Health-Related Costs of Intimate Partner Violence: Using Linked Police and Health Registers

This study aims to estimate direct health-related costs for victims of intimate partner violence (IPV) using nationwide linked data based on police reports and two healthcare registers in Finland from 2015 to 2020 (N = 21,073). We used a unique register dataset to identify IPV victims from the data based on police reports and estimated the attributable costs by applying econometric models to individual-level data. We used exact matching to create a reference group who had not been exposed to IPV. The mean, unadjusted, attributable healthcare cost for victims of IPV was €6,910 per individual over the 5-year period after being first identified as a victim. When adjusting for gender, age, education, occupation, and mental-health- and pregnancy-related diagnoses, the mean attributable health-related cost for the 5 years was €3,280. The annual attributable costs of the victims were consistently higher than those for nonvictims during the entire study period. Thus, our results suggest that the adverse health consequences of IPV persist and are associated with excess health service use for 5 years after exposure to IPV. Most victims of IPV were women, but men were also exposed to IPV, although the estimates were statistically significant only for female victims. Victims of IPV were over-represented among individuals outside the labor force and lower among those who were educated. The total healthcare costs of victims of IPV varied according to the socioeconomic factors. This study highlights the need for using linked register data to understand the characteristics of IPV and to assess its healthcare costs. The study results suggest that there is a significant socioeconomic gradient in victimization, which could also be useful to address future IPV prevention and resource allocation.

Spatial-temporal distribution of maxillofacial injuries resulting from intimate partner violence against women

BACKGROUND/AIM

Maxillofacial trauma resulting from intimate partner violence (IPV) represents an important oral health problem. In this sense, the aim of this study was to investigate the spatial-temporal distribution of maxillofacial trauma resulting from IPV against women, using a geostatistical approach.

MATERIALS AND METHODS

An ecological study was carried out including the analysis of confirmed IPV cases against women treated at a Center for Forensic Medicine and Dentistry over a four-year observation period, as well as the evaluation of population data from the victims' places of residence extracted from the last demographic census of the Brazilian Institute of Geography and Statistics. Statistical analysis included: (i) finite mixture modeling to establish incidence trajectory patterns; (ii) Getis-Ord indicator (Gi*) for spatial autocorrelation; (iii) spatial regression analysis (p < .05).

RESULTS

Two distinct trajectory patterns (TP1 and TP2) related to IPV incidence were identified using finite mixture modeling, suggesting spatial-temporal disparities at the regional level. In TP1, it was observed that IPV incidence was relatively low and remained stable over time, covering almost two-thirds (62.0%) of investigated spatial units. TP2 was characterized by higher IPV incidence with a tendency to increase in the last year, including more than one-third of neighborhoods (38.0%). Autocorrelation analysis showed a predominance of hot areas (hotspots) in the Eastern zone (p < .05) and in the Western zone (p < .05); and cold areas (coldspots) in the Northern zone (p < .05). In addition, statistically significant association was observed among neighborhoods with higher percentage of households with family householder without income and higher incidence of maxillofacial trauma resulting from IPV against women (β = 5.305; SE = 1.741; p = .002).

CONCLUSIONS

The findings indicate an association between higher IPV incidence against women, maxillofacial trauma, and socio-spatial vulnerability.

Systematic Review of Per Person Violence Costs

INTRODUCTION

Data on the long-term and comprehensive cost of violence are essential for informed decision making regarding the future benefits of resources directed toward violence prevention. This review aimed to summarize original per-person estimates of the attributable cost of interpersonal violence to support public health economic research and decision making.

METHODS

In 2023, English-language peer-reviewed journal articles published in 2000-2022 with a focus on high-income countries reporting original per-person average cost of violence estimates were identified using index terms in multiple databases. Study contents, including violence type (e.g., adverse childhood experiences), timeline and payer cost perspective (e.g., hospitalization event-only healthcare payer cost), and associated per-person cost estimates, were summarized. Costs were in 2022 U.S. dollars.

RESULTS

Per-person cost estimates related to adverse childhood experiences, community violence, sexual violence, intimate partner violence, homicide, firearm violence, youth violence, workplace violence, and bullying from 73 studies (majority focusing on the U.S.) were summarized. For example, among 23 studies with a focus on adverse childhood experiences, monetary estimates ranged from $390 for adverse childhood experience-related annual healthcare out-of-pocket costs per U.S. adult with ≥3 adverse childhood experiences to $20.2 million for the lifetime societal economic burden of a U.S. child maltreatment fatality.

