The Impact of Crime Victimization on Women's Medical Use

Changes in Psychiatric and Medical Conditions and Health Care Utilization Following a Diagnosis of Sexual Assault: A Retrospective Cohort Study

INTRODUCTION

Sexual assault (SA) is alarmingly common and is associated with higher prevalence of psychiatric and medical conditions. However, many prior studies are limited to cross-sectional designs. Health care systems with electronic health records provide unique longitudinal data to examine whether SA is associated with changes in health and health care utilization.

METHODS

The sample included 1350 Kaiser Permanente Northern California adult female patients with a SA diagnosis from 2009 to 2015 and 4050 adult female patients without a SA diagnosis, matched on age, medical facility, and continuous enrollment during the study period. Using a retrospective cohort design, we tested whether a SA diagnosis was associated with 12-month changes in psychiatric and medical comorbidities and health care utilization using difference-in-difference models. Analyses were conducted in 2017.

RESULTS

Patients with a SA diagnosis had a higher prevalence of psychiatric and medical comorbidities and greater health care utilization than matched patients without SA in the 12 months before the SA diagnosis, and greater increases in the prevalence of psychiatric disorders and stress-related somatic conditions, and psychiatry and obstetrics/gynecology utilization (all P<0.001), 12 months after the SA diagnosis, relative to matched non-SA patients during this time.

DISCUSSION

SA is associated with increases in psychiatric disorders and stress-related somatic conditions as well as increases in utilization of psychiatry and obstetrics/gynecology. Clinicians should be trained in how to inquire about, respond to, and refer women who have experienced SA.

Sexual violence screening practices of student health centers located on universities in Florida

OBJECTIVE

The purpose of this study is to describe current sexual violence screening practices of student health centers located on universities in Florida.

PARTICIPANTS

Institutional level data was collected from 33 student health centers from November 2015 through January 2016. The student health centers were located on public or private universities.

METHODS

A cross-sectional descriptive study design was used. Data was collected from student health center representatives through use of a telephone administered survey.

RESULTS

Findings reveal that the majority of student health centers screen for sexual violence. However, not all use effective screening strategies. Further, the majority of screening questions used are not specific to sexual violence.

CONCLUSIONS

Findings can be used to assist universities with responding to campus sexual violence among the college population. Recommendations for strengthening sexual violence screening practices and future research are provided.

Emergency Department Visits and Injury Hospitalizations for Female and Male Victims and Perpetrators of Intimate Partner Violence

Introduction. The potential for hospital-based interventions for male victims of intimate partner violence (IPV) as well as adult perpetrators of both genders has been largely unexplored despite early evidence of acute-care utilization that may be as high as female victims. The current investigation compared the emergency department (ED) and injury-related-hospitalization rates of IPV-involved individuals against standardized national norms, assessing differences by gender and victim/perpetrator-status. Methods. This cross-sectional study collected one-year ED and in-patient visit data from hospital records for individuals listed as victim or perpetrator in an IPV criminal charging request in a Midwestern county (N=2,937). Expected rates were calculated based upon age-adjusted national norms. Results. The IPV-involved population generated ED rates 4.1 times higher than expected and injury-related-hospitalization rates that were 4.0 times higher than expected. Bi-directionally-violent individuals (both victim and perpetrator in IPV charges) consistently had the highest utilization rates (ED 8.4 RR, injury-hospitalization 22.5 RR). Victims, primarily female, had higher ED-visits than perpetrators, primarily male (victims = 4.6 RR, perpetrator = 3.1 RR). Perpetrators, though, had higher injury hospitalizations (victims = 0.8RR, perpetrators = 5.5 RR). Conclusions. Substantial opportunities exist within acute-care medical settings to intervene with IPV-involved women, men, victims, and perpetrators, although the magnitude of the opportunity varied by setting, gender and victim/perpetrator-status.

Inpatient hospitalization and intimate partner violence: who are we treating?

BACKGROUND

The majority of research into health care use of intimate partner violence (IPV) has focused on female victims and primarily their emergency department use. There are limited data on injury-related hospitalization rates for female victims and even less for male victims and perpetrators. The goal of this study was to determine the annualized rates of inpatient injury-related hospitalization among individuals involved as either victims or defendants in IPV.

METHODS

This was an observational retrospective study linking data from two Level 1 trauma centers and the county prosecutor's office from 2000 to 2010 in Kalamazoo County, Michigan. (1) Hospital data included injury-related admissions (DRG International Classification of Diseases-9th Rev. codes 800-959.9 excluding 905-909.9). (2) Prosecutor data contained all charging requests for crimes between intimate partners. Annualized rates were calculated for the year before the IPV crime and for the year after, using the following algorithm: (number of hospitalizations) / (total population) × (per 10,000). Confidence intervals and two-sided statistical significance were calculated at the 95% confidence level.

RESULTS

During the study period, 21,179 IPV crimes were committed, involving 12,913 individual defendants and 14,797 victims. There were 30,301 injury-related hospitalizations by this group during this period. Compared with national hospitalization rates of 3.2 per 10,000 people for injury/poisoning (DRG International Classification of Diseases-9th Rev. 800-959.9 and 990-995), IPV victim annual admission rates were 31.9, defendants at 90.4, and bidirectional individuals at 339.1 per 10,000 people, in the 2 years surrounding the crime. Males, regardless of crime role, have higher injury-related hospitalization rates in this period compared with females (male, 115.6; female, 41.8). Males (victims or defendants) and bidirectional participants of either sex had rates that were significantly higher the year after than the year before the crime.

