partner violence perpetration and victimization compared with women who reported neither type of substance use. Men's at-risk drinking and cannabis use were not associated with elevated odds of intimate partner violence perpetration or victimization.

DISCUSSION

Brief screening of patients' at-risk drinking and cannabis use behaviors may help identify those at greater risk for intimate partner violence and those in need of referral to treatment.

Asking the Right Questions: Screening Men for Partner Violence

With lifetime intimate partner violence (IPV) victimization rates for self-identified men between 14% and 20%, and an expanding understanding of gender as a nonbinary construct, practitioners in some clinical environments have expressed interest in screening all patients for IPV. Yet, few IPV screening instruments have been validated for use in nonfemale populations. This research tests the appropriateness and acceptability of a screening instrument developed for use with women.A literature review was completed to determine the current state of research into IPV screening practices tailored to men. Next, cognitive interviews were conducted to test a 9-question IPV screening instrument with men considered at average and elevated risk for experiencing partner violence. Participants were read the questions aloud and asked about item comprehension and question appropriateness and acceptability.The literature review uncovered no published reports describing routine clinic based IPV screening of men, and only two screening instruments had been validated with men. Twenty men participated in cognitive interviews from a variety of settings in a large urban center. All participants accurately described the intended meaning of each question and verified the appropriateness of asking the questions.This work addresses the gap in research on routine IPV screening with men, building on efforts to screen individuals and support improved health and response to violence to those across the gender spectrum.

Intimate partner violence in women with breast and gynaecologic cancers: A systematic review

AIM

The current study aimed to systematically review the data obtained from studies on women with breast and gynaecologic cancers subjected to Intimate Partner Violence (IPV).

DESIGN

Systematic review without meta-analysis.

DATA SOURCES

PubMed, ProQuest, Google Scholar, Scopus, Web of Science; databases were searched without time limit.

REVIEW METHOD

The PRISMA model was guided the systematic literature search using Boolean keywords and operators. PICO statement was used to develop a question of this review. Studies examining women with breast and gynaecologic cancers subjected to IPV were included in the study after the quality of the articles was reviewed.

RESULTS

Eight studies that met the inclusion criteria and were conducted between 2000 and 2021 were included in the study.

CONCLUSIONS

Studies confirm the effect of IPV on the severity and consequences of breast and gynaecologic cancers. Having a history of IPV can indirectly lead to breast and gynaecologic cancers. On the other hand, women suffering from IPV are more likely than other women to delay screening or not perform screening for cancer.

IMPACT

The dimensions and nature of violence and the disclosure or non-disclosure of violence in vulnerable women are strongly affected by society's culture. Therefore, researchers need to have sufficient knowledge of the culture and social factors governing the community to achieve reliable findings related to IPV in qualitative, quantitative, and psychometric studies and the design of IPV assessment tools. It is recommended that IPV screening teams, that is, multidisciplinary teams of trained physicians, nurses and social workers, participate in two-way screening programmes: IPV screening for women with gynaecological cancer and screening for gynaecological cancer in women with IPV.

Interrelationships of Economic Stressors, Mental Health Problems, Substance Use, and Intimate Partner Violence among Hispanic Emergency Department Patients: The Role of Language-Based Acculturation

We analyzed the interrelationships of economic stressors, mental health problems, substance use, and intimate partner violence (IPV) among a sample of Hispanic emergency department patients and probed if Spanish language preference, which may represent low acculturation and/or immigrant status, had a protective effect, in accordance with the Hispanic health paradox. Study participants (n = 520; 50% female; 71% Spanish speakers) provided cross-sectional survey data. Gender-stratified logistic regression models were estimated for mental health problems (PTSD, anxiety, depression), substance use (risky drinking, cannabis, illicit drug use), and IPV. Results showed that economic stressors were linked with mental health problems among men and women. Among men, PTSD was associated with greater odds of cannabis and illicit drug use. Men who used cannabis and illicit drugs were more likely to report IPV. Male Spanish speakers had lower odds of anxiety and cannabis use than English speakers. Female Spanish speakers had lower odds of substance use and IPV than English speakers. The protective effect of Spanish language preference on some mental health, substance use, and IPV outcomes was more pronounced among women. Future research should identify the mechanisms that underlie the protective effect of Spanish language preference and explore factors that contribute to the observed gender differences.

