Why Physicians and Nurses Ask (or Don’t) About Partner Violence: Women are not likely to disclose abuse unless directly asked

Editor's Note: When we had a recent procedure, I was asked not once, but twice, in the hospital outpatient area before and after the procedure by different nurses, if I had any problems at home with abuse, explaining that in the state of California they were mandated to ask that question.

Why physicians and nurses ask (or don’t) about partner violence: a qualitative analysis

Here are links we've found that might be helpful in domestic violence from a United States government site:

National Abuse Hotline

Reasons for Screening in Health Care Settings; Domestic violence is prevalent among women

According to the 2010 National Intimate Partner and Sexual Violence Survey (NISVS), more than one in three women have experienced physical violence at the hands of an intimate partner, including a range of behaviors from slapping, pushing or shoving to severe acts such as being beaten, burned, or choked. An estimated 3.6 percent of women reported experiencing these behaviors in the 12 months prior to taking the survey. Roughly one in four women (24.3%) have experienced severe physical violence, which includes having been slammed against something, having been hit with something hard, or having been beaten. Additionally, nearly one in ten women in the United States (9.4%) have been raped by an intimate partner in her lifetime.

Intimate partner violence is associated with life-threatening injuries as well as other physical and mental health problems of both an immediate and long-term nature. In its most severe form, physical IPV can result in death or major injuries. According to the CDC’s National Violent Death Reporting System, in 2003, 20 percent of homicides were directly associated with intimate partner conflict. For victims aged 40 to 44 years old, intimate partner violence was the most common form of violence resulting in death (Centers for Disease Control, 2006).

Physical violence can also result in less severe injuries, including bruises, black eyes, cuts, scratches, or swelling. These types of physical injuries are commonly associated with abuse and may trigger clinicians to ask their patients about IPV. Sexual abuse can result in injuries or infections, such as vaginal and anal tearing, bladder or vaginal infections, and sexually transmitted infections. These types of injuries may also cause a clinician to ask about abuse .

IPV is also associated with a number of long-term health impacts that may be more difficult for a health care provider to identify as resulting from abuse. Sustained exposure to violence is linked with central nervous system problems, including back pain, headaches, and seizures, as well as gastrointestinal problems. Sexual abuse is associated with higher risk of contracting sexually transmitted diseases, such as HIV/AIDS, either through forced unprotected sex or through the increased likelihood of risky sexual behavior.

The severe and prolonged stress caused by IPV can be detrimental to mental health as well. IPV is a major risk factor for depression, deliberate self-harm, and suicide . One study found that women who had experienced domestic violence were over twice as likely to suffer from depression than women who had never experienced abuse. IPV is also correlated with alcohol and drug abuse. One study found that survivors of IPV were over nine times more likely to be dependent on alcohol than women who had not experienced abuse, and eight times more likely to have used illicit drugs in the past 12 months .

Research indicates that the relationship between IPV and alcohol and drug abuse by the victim is complicated. Abuse may be more likely to occur when the victim is under the influence of alcohol or drugs. However, survivors often "self-medicate" to cope with abuse, suggesting that identifying abuse as a root cause for alcohol and drug abuse may be useful in providing treatment.

In addition to the direct linkage between IPV and physical and mental health problems, IPV can affect health outcomes in indirect ways. For example, the National Intimate Partner and Sexual Violence Survey reports that nearly 30 percent of women who have experienced any kind of violence, including physical violence, stalking, and/or rape, reported at least one major detrimental impact related to these experiences, such as being fearful or missing at least one day of work. The debilitative impact of abuse can potentially inhibit a woman’s ability to attend medical appointments, adhere to medical treatment plans, or overcome other adverse behaviors such as smoking, substance abuse, or overeating.

Furthermore, abuse can have intergenerational health effects. IPV can result in unintended pregnancies either through forced unprotected sex, risky sexual behavior associated with abuse, or through reproductive coercion, which occurs when one partner interferes with the other’s method of birth control. IPV that occurs during pregnancy is associated with preterm birth, low birth weight, and lower gestational age. These health consequences may have negative effects on the cognitive and motor skill development of newborns. Moreover, children who witness domestic violence are at increased risk of experiencing emotional, physical, and sexual abuse themselves. Witnessing IPV in childhood is one of 10 adverse childhood experiences linked to negative health outcomes across the life course, including depression, alcoholism, adolescent pregnancy, and suicide attempts (CDC, 2012). The numerous direct and indirect effects that IPV can have on short and long-term physical and mental health are frequently cited as justification for regular screening.

Editor's Note: We have removed citations for these recent studies but they can be seen in full at the ASPE POLICY BRIEF: Screening for Domestic Violence in Health Care Settings

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Why Physicians and Nurses Ask (or Don’t) About Partner Violence: Women are not likely to disclose abuse unless directly asked

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