Intimate Partner Violence - The Hidden Burden Is Common
May 17, 2006
There is a chronic condition that as many as 44% of women have experienced.
It adversely affects their physical and mental health. Screening for it is
inadequate, and interventions are unclear. Two articles from Group Health
Cooperative in Seattle and two commentaries in the June issue of the American
Journal of Preventive Medicine examine intimate partner violence (IPV) and
make recommendations for next steps in addressing this issue.
With colleagues from Harborview Injury Prevention and Research Center and the
University of Washington, Group Health researchers evaluated the prevalence,
timing, and severity of IPV in women, and the association between IPV and
women's health and health behaviors.
In the first research article, Robert S. Thompson, MD, and colleagues found that
IPV was not only highly prevalent (up to 44% of the more than 3,400 women said
they experienced IPV as an adult) but also chronic, lasting more than 5 years
and in some cases more than 20 years. Most abused women experienced more than
one type of IPV: for example, physical IPV and verbal threats. In addition, the
severity of abuse was rated as moderately or extremely violent in 30% to 60% of
reports, depending on the type of IPV.
“A picture emerges of both physical and non-physical IPV as very common,
chronic, intergenerational, and present in highly overlapping forms,”
according to Thompson, senior investigator at Group Health Center for Health
Studies. He and his coauthors conclude:
-- The time has arrived to mount and evaluate major interventions in day-to-day
medical practice, as they and others have proposed.
-- These efforts could employ universal routine questioning coupled with links
to institutional and community services, so the practitioner's fear of opening
Pandora's Box is adequately addressed.
-- Many women want to answer questions addressing IPV, so the potential negative
effects of asking about IPV seem exaggerated.
Amy E. Bonomi, PhD, MPH, research associate at Group Health Center for Health
Studies, is the lead author of the second research article. She and her
coauthors reported that rates of depression, physical symptoms, and social
isolation were significantly higher in women who experienced IPV compared to
women who never experienced IPV. Exposure to physical and/or sexual IPV in the
past five years had the strongest adverse health effects for women. The longer
women were exposed to IPV, the worse their health outcomes: This had not been
shown before.
“In light of these findings and those from previous studies, it is critical to
focus on strategies for the primary and secondary prevention of IPV that can be
used not only in healthcare settings but also in other individual, community,
and social arenas,” says Bonomi.
These findings provide “the additional challenge for us in the preventive
medicine and public health communities to advocacy and action to prevent IPV,”
Ann L. Coker, PhD, of the University of Texas Health Science Center, in Houston,
writes in the accompanying editorial. “Identifying IPV and intervening to
reduce the mental, physical, and social consequences of IPV must become a health
priority so that providers can competently care for women, children, families,
and communities.”
James S. Marks, MD, MPH, senior vice president of the Robert Wood Johnson
Foundation, in Princeton, NJ, considers it unlikely that the 44% figure is an
overestimate. “A primary challenge in studying IPV has been the understanding
that prevalence rates likely underestimate this public health problem because of
the stigma and shame associated with it,” he writes in his commentary
introducing the two research articles.
The introductory article is “Does a Failure to Count Mean It
Fails to Count? Addressing Intimate Partner Violence” by James S. Marks, MD,
MPH, and Elaine F. Cassidy, PhD. The first article, on IPV incidence, is
“Intimate Partner Violence-Prevalence, Types, and Chronicity in Adult Women”
by Robert S. Thompson, MD; Amy E. Bonomi, PhD, MPH; Melissa Anderson, MS; Robert
Reid, MD, PhD; Jane Dimer, MD; David Carrell, PhD; and Frederick P. Rivara, MD,
MPH. The paper analyzing health effects is “Intimate Partner Violence and
Women's Physical, Mental, and Social Functioning” by Amy E. Bonomi, PhD, MPH;
Robert S. Thompson, MD; Melissa Anderson, MS; Robert J. Reid, MD, PhD; David
Carrell, PhD; Jane A. Dimer, MD; and Frederick P. Rivara, MD, MPH. The final
article suggesting future efforts against IPV is “Preventing IPV: How We Will
Rise to This Challenge” by Ann L. Coker, PhD. These appear in the American
Journal of Preventive Medicine, Volume 30, Issue 6 (June 2006).
© 2006 American Journal of Preventive Medicine. All rights reserved.
Unauthorized use prohibited.
ABOUT THE AMERICAN JOURNAL OF PREVENTIVE MEDICINE
The American Journal of Preventive Medicine (ajpm-online.net)
is the official journal of The American College of Preventive Medicine (acpm.org)
and The Association of Teachers of Preventive Medicine (atpm.org).
It publishes articles in the areas of prevention research, teaching, practice
and policy.
Original research is published on interventions aimed at the prevention of
chronic and acute disease and the promotion of individual and community health.
The journal features papers that address the primary and secondary prevention of
important clinical, behavioral and public health issues such as injury and
violence, infectious disease, women's health, smoking, sedentary behaviors and
physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse.
Papers also address educational initiatives aimed at improving the ability of
health professionals to provide effective clinical prevention and public health
services. The journal also publishes official policy statements from the two
co-sponsoring organizations, health services research pertinent to prevention
and public health, review articles, media reviews, and editorials.
The American Journal of Preventive Medicine is ranked 9th out of 93
Public, Environmental & Occupational Health titles and 14th out of 103
General and Internal Medicine titles according to the Institute for Scientific
Information's 2004 Journal Citation Reports.
ABOUT ELSEVIER
Elsevier is a world-leading publisher of scientific, technical and medical
information products and services. Working in partnership with the global
science and health communities, Elsevier's 7,000 employees in over 70 offices
worldwide publish more than 2,000 journals and 1,900 new books per year, in
addition to offering a suite of innovative electronic products, such as
ScienceDirect (sciencedirect.com),
MD Consult (mdconsult.com),
Scopus (info.scopus.com),
bibliographic databases, and online reference works.
Elsevier (elsevier.com)
is a global business headquartered in Amsterdam, The Netherlands and has offices
worldwide. Elsevier is part of Reed Elsevier Group plc (reedelsevier.com),
a world-leading publisher and information provider. Operating in the science and
medical, legal, education and business-to-business sectors, Reed Elsevier
provides high-quality and flexible information solutions to users, with
increasing emphasis on the Internet as a means of delivery. Reed Elsevier's
ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK
and ENL (New York Stock Exchange).