The COVID-19 Pandemic and Intimate Partner Violence against Women in the Czech Republic: Incidence and Associated Factors

Intimate partner violence (IPV) is a burning social issue worldwide. According to global statistics, the incidence of IPV has increased during the COVID-19 pandemic due to restrictive measures (e.g., reduced social contacts, the need to stay at home often with a perpetrator in the same household). This study aims to provide data about the incidence of IPV and its associated factors during the COVID-19 pandemic in the Czech Republic. A representative online sample of 429 Czech women living with a partner at least 3 months before COVID-19 participated in the study. In an online interview, women reported IPV incidents 3 months before and during the first and second waves of the COVID-19 pandemic. Using non-parametric repeated measures ANOVA, a significant difference between the total IPV score and the given time periods was found. In addition, the results of the research showed a significant effect of the tension in the relationship with the partner, depression rate, and partner support on the total IPV score in the first and second wave of the COVID-19 pandemic. These results bring important insights into IPV incidence during the COVID-19 pandemic and suggest factors that might lead to an increased risk of IPV.

Association between intimate partner violence during pregnancy and risk of preterm birth

Background

Preterm birth is a risk factor for child survival in both the short and long term. In Zimbabwe, the prevalence of preterm birth is rising, and there are growing concerns about the adverse consequences. This study explored the association between intimate partner violence (IPV) during pregnancy and preterm birth in Zimbabwe.

Methods

Using data from the 2015 Zimbabwe Demographic and Health Survey, we applied propensity score matching to estimate the effect of IPV during pregnancy on preterm birth among women of reproductive age (15–49 years). A total of 4833 pregnant women who gave birth during the five years preceding the survey were analysed.

Results

We successfully matched 79 women who were exposed to IPV during pregnancy to 372 unexposed during pregnancy. Using the matched sample, the probability of preterm delivery was significantly higher among women who were exposed to IPV during pregnancy than those who were not exposed. The findings showed that 7 out of 79 (8.9%) of women exposed to IPV during pregnancy experienced preterm delivery, and 11 out of 372 (3.0%) of those who were not exposed to IPV during pregnancy experienced preterm delivery. In the urban areas, those exposed to IPV during pregnancy were almost five times more likely to experience preterm delivery (OR = 4.8, 95% CI 2.0–11.6), but the association was not significantly different among women in rural areas.

Conclusion

The findings showed that women exposed to IPV during pregnancy were at increased risk of preterm birth. Some of the risk factors associated with IPV were urban residence, low economic status and unemployment. Effective policies and programmes are required to address the issue of IPV in Zimbabwe.

The Impact of Depressive Symptoms on Response to Integrated Cognitive Behavioral Therapy for Substance Use Disorders and Intimate Partner Violence

Purpose

Past studies demonstrated the efficacy of integrated cognitive-behavioral therapy (CBT) for substance use disorder (SUD) and intimate partner violence (IPV) as well as high rates of depressive symptoms in this population. However, little is known about how depressive symptoms impact treatment outcomes. We hypothesized that integrated CBT, but not standard drug counseling (DC), would buffer the negative effects of depressive symptoms on treatment response.

Design/methodology/approach

A secondary analysis of a randomized trial compared men assigned to 12 weeks of integrated CBT for SUD and IPV (n=29) to those in DC (n=34).

Findings

Most (60%) of the sample reported any depressive symptoms. Controlling for baseline IPV, reporting any depressive symptoms was associated with more positive cocaine screens during treatment. Among men with depressive symptoms, integrated CBT but not DC was associated with fewer positive cocaine screens. Controlling for baseline alcohol variables, integrated CBT and depressive symptoms were each associated with less aggression outside of intimate relationships (e.g., family, strangers) during treatment. For men without depressive symptoms, integrated CBT was associated with less non-IPV aggression compared to DC. Effects were not significant for other substances, IPV, or at follow-up.

Originality

Although integrated CBT's efficacy for improving SUD and IPV has been established, moderators of treatment response have not been investigated.

Practical Implications

Integrated CBT buffered depressive symptoms' impact on cocaine use, yet only improved non-IPV aggression in men without depressive symptoms.

Research Limitations/Implications

This study found some evidence for differential response to CBT by depressive symptoms on cocaine and aggression at end of treatment, which did not persist three months later. Future studies should explore mechanisms of integrated CBT for SUD and IPV, including mood regulation, on depressive symptoms in real-world samples.

