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• W140492093 abstract "Thompson and colleagues1Thompson R.S. Bonomi A.E. Anderson J.E. et al.Intimate partner violence prevalence, types, and chronicity in adult women.Am J Prev Med. 2006; 30: 447-457Abstract Full Text Full Text PDF PubMed Scopus (349) Google Scholar document that intimate partner violence (IPV) rates are high among women seeking medical care (lifetime prevalence of 44%; 15% currently experiencing IPV) and provide new insight on the chronicity of IPV. Bonomi and colleagues2Bonomi A.E. Thompson R.S. Anderson M. et al.Effects of intimate partner violence on women’s physical, mental, and social functioning.Am J Prev Med. 2006; 30: 458-466Abstract Full Text Full Text PDF PubMed Scopus (447) Google Scholar further document that both physical and psychological IPV have significant mental, physical, and social consequences; in addition, as duration of IPV increases, so too does symptom severity. These two reports support the findings from a growing and consistent literature indicating that among women seeking healthcare, IPV is prevalent3Tjaden P. Thoennes N. Full report of the prevalence, incidence, and consequences of violence against women. U.S. Department of Justice, Washington DC2000Crossref Google Scholar, 4Coker A.L. Smith P.H. McKeown R.E. King M.J. Frequency and correlates of intimate partner violence by type physical, sexual, and psychological battering.Am J Public Health. 2000; 90: 553-559Crossref PubMed Scopus (606) Google Scholar, 5Gin N.E. Rucker L. Frayne S. Cygan R. Hubbell F. Prevalence of domestic violence among patients in three ambulatory care internal medicine clinics.J Gen Intern Med. 1991; 6: 317-322Crossref PubMed Scopus (145) Google Scholar, 6Rath G.D. Jarratt L.G. Battered wife syndrome overview and presentation in the office setting.S D J Med. 1990; 43: 19-25PubMed Google Scholar, 7McNutt L.A. Carlson B.E. Persaud M. Postmus J. Cumulative abuse experiences, physical health and health behaviors.Ann Epidemiol. 2002; 12: 123-130Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar, 8McFarlane J.M. Groff J.Y. O’Brien J.A. Watson K. Prevalence of partner violence against 7,443 African American, White, and Hispanic women receiving care at urban public primary care clinics.Public Health Nurs. 2005; 22: 98-107Crossref PubMed Scopus (36) Google Scholar, 9Rennison C.M. Intimate partner violence, 1993–2001. U.S. Department of Justice. Bureau of Justice Statistics, Washington DC2002Google Scholar, 10Krug E.G. Dahlberg L.L. Mercy J.A. Zwi A.B. Lozano R. World report on violence and health. World Health Organization, Geneva2002Abstract Full Text Full Text PDF Scopus (1535) Google Scholar and has significant mental and physical health effects.7McNutt L.A. Carlson B.E. Persaud M. Postmus J. Cumulative abuse experiences, physical health and health behaviors.Ann Epidemiol. 2002; 12: 123-130Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar, 11Campbell J. Jones A.S. Dienemann J. et al.Intimate partner violence and physical health consequences.Arch Intern Med. 2002; 162: 1157-1163Crossref PubMed Scopus (683) Google Scholar, 12Campbell J. Lewandowski L.A. Mental and physical health effects of intimate partner violence on women and children.Psychiatric Clin N Am. 1997; 20: 353-374Abstract Full Text Full Text PDF PubMed Scopus (422) Google Scholar, 13Coker A.L. Davis K.E. Arias I.A. et al.Physical and mental health effects of intimate partner violence for men and women.Am J Prev Med. 2002; 23: 260-268Abstract Full Text Full Text PDF PubMed Scopus (1553) Google Scholar, 14Coker A.L. Smith P.H. Bethea L. King M.R. McKeown R.E. Physical health consequences of physical and psychological intimate partner violence.Arch Fam Med. 2000; 9: 451-457Crossref PubMed Scopus (781) Google Scholar, 15McFarlane J. Malecha A. Watson K. et al.Intimate partner sexual assault against women frequency, health consequences, and treatment outcomes.Obstet Gynecol. 2005; 105: 99-108Crossref PubMed Scopus (204) Google Scholar Battered women, their children, family, friends, and those who provide legal, medical, and social services for battered women and their families have known this for years. Work by Thompson and colleagues1Thompson R.S. Bonomi A.E. Anderson J.E. et al.Intimate partner violence prevalence, types, and chronicity in adult women.Am J Prev Med. 2006; 30: 447-457Abstract Full Text Full Text PDF PubMed Scopus (349) Google Scholar and Bonomi and colleagues2Bonomi A.E. Thompson R.S. Anderson M. et al.Effects of intimate partner violence on women’s physical, mental, and social functioning.Am J Prev Med. 2006; 30: 458-466Abstract Full Text Full Text PDF PubMed Scopus (447) Google Scholar provide the additional challenge for us in the preventive medicine and public health communities to advocacy and action to prevent IPV. 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. Partner violence is a strong risk factor for a range of poor health outcomes and compromised functioning. Why are we not universally screening women (and men; “women” will be used to indicate both genders) for IPV victimization? The recent U.S. Preventive Services Task Force16U.S. Preventive Services Task ForceScreening for family and intimate partner violence recommendation statement.Ann Intern Med. 2004; 140: 382-386Crossref PubMed Scopus (145) Google Scholar issued an “I” recommendation on routine screening of adult women for IPV, indicating that the evidence to support the effectiveness of screening women for IPV in the primary care setting is lacking, of poor quality, or the balance of the benefits and harms cannot be determined. While a similar report, Prevention and Treatment of Violence Against Women17Canadian Task Force for Preventive Health Prevention and Treatment of Violence Against Women. 