Physical health consequences of physical and psychological intimate partner violence

BACKGROUND

Past studies that have addressed the health effects of intimate partner violence (IPV) have defined IPV as violence based on physical blows that frequently cause injuries. To our knowledge, no epidemiologic research has assessed the physical health consequences of psychological forms of IPV.

OBJECTIVE

To estimate IPV prevalence by type and associated physical health consequences among women seeking primary health care.

DESIGN

Cross-sectional survey.

SETTING AND PARTICIPANTS

A total of 1152 women, aged 18 to 65 years, recruited from family practice clinics from February 1997 through January 1999 and screened for IPV during a brief in-clinic interview; health history and current status were assessed in a follow-up interview.

RESULTS

Of 1152 women surveyed, 53.6% ever experienced any type of partner violence; 13.6% experienced psychological IPV without physical IPV. Women experiencing psychological IPV were significantly more likely to report poor physical and mental health (adjusted relative risk [RR], 1.69 for physical health and 1.74 for mental health). Psychological IPV was associated with a number of adverse health outcomes, including a disability preventing work (adjusted RR, 1.49), arthritis (adjusted RR, 1.67), chronic pain (adjusted RR, 1.91), migraine (adjusted RR, 1.54) and other frequent headaches (adjusted RR, 1.41), stammering (adjusted RR, 2.31), sexually transmitted infections (adjusted RR, 1.82), chronic pelvic pain (adjusted RR, 1.62), stomach ulcers (adjusted RR, 1.72), spastic colon (adjusted RR, 3.62), and frequent indigestion, diarrhea, or constipation (adjusted RR, 1.30). Psychological IPV was as strongly associated with the majority of adverse health outcomes as was physical IPV.

CONCLUSIONS

Psychological IPV has significant physical health consequences. To reduce the range of health consequences associated with IPV, clinicians should screen for psychological forms of IPV as well as physical and sexual IPV.

Behçet's disease and pheochromocytoma

A 46-year-old black female with a history of Behçet's Disease was admitted with a diagnosis of abdominal pain. She had complained of palpitations, diaphoresis, anxiety, and fatigue for years which had been variously attributed to the perimenopause and her Behçet's. During her hospital evaluation, she had an episode of supraventricular tachycardia associated with severely elevated blood pressure. Subsequent evaluation revealed a large pararenal mass which was found to be a pheochromocytoma. Search of six databases revealed this to be only the second case report in the English literature of a pheochromocytoma in association with Behçet's Disease.

Physical violence during pregnancy: maternal complications and birth outcomes

OBJECTIVE

To assess the association between physical violence during the 12 months before delivery and maternal complications and birth outcomes.

METHODS

We used population-based data from 6143 women who delivered live-born infants between 1993 and 1995 in South Carolina. Data on women's physical violence during pregnancy were based on self-reports of "partner-inflicted physical hurt and being involved in a physical fight." Outcome data included maternal antenatal hospitalizations, labor and delivery complications, low birth weights, and preterm births. Odds ratios and 95% confidence intervals were calculated to measure the associations between physical violence, maternal morbidity, and birth outcomes.

RESULTS

The prevalence of physical violence was 11.1%. Among women who experienced physical violence, 54% reported having been involved in physical fights only and 46% had been hurt by husbands or partners. In the latter group, 70% also reported having been involved in fighting. Compared with those not reporting physical violence, women who did were more likely to deliver by cesarean and be hospitalized before delivery for maternal complications such as kidney infection, premature labor, and trauma due to falls or blows to the abdomen.

CONCLUSION

Physical violence during the 12 months before delivery is common and is associated with adverse maternal conditions. The findings support the need for research on how to screen for physical violence early in pregnancy and to prevent its consequences.

Primary prevention of child abuse

In 1993, the U.S. Advisory Board on Child Abuse and Neglect declared a child protection emergency. Between 1985 and 1993, there was a 50 percent increase in reported cases of child abuse. Three million cases of child abuse are reported in the United States each year. Treatment of the abuser has had only limited success and child protection agencies are overwhelmed. Recently, efforts have begun to focus on the primary prevention of child abuse. Primary prevention of child abuse is defined as any intervention that prevents child abuse before it occurs. Primary prevention must be implemented on many levels before it can be successful. Strategies on the societal level include increasing the "value" of children, increasing the economic self-sufficiency of families, discouraging corporal punishment and other forms of violence, making health care more accessible and affordable, expanding and improving coordination of social services, improving the identification and treatment of psychologic problems, and alcohol and drug abuse, providing more affordable child care and preventing the birth of unwanted children. Strategies on the familial level include helping parents meet their basic needs, identifying problems of substance abuse and spouse abuse, and educating parents about child behavior, discipline, safety and development.

Clinical similarities and demographic differences between residency and private practice patients

BACKGROUND

This study compared the clinical and demographic mix of patients at a family practice residency site in South Carolina to those from other regions and demonstrated the effectiveness of a computerized medical record in facilitating such analysis.

METHODS

Patient visits to Richland Family Practice Center (RFP), the outpatient care site for the University of South Carolina School of Medicine, were retrospectively sampled for the period July 1992-June 1993. Data analysis used descriptive statistics and contingency tables. A time test comparing manual and computerized data retrieval was also performed.

RESULTS

The patients seen were predominantly female (75.2%) and African-American (68%). RFP treated proportionately more federally funded and minority patients than did community-based physicians. The top five principal diagnoses at RFP were hypertension, diabetes mellitus, general medical examination, normal pregnancy, and acute upper respiratory infection; the top 20 principal diagnoses accounted for 51.3% of all visits. When compared to the top 20 diagnoses for all family and general practice physicians in the southern United States, considerable overlap was present, confirming clinical similarity between patient populations at residency and private practice sites. Computerized data retrieval was faster and more complete than manual data retrieval.

CONCLUSIONS

Diagnoses encountered at RFP and reported by other family practice residencies generally parallel those documented in family practice in various geographic regions. However, residencies differ from private practices in that they care for more economically disadvantaged patients. Computerized medical records systems facilitate research within a residency program.