Intimate Partner Violence and Controlling Behaviors Experienced by Emergency Department Patients: Differences by Sexual Orientation and Gender Identification

The objective of this study was to estimate the prevalence of intimate partner violence (IPV) in an emergency department (ED) by sexual orientation and gender identification. We conducted a cross-sectional survey of adult patients (n = 1,136) presenting to a Level I Trauma Center ED from November 2015 to November 2016. Multivariable logistic regression analysis was used to estimate the adjusted odds ratio (aOR) of reporting any IPV or IPV subtypes (physical or sexual IPV or battering) by sexual orientation and gender identification, controlling for confounders. Overall, 11.6% (132 / 1,136) of those surveyed were IPV positive. The prevalence of IPV was significantly higher in lesbian, gay, bisexual, transgender, and questioning (LGBTQ) patients than in heterosexuals (18.3% vs. 10.8%, p = .0151); prevalence was highest among bisexuals (21.6%) and gay men (18.5%). IPV prevalence did not differ significantly in females versus males (13.5% vs. 9.2%, p = .0872). After controlling for age, the odds of reporting any IPV was highest among females (aOR = 1.67; 95% confidence interval [CI] = [1.10, 2.53]); no significant differences were found by sexual orientation. Gay patients (aOR = 5.50; 95% CI = [1.60, 18.94]) and females (aOR = 2.70; 95% CI = [1.46, 9.99]) had significantly higher odds of reporting physical or sexual IPV than heterosexuals and males, respectively. The study is among the first to report IPV prevalence by sexual orientation in an ED patient population. The reported IPV was higher among LGBTQ patients than heterosexual patients although this relationship diminished when controlling for covariates. These data begin to define the scope of IPV among LGBTQ ED patients and may be used to inform brief interventions to reduce the IPV-related morbidity experienced by ED patients.

Frequency of Intimate Partner Violence among an Urban Emergency Department Sample: A Multilevel Analysis

Intimate partner violence (IPV) is a pervasive public health problem. Within the U.S., urban emergency department (ED) patients have elevated prevalence of IPV, substance use, and other social problems compared to those in the general household population. Using a social-ecological framework, this cross-sectional study analyzes the extent to which individual, household, and neighborhood factors are associated with the frequency of IPV among a socially disadvantaged sample of urban ED patients. Confidential survey interviews were conducted with 1037 married/partnered study participants (46% male; 50% Hispanic; 29% African American) at a public safety-net hospital. Gender-stratified multilevel Tobit regression models were estimated for frequency of past-year physical IPV (perpetration and victimization) and frequency of severe IPV. Approximately 23% of participants reported IPV. Among men and women, impulsivity, adverse childhood experiences, substance use, and their spouse/partner's hazardous drinking were associated with IPV frequency. Additionally, household food insufficiency, being fired or laid off from their job, perceived neighborhood disorder, and neighborhood demographic characteristics were associated with IPV frequency among women. Similar patterns were observed in models of severe IPV frequency. IPV prevention strategies implemented in urban ED settings should address the individual, household, and neighborhood risk factors that are linked with partner aggression among socially disadvantaged couples.

Drinking Context-Specific Dose-Response Models of Intimate Partner Violence Among an Urban Emergency Department Sample

OBJECTIVE

This cross-sectional study evaluates the association between physical intimate partner violence (IPV) and frequencies of drinking and volume consumed in six different contexts among a sample of urban emergency department (ED) patients.

METHOD

We obtained survey data from 1,037 married, cohabiting, or partnered patients (53% female; 50% Hispanic; 29% African American) at a Northern California safety-net hospital. Past-year physical IPV was measured with the Revised Conflict Tactics Scale. We asked patients about frequency of drinking and usual number of drinks consumed at bars, restaurants, homes of friends or relatives, own home, public places such as street corners or parking lots, and community centers or large events. Gender-stratified dose-response models were estimated for frequencies of IPV perpetration and victimization, with adjustment for sociodemographic and psychosocial factors, marijuana use, and spouse/partner problem drinking.

RESULTS

None of the women's context-based frequency and volume measures were associated with frequency of IPV victimization. Women's volume of alcohol consumed at home was associated positively with frequency of their IPV perpetration (β = .008, SE = .003, p < .01), and volume consumed in public places was associated negatively with this outcome (β = -.023, SE = .010, p < .05). Among men, none of the context-based frequency and volume measures were associated with frequency of either IPV outcome. Spouse/partner's problem drinking was associated with each gender's IPV victimization, and with IPV perpetration by men.

CONCLUSIONS

Frequency of drinking and volume consumed in specific contexts do not substantively contribute to frequency of IPV perpetration or victimization in this sample of urban ED patients.

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.

