Intimate Partner Violence and Healthcare

Intimate partner violence is one of the largest public health problems globally, yet detection and intervention by healthcare professionals remains largely inadequate. Intimate partner violence (IPV) is defined as “any behavior within an intimate relationship that causes physical, psychological, or sexual harm to those in the relationship,” (World Health Organization, 2012). Although IPV does not discriminate between race, socioeconomic status, or religion, victims of IPV are generally women. A 2013 report by the World Health Organization (WHO) stated that one in three women globally report physical or sexual violence by an intimate partner (Moreno et al., 2015). Additionally, in 2013, “62% of female homicides were attributed to their husbands or boyfriends,” in the US (Alvarez et al., 2016). Another 2013 report from Canada stated that, “intimate partner violence accounted for 53% of police-reported incidents and spousal violence for the remaining 47%,”  (Vonkeman et al., 2019).

During the COVID-19 pandemic, the abuse appears to only have worsened. A study published in 2020 concluded that “there was a higher rate of physical intimate partner violence (IPV), with more severe injuries on radiologic images, despite fewer patients reporting IPV,” (Gosangi et al., 2020). Researchers attributed the more severe injuries to the mandatory stay at home orders, while there were fewer reports as healthcare professionals were overwhelmed with treating cases of COVID-19 and not as focused on IPV intervention.  

Despite IPV’s global prevalence, there is a lack of agreement as to the best approach for detection and intervention. In fact, universal screening for IPV is actually discouraged by WHO but instead encourages healthcare providers to investigate patients showing injuries that could be attributed to IPV (Martinez-Garcia, 2021). As a result, it is imperative that healthcare professionals are actively aware and searching for these signs among their patients.

Unfortunately, there are many barriers that prevent healthcare professionals from providing this level attention to their patients. One of the largest factors is personal opinions and beliefs of the healthcare professional towards IPV. A study conducted in Bogota, Colombia interviewed 27 health care professionals about their attitudes towards IPV and found that “many mentioned that they did not want to “invade the patient's private life,” and that “they did not want to get involved” between the people in the relationship and that it isn’t anyone else’s concern” (Baig et al., 2012). However, what this belief fails to recognize is that this stigma around IPV is exactly what allows abusers to perpetrate violence as they are often not held accountable. 

This stigma is not limited to healthcare professionals in Colombia, however. Another study conducted within a Korean American pocket in Los Angeles found that Korean American physicians not only dismissed IPV concerns, but that their “response was driven by the degree to which the physician was enculturated to mainstream medical practice norms regarding IPV in the United States.” (Chung et al., 2008). Enculturation was defined by the researchers in the study as the extent to which the physician applied US medical norms in their practice. The study found that physicians that were identified as having low enculturation denied the presence of IPV in the Korean community as they believed IPV only occurred among poorer, non-Koreans such as Latinos for which violence was more commonplace. They also found that low enculturation was also correlated with the belief that IPV was not a real medical issue and thus not their place to intervene (Chung et al., 2008).  These personal beliefs that healthcare professionals hold impact how likely they are to view IPV as a real problem and intervene to help their patient. 

Another obstacle in the way of proper detection and intervention of IPV is the lack of education about IPV and proper screening tools to use. A study conducted in Canada examined the response of the emergency department to IPV in an urban setting. Researchers found that although staff could correctly determine appropriate screening questions to ask, “87.3% of respondents were not aware of current screening tools,” (Vonkeman et al., 2019).  Additionally, “81.8% of the ED staff had not received any formal training on domestic or intimate partner violence,” (Vonkeman et al., 2019). These results illustrate the dire need to invest in IPV training for healthcare professionals, as they need to be actively aware of how to detect IPV since it is not universally screened for as aforementioned. 

Additionally, a separate study surveyed mental health professionals to explore their attitudes and knowledge towards IPV. After surveying 130 professionals, researchers found that only 15% of professionals routinely asked about domestic violence and only 27% “provided information to service users following disclosure,” (Nyame et al., 2013).  Evidently, healthcare professionals are unsure not only how to screen for IPV but also how to intervene and offer support if a patient is a victim. 