CONCLUSION

Individuals involved in IPV have a 10-fold higher injury-related hospitalization rate as compared with age-matched national rates. Admission rates vary by sex, crime role, and time frame, with males and bidirectional participants having the highest rates.

LEVEL OF EVIDENCE

Epidemiological study, level III.

Barriers to screening for domestic violence in the emergency department

The identification of victims of domestic violence is important to prevent further abuse and injury. The purposes of this pilot project were to identify potential barriers emergency department registered nurses encounter in screening patients for domestic violence and to assess nurses' educational backgrounds for continuing education and training needs. The most significant potential barriers to screening identified were a lack of education and instruction on how to ask questions about abuse, language barriers between nurses and patients, a personal or family history of abuse, and time issues. These findings may benefit other researchers who are trying to determine the continuing education needs of emergency department staffs.

Missed opportunities: emergency department visits by police-identified victims of intimate partner violence

STUDY OBJECTIVE

We examine all emergency department (ED) utilization by police-identified women victims of intimate partner violence as part of an intimate partner violence ED surveillance study to determine the frequency and characteristics of visits and the extent of intimate partner violence screening and identification by ED staff.

METHODS

We conducted a retrospective observational case series reviewing countywide EDs visits, 1999 to 2001, for women victims in the 2000 prosecutor's intimate partner violence database. Stratifying visits by whether the woman presented with an injury, we assessed documentation of intimate partner violence screening and identification and mental health and substance abuse in the medical records.

RESULTS

Of 964 female intimate partner violence victims in the 2000 prosecutor's intimate partner violence database, 616 (63.9 %) received care in at least 1 ED in the year of the index assault. During the 3-year study period, 788 (81.7%) victims generated a total of 4,456 ED visits. Intimate partner violence screening was documented in 1,349 (30.3%) of the 4,456 visits but resulted in only 259 (5.8%) positive screens. However, because they use the ED so frequently, 23.0% of individual intimate partner violence victims were eventually identified. The median number of visits for victim ED users was 4 (range 1 to 71), and visits were just as likely to occur before the known intimate partner violence incident as after, although ED visits tended to peak in the month of the incident. Injury-related visits were 50% more likely to have documented IPV screening, however, most visits (71.2%) by IPV victims were for noninjury-related complaints.

CONCLUSION

Police-identified intimate partner violence victims utilize emergency care at extremely high rates, usually without identification or referral to intimate partner violence resources.

Primary care and victims of domestic violence

Providing quality health care involves integrating routine inquiry about domestic violence into ongoing clinical practice. This means asking all women patients, and others who may be at risk, about abuse in their lives. Whether or not a woman chooses to use services or leave her partner, our intervention is very important. Some women return to violent partners several times before they feel safe enough to leave, feel they can survive on their own, or can accept that the person they love will not change. Make sure that she has follow-up for her medical problems and appropriate referrals for mental health and substance abuse problems when indicated.

Relinquishing the need to "fix it": medical intervention with domestic abuse

The grounded theory method was used to study obstetricians/gynecologists' interactions with victims of domestic abuse. Double-bind conflict emerged as the basic social psychological problem. Physicians struggled between approaching domestic abuse as a legitimate medical problem or retreating from it as an overwhelming social issue. Resolution occurred through a three-stage process that changed the doctors' objective from "fixing" the abuse to supporting the patient. This goal revision required education on the dynamics of domestic abuse, confrontation of personal issues, and formation of community partnerships. Implications include development of curricula and protocols to create a united front against domestic abuse within health care, social service, legal, and law enforcement communities.

Nursing practice with incarcerated women: caring within mandated (sic) alienation

The number of incarcerated women in the United States is increasing at an alarming rate. Incarcerated women often come from environments that are significant for violence, drug abuse, and a kind of chronic chaos. Many enter the penal system with acute and chronic physical problems along with mental health issues that have long gone unaddressed. From a critical hermeneutical perspective, professional and personal experience and dialogical engagement with other prison nurses are combined to examine the structure and development of caring practices behind prison walls. Analysis to date reveals the distorting and perverting effect prison systems have on the practice of nursing, a situation in which personal relationships are forbidden. In substantive ways, nurses are ordered not to care.

The impact of a history of rape and incest on the posthysterectomy experience

I conducted a cross-sectional study to examine the impact of a history of rape and/or incest on the posthysterectomy experience. The sample consisted of 92 women recovering from elective hysterectomies. They were interviewed at 6, 12, 18, and 24 months after their operations. The Derogotis Sexual Functioning Index, the Center for Epidemiologic Studies-Depression Scale, and two hysterectomy-related questionnaires were administered. An analysis of variance compared abused with nonabused women on their sexual functioning, depression level, and satisfaction with their hysterectomy decision. Abused women had a significantly (p < .05) higher level of depression in the first year after the hysterectomy but not in the second year after the operation. Results suggest the need for expanded preoperative sexual history assessments and interventions and also to define areas for further research.