Pregnant Adolescents As Perpetrators and Victims of Intimate Partner Violence

The role of pregnant adolescents as perpetrators of intimate partner violence (IPV) is not well understood. Socioecological factors associated with IPV (physical assault and injury, and psychological aggression) perpetrated by pregnant adolescents and the association between IPV and attitudes toward the use of physical punishment to discipline children were examined among 246 pregnant adolescents. Pregnant adolescents were more likely to report perpetrating both physical assault (24%) and psychological aggression (52.7%) than being the recipient (12.2% and 38.6%, respectively) and having been physically injured (7%) than inflicting injury (4.1%). Risk factors for perpetrating physical assault included prior assault by partner, being African American, exposure to community violence, being in trouble with the police, and multiple lifetime drug use. IPV perpetrators had more favorable attitudes toward the use of physical punishment. Interventions should address IPV and parenting attitudes in young couples to maximize the health and safety of both mother and unborn child.

Co-Occurrence of Multiple Risk Factors and Intimate Partner Violence in an Urban Emergency Department

INTRODUCTION

Urban emergency departments (ED) provide care to populations with multiple health-related and overlapping risk factors, many of which are associated with intimate partner violence (IPV). We examine the 12-month rate of physical IPV and its association with multiple joint risk factors in an urban ED.

METHODS

Research assistants surveyed patients regarding IPV exposure, associated risk factors, and other sociodemographic features. The joint occurrence of seven risk factors was measured by a variable scored 0-7 with the following risk factors: depression; adverse childhood experiences; drug use; impulsivity; post-traumatic stress disorder; at-risk drinking; and partner's score on the Alcohol Use Disorders Identification Test. The survey (N = 1037) achieved an 87.5% participation rate.

RESULTS

About 23% of the sample reported an IPV event in the prior 12 months. Logistic regression showed that IPV risk increased in a stepwise fashion with the number of present risk factors, as follows: one risk factor (adjusted odds ratio [AOR] [3.09]; 95% confidence interval [CI], 1.47-6.50; p<.01); two risk factors (AOR [6.26]; 95% CI, 3.04-12.87; p<.01); three risk factors (AOR = 9.44; 95% CI, 4.44-20.08; p<.001); four to seven risk factors (AOR [18.62]; 95% CI, 9.00-38.52; p<001). Ordered logistic regression showed that IPV severity increased in a similar way, as follows: one risk factor (AOR [3.17]; 95% CI, 1.39-7.20; p<.01); two risk factors (AOR [6.73]; 95% CI, 3.04-14.90; p<.001); three risk factors (AOR [10.36]; 95%CI, 4.52-23.76; p<.001); four to seven risk factors (AOR [20.61]; 95% CI, 9.11-46.64; p<001).

CONCLUSION

Among patients in an urban ED, IPV likelihood and IPV severity increase with the number of reported risk factors. The best approach to identify IPV and avoid false negatives is, therefore, multi-risk assessment.

Problem Drinking and Marijuana Use as Risks for Unidirectional and Bidirectional Partner Violence

Despite evidence that most who perpetrate intimate partner violence (IPV) also report victimization, little is known about bidirectional IPV among Emergency Department (ED) patients and its association with problem drinking and marijuana use. We conducted an observational, cross-sectional survey among low- and moderate-acuity patients at a Northern California safety-net ED. Physical IPV was measured with the Revised Conflict Tactics Scale (CTS2). We recorded patient's frequency of intoxication and marijuana use. Spouse/partner's problem drinking and marijuana use were measured dichotomously. Odds Ratios [ORs] and 95% confidence intervals [CIs] were estimated using multinomial logistic regression models of unidirectional and bidirectional IPV. Among 1,037 patients (53% female), perpetration only, victimization only, and bidirectional IPV were reported by 3.8%, 6.2%, and 13.3% of the sample, respectively. Frequency of intoxication was associated with perpetration (OR 1.50; 95% CI 1.18 to 1.92) and bidirectional IPV (OR=1.34; 95% CI 1.13 to 1.58). Days of marijuana use were associated with bidirectional IPV (OR=1.15; 95% CI 1.03 to 1.28). Patients whose partners were problem drinkers were at risk for victimization (OR=2.56; 95% CI=1.38, 4.76) and bidirectional IPV (OR=1.97; 95% CI 1.18, 3.27). Among patients who reported any past-year IPV, most experienced bidirectional aggression. ED staff should consider asking patients who are married, cohabiting, or in a dating relationship about their experience with past-year IPV and inquire about their substance use patterns and those of their romantic partner, to share information about potential linkages. Medical and recreational marijuana legalization trends underscore the importance of further research on IPV and marijuana.