The incompetence of healthcare professionals to intervene for victims of IPV, whether due to personal bias or lack of education, can have severe health consequences for these victims, ranging from physical to psychological. Experiencing IPV puts women at “greater risk for chronic pain, asthma, gastrointestinal, neurological, reproductive health problems, and poor mental health (notably post-traumatic stress disorder, depression, substance abuse) as well as increased injury and mortality from homicide and suicide” (Centers for Disease Control and Prevention, 2008). Even after immediate treatment for injuries sustained by an abuser, “survivors have 20% more health-care utilization compared to nonabused women,” (Centers for Disease Control and Prevention, 2008).

Unfortunately, IPV doesn’t only affect the victim in the relationship: there is evidence that living in a household experiencing IPV also means child abuse is more likely to occur, as well as exposure to IPV against the mother resulting in the continuation of the cycle for the child, whether that be perpetrating or experiencing IPV later in life. Moreover, studies conducted in low-income countries found that children whose mothers were abused “are less likely to be immunized and are at greater risk of dying before the age of five” (World Health Organization, 2012). These studies show how intimate partner violence doesn’t only affect the victim, but rather creates trauma that can be passed down generations. Thus, it is of the utmost importance that intervention occurs when possible, such as through the role of healthcare professionals. 

Figure 1: Healthcare professionals have an important role in secondary and tertiary prevention of intimate partner violence and work with legal and social services to ensure proper intervention for their patients (Moreno et al., 2015). 

As Figure 1 illustrates, the role of healthcare professionals isn’t solely to identify IPV but also work more broadly with the legal system or social workers to connect their patients to appropriate resources. Intimate partner violence is a complex issue and requires attention from more than one facet of healthcare. Now more than ever, healthcare professionals should receive formal training to equip themselves with the tools to intervene. 

References

Alvarez, C., Fedock, G., Grace, K., Campbell, J. (2016). Provider Screening and Counseling for Intimate Partner Violence: A Systematic Review of Practices and Influencing Factors. Sage. https://doi.org/10.1177/1524838016637080

Baig, A., Ryan, G., Rodriguez, M. (2012). Provider Barriers and Facilitators to Screening for Intimate Partner Violence in Bogotá, Colombia. Health Care for Women International. https://doi.org/10.1080/07399332.2011.646368

Centers for Disease Control and Prevention. (2008). Adverse health conditions and health risk behaviors associated with intimate partner violence--United States, 2005. MMWR: Morbidity and mortality weekly report. Retrieved December 17, 2022, from https://www.safetylit.org/citations/index.php?fuseaction=citations.viewdetails&citationIds%5B%5D=citjournalarticle_84669_28 

Chung, G., Oswald, R., Hardesty, J. (2008). Enculturation as a Condition Impacting Korean American Physicians' Responses to Korean Immigrant Women Suffering Intimate Partner Violence. Health Care for Women International. https://doi.org/10.1080/07399330802523568

Gosangi, B., Park, H., Thomas, R., Gujrathi, R., Bay, C., Raja, A., Seltzer, S., Balcom, M., McDonald, M (2020). Exacerbation of Physical Intimate Partner Violence during COVID-19 Pandemic. Radiology. https://doi.org/10.1148/radiol.2020202866

Martinez-Garcia, E. (2021). Sexist Myths Emergency Healthcare Professionals and Factors Associated with the Detection of Intimate Partner Violence in WomenE. International Journal of Environmental Research and Public Health. https://doi.org/10.3390/ijerph18115568

Moreno, C., Hegarty, K.,Lucas d'Oliveria, A.,Koziol-McLain, J.,Colombini, M., Feder, G. (2015) The health-systems response to violence against women. The Lancet. https://doi.org/10.1016/S0140-6736(14)61837-7

Nyame, S., Howard, L., Feder, G., Trevellion, K. (2013). A survey of mental health professionals' knowledge, attitudes and preparedness to respond to domestic violence. Journal of Mental Health. https://doi.org/10.3109/09638237.2013.841871

Vonkeman, J., Atkinson, P., Fraser, J., McCloskey, R., Boyle, A (2019) Intimate Partner Violence Documentation and Awareness in an Urban Emergency