2001Google Scholar from Canada also concluded that there was insufficient evidence to recommend for or against routine screening for IPV, they noted the obvious potential harm of doing nothing. These reports strongly encourage large, long-term, randomized clinical trials to directly address the question of whether IPV screening compared with not screening improves IPV victims’ safety and well-being. Unfortunately, only extremely limited federal funding has been made available to foster research to respond to these reports. Appropriate funding is needed to meet this challenge of IPV prevention. Few clinicians routinely screen women for partner violence18Smith P.H. Danis M. Helmick L. Changing the health care response to battered women a health education approach.Fam Community Health. 1998; 20: 1-18Crossref Scopus (26) Google Scholar; the majority who are “screening” are asking only women with symptoms such as depression, anxiety, or injuries. Asking these women is tertiary prevention; the violence has occurred, as have at least some of the consequences. Our challenge is to move toward primary and secondary prevention. The goal for secondary prevention is to identify women who have experienced physical and psychological IPV. In addition, because current and past IPV have important short- and longer-term health consequences,2Bonomi A.E. Thompson R.S. Anderson M. et al.Effects of intimate partner violence on women’s physical, mental, and social functioning.Am J Prev Med. 2006; 30: 458-466Abstract Full Text Full Text PDF PubMed Scopus (447) Google Scholar universal IPV screening should address abuse by a current partner as well as abuse in past relationships. Once screened, healthcare providers can supply information about the effects of IPV on health, safety planning, and guided referrals. Many battered women do not recognize the effect of violence on health; as healthcare providers, making this link in a healthcare setting is our professional responsibility. Healthcare settings are safe environments for patients to receive and process information on legal, social, and other community-based services for violence victims. The patient has the choice to act on the information provided when she feels safe and ready to access services. It is the responsibility of the healthcare provider to identify the health threat and to provide information on safety and the range of community resources to empower women to make the best decisions for them. An often-cited frustration of clinicians who do identify IPV is that women stay with their abusive partners. We need to recognize that men and women in abusive relationships have been in this cycle for some time.19Weiss E. Surviving domestic violence, voices of women who broke free. Agreka Books, Scottsdale AZ2000Google Scholar This is a chronic condition, a point strongly reinforced by the present work.1Thompson R.S. Bonomi A.E. Anderson J.E. et al.Intimate partner violence prevalence, types, and chronicity in adult women.Am J Prev Med. 2006; 30: 447-457Abstract Full Text Full Text PDF PubMed Scopus (349) Google Scholar And, like learning to manage other chronic conditions, helping patients make the right decision for their situation takes time. While IPV victims cannot control their partner’s choice to use violence, they can change their response and they can act to increase their own safety. However, it is well-documented that the most dangerous time for a battered woman is when she tries to leave. Effective screening requires having appropriate referral services ready. Women must have the social, financial, and legal support to leave safely. Healthcare providers also need support from their administrators and health insurance providers to supply the information and support that patients need to address their IPV. Primary prevention to reduce IPV means changing attitudes. As the recent change in the acceptability of smoking in public places indicates, attitudes can be changed. To implement universal IPV screening, attitudes will need to change. When IPV screening is shown to be both efficacious and effective, universal screening of everyone receiving healthcare must become the social norm. Asking about IPV is a powerful statement to the victim. Asking removes the veil of secrecy and supports disclosure. Asking changes the social norms surrounding the secrecy of IPV for victims. Asking also changes the social norms in healthcare settings. Asking will eventually change our community’s social norms, which allow IPV to continue. To be sure, there are many unanswered questions about how to screen, which staff should screen, when to screen, how often to screen, and who should be screened. The findings reported by Thompson and colleagues1Thompson R.S. Bonomi A.E. Anderson J.E. et al.Intimate partner violence prevalence, types, and chronicity in adult women.Am J Prev Med. 2006; 30: 447-457Abstract Full Text Full Text PDF PubMed Scopus (349) Google Scholar and Bonomi and colleagues,2Bonomi A.E. Thompson R.S. Anderson M. et al.Effects of intimate partner violence on women’s physical, mental, and social functioning.Am J Prev Med. 2006; 30: 458-466Abstract Full Text Full Text PDF PubMed Scopus (447) Google Scholar however, leave no question that we have a responsibility and obligation as healthcare providers to identify IPV as the considerable health threat that it is and to intervene to prevent the life-long consequences of IPV. We in the public health and medical communities must aggressively advocate for sufficient funding to prioritize evaluation research to test and validate screening and intervention to prevent IPV. The National Institutes of Health roadmap initiative, begun in 2004, to form long-term interdisciplinary research centers is presently being applied to a number of priority areas, such as asthma and heart disease in diabetics. Expanding this initiative for IPV would provide a means to collectively address this prevalent yet preventable health threat. No financial conflict of interest was reported by the authors of this paper." @default.
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