When Partners Turn Violent: Understanding Causality & Signs

Intimate partner violence (IPV) occurs across all cultures, ethnicities, socioeconomic classes, and educational backgrounds. Nurses should be aware of IPV and causative factors that include personal attributes, stressors, and community issues. The Intimate Partner Exposome conceptual model is used to identify exogenous and endogenous IPV risk factors. In addition, distinctive environmental factors can increase risk for IPV. The purpose of this article is to increase recognition of causative factors and presenting signs to enhance the nurse's ability to identify and assist IPV victims.

Drinking and Intimate Partner Violence Severity Levels Among U.S. Ethnic Groups in an Urban Emergency Department

BACKGROUND

Emergency departments (EDs) provide care to ethnically diverse populations with multiple health-related risk factors, many of which are associated with intimate partner violence (IPV). This paper examines ethnic-specific 12-month rates of physical IPV by severity and their association with drinking and other sociodemographic and personality correlates in an urban ED sample.

METHODS

Research assistants surveyed patients at an urban ED regarding IPV exposure as well as patterns of alcohol and drug use, psychological distress, adverse childhood experiences (ACEs), and other sociodemographic features.

RESULTS

The survey (N = 1,037) achieved an 87.5% participation rate. About 23% of the sample reported an IPV event in the past 12 months. Rates were higher (p < 0.001) among blacks (34%), whites (31%), and multiethnic (46%) respondents than those among Asians (13%) and Hispanics (15%). Modeled results showed that black respondents were more likely than Hispanics (reference) to report IPV (adjusted odds ratio [AOR] = 1.69, 95% confidence interval [CI] = 1.98-2.66, p < 0.05) and that respondents' partner drinking was associated with IPV (AOR = 1.85, 95% CI = 1.25-2.73, p < 0.01) but respondents' drinking was not. Use of illicit drugs, younger age, impulsivity, depression, partner problem drinking, ACEs, and food insufficiency were all positively associated with IPV.

CONCLUSIONS

There was considerable variation in IPV rates across ethnic groups in the sample. The null results for the association between respondents' drinking and IPV was surprising and may stem from the relatively moderate levels of drinking in the sample. Results for ethnicity, showing blacks as more likely than Hispanics to report IPV, support prior literature.

[The association between victimization resulting from intimate partner violence and depression among Brazilian adults]

The scope of this article was to assess the association between Intimate Partner Violence (IPV) and depression among Brazilian adults. This cross-sectional study used data from the 2013 National Health Survey with a representative sample of 49,025 Brazilian adults, with information on IPV, depression and socio-demographic conditions. For a description of characteristics associated with depression, including the core IPV data, analyses of simple and multiple logistic regression were performed. The analyses were performed using Stata 13.0 software. The prevalence of IPV was 1% in the general population, and 0.38% among men and 1.58% among women. The prevalence of depression was 3.94% (CI 95% = 3.68-4.22) in the general population, 1.67% (CI 95% = 1.40-1.94) among men and 6.03% (CI 95% = 5.57- 6.48) among women. Victims of IPV were more likely to report depression than non-victims (aOR = 2.90; CI 95% = 1.38-6.09). The conclusion drawn is that depression is associated with intimate partner victimization, which has important implications from a public health standpoint.

Double jeopardy: Predictors of elevated lethality risk among intimate partner violence victims seen in emergency departments

Many intimate partner homicide victims visit emergency departments (EDs) prior to their deaths, yet their lethality risk is not well understood. eHealth interventions for intimate partner violence (IPV) improve provider information, tailor care to victim need and link victims to services. We analyzed ED patients' lethality risk using one such intervention, Domestic Violence Report and Referral (DVRR). DVRR records were assessed for 263 female patients aged 16 and older seen for IPV at an urban, high-traffic, Northern California ED in 2014-15. Multiple linear regression was used to test the association of children's presence at home, pregnancy, age, and abuser-victim relationship with victim's lethality risk using the Danger Assessment (DA) score from the Lethality Risk Assessment for Intimate Partner Femicide. Differences in means were assessed using t- and F-tests. The mean DA score indicated high lethality risk, with a third of respondents (33.1%) reporting very high DA scores. Multiple linear regression models indicated that increasing victim age (β=0.20/year; 95% CI: 0.11-0.29), children's presence at home (β=2.61, 95% CI: 0.63-4.58), and perpetrator reported as dating partner (β=4.50, 95% CI: 1.62-7.38) or ex-partner (β=4.38, 95% CI: 1.10-7.66) were significantly associated with the DA score (p<0.05). Use of DA scores as ED risk assessment tools in response to IPV victimization could help hospital staff and IPV advocates direct resources toward highest-need patients, improving health outcomes without additional burden on hospitals. These results also foreground eHealth interventions' utility in linking providers and IPV advocates and reducing the risk of intimate partner homicide.