CONCLUSIONS

This review provides a descriptive summary of available per-person cost of violence estimates. Results can help public health professionals to describe the economic burden of violence, identify the best available estimate for a particular public health question, and address data gaps. Ultimately, understanding the long-term and comprehensive cost of violence is necessary to anticipate the economic benefits of prevention.

Health Outcomes in Women Victims of Intimate Partner Violence: A 20-Year Real-World Study

Intimate partner violence is characterized by violent actions against a person perpetrated by his or her former or current partner, regardless of cohabitation. It most frequently affects women, and one of its most relevant outcomes is the health problems associated with the experience of repeated violence. Thus, the main objective of this study is to analyse the prevalence of health problems among women for whom there was a medical suspicion of being victims of intimate partner violence. The specific objectives are to analyse the prevalence of (a) health risk behaviours; (b) traumatic injuries and intoxications; (c) mental health conditions; and (d) somatic diseases. We conducted a real-world, retrospective, observational, cross-sectional and multicentric study based on secondary data analyses of electronic health records and health care register data in patients of the Local Healthcare Unit of Matosinhos (between 2001 and 2021). The identified data were extracted from electronic health records corresponding to the Health Insurance Portability and Accountability Act Safe Harbor Standard. Information was obtained considering the International Classification of Diseases, the International Classification of Primary Care, and the Anatomical Therapeutic Chemical Classification System, as well as clinical notes (according to previously defined keywords). Considering all information sources, 1676 cases were obtained. This number means that just 2% of the women observed at this health care unit were suspected of being victims of intimate partner violence, which is far from the known statistics. However, we found much higher rates of all health risk behaviours, trauma and intoxication cases, mental health conditions, and somatic disorders we looked for, when compared to the general population. Early detection of these cases is mandatory to prevent or minimize their related health outcomes.

Fourteen Main Obstacles on the Journey to Post-Traumatic Growth as Experienced by Female Survivors of Intimate Partner Violence: "It Was All So Confusing"

In this study, we identified 14 obstacles experienced by female survivors of intimate partner violence who had, nonetheless, reached post-traumatic growth (PTG), which is a positive psychological change by a person following serious difficulties or traumatic events. Intimate partner violence (IPV) is such a trauma. The purpose of this study was to analyze the obstacles to PTG as experienced by women who have succeeded in reaching PTG following traumatic IPV. Participants were twenty-two women aged 23–56 who self-reported their PTG according to the working definition used. The participants reported feelings of diminished self-worth that had negatively influenced their lives and how these negative feelings delayed their PTG. The overriding theme of the study was “It was all so confusing”, which expressed the essence of the participants’ feelings when describing the obstacles they encountered on their journey to PTG. Most of those obstacles were intrapersonal, i.e., negative personal feelings and negative perspectives towards themselves. Other obstacles reported by participants were physical and psychological health problems, challenging personal circumstances, and the perpetrator, as well as laws, regulations, and institutional social systems. This study reveals the broad range of obstacles encountered by women on their journey to PTG following IPV, emphasizing the necessity of an interdisciplinary approach when holistically considering their situation and supporting them on their journey towards PTG.

Violence against women: An observational study in an Italian emergency department

Violence against women is a pervasive phenomenon affecting one in three women aged ≥15 in the world that are more likely to visit an emergency department (ED) for the serious physical and psychological consequences of the abuse. The aim of this observational single-centre study is to describe the socio-demographic and clinical variables associated with violence against women. We enrolled 425 female patients who attended an Italian ED for trauma on 2019 and the patients' information was collected and analyzed with descriptive statistics. The average age of the patients was 41.5 (standard deviation = 14.2) years. 74.6% of the women were Italians, and 86.6% were of metropolitan origin. The reasons for the ED visit included aggression (67.5%), accidental trauma (29.0%) and unknown reasons (3.5%). Multivariate analysis confirmed that three factors were independently associated with violence: nationality (odds ratio [OR] = 0.27; 95% confidence interval [CI], 0.09-0.77), head/face/neck injuries (OR = 7.32; 95% CI, 3.76-14.27) and multiple injuries (OR = 8.52; 95% CI, 1.03-70.47). Age over 25 was a protective factor. The study confirmed that being a foreigner and having head/face/neck injuries or multiple injuries are associated with violence against women.