Prevalence and pattern of domestic violence at the Center for Forensic Medical Services in Pekanbaru, Indonesia

Background: Domestic violence (DV) is still a significant public health problem, especially in women’s health. Few studies have reported the prevalence and domestic violence in Indonesia. The aim of this study was to identify the prevalence, type of violence, and forensic examination on domestic violence victims in emergency departments.Methods: This study was a retrospective analysis of domestic violence victims observed in the Emergency Department at the Bhayangkara Hospital, Pekanbaru, Indonesia, between 2010 and 2014. The determinations of DV cases are based on the medico-legal reports (visum et repertum) and the police’s official inquiry letters.Results: Out of 6,876 medico-legal injury reports of living victims were reviewed, and 755 (10,9%) cases were DV. The majority of victims in DV were women (93.8%) with childbearing age group as the highest frequency (77.9%). Most of the DV victims were housewives (67.0%). Moreover, physical assault was the most common DV types (98.7%). Bruise was the predominant type of wound among the DV victims (76.2%), and almost half of the victims had abrasions (48.1%). Head and limbs were the predominant sites of wound. Blunt injury was found in more than three-quarters of the victims (88.5%).Conclusion: The prevalence of domestic violence was high among living victims in the emergency department, with women as the majority of victims.

Intimate partner violence trends in Brazil: data from two waves of the Brazilian National Alcohol and Drugs Survey

OBJECTIVE

To compare intimate partner violence (IPV) prevalence rates in 2006 and 2012 in a nationally representative household sample in Brazil. The associations between IPV and substance use were also investigated.

METHODS

IPV was assessed using the Conflict Tactic Scale-R in two waves (2006/2012) of the Brazilian Alcohol and Drugs Survey. Weighted prevalence rates and adjusted logistic regression models were calculated.

RESULTS

Prevalence rates of IPV victimization decreased significantly, especially among women (8.8 to 6.3%). The rates of IPV perpetration also decreased significantly (10.6 to 8.4% for the overall sample and 9.2 to 6.1% in men), as well as the rates of bidirectional violence (by individuals who were simultaneously victims and perpetrators of violence) (3.2 to 2.4% for the overall sample). Alcohol increased the likelihood of being a victim (odds ratio [OR] = 1.6) and perpetrator (OR = 2.4) of IPV. Use of illicit drugs increased up to 4.5 times the likelihood of being a perpetrator.

CONCLUSIONS

In spite of the significant reduction in most types of IPV between 2006 and 2012, violence perpetrated by women was not significantly reduced, and the current national rates are still high. Further, this study suggests that use of alcohol and other psychoactive drugs plays a major role in IPV. Prevention initiatives must take drug misuse into consideration.

Domestic Violence in Methamphetamine Psychotic Users, Psychiatric Inpatients, and Healthy People: A Comparative Study

BACKGROUND

Domestic violence is a serious threat to the physical and mental health of women. The aim of the present study was to find and compare the frequency of domestic violence between methamphetamine users, patients with psychiatric disorders, and healthy people.

METHODS

In this analytical cross-sectional study, methamphetamine users (n=30) and patients with psychiatric disorders (n=30) were women whose husbands were hospitalized during 2014 in Shafa Psychiatric Hospital in Guilan. Diagnosis was done with DSMIV-TR. Healthy people (n=60) were women whose husbands had no primary or drug induced psychiatric disorder or addiction. CTS-2 test was used to evaluate violence.

RESULTS

The frequency of psychological, physical and sexual violence in the groups suffering from psychiatric disease and methamphetamine users was higher than the healthy group (P=0.001). We observed a direct correlation between the mean of psychological and physical violence in the three groups (r=0.9, P=0.001), (r=0.7, P=0.0001) and (r=0.53, P=0.005), respectively. Direct correlation between the psychological and physical violence was only observed in the healthy group (r=0.8, P=0.007).

CONCLUSION

The results showed that methamphetamine users such as psychiatric patients are at increased risk of violence. Domestic violence screening of these patients is necessary. It seems that this substance is a new source of increasing domestic violence with more undesirable outcomes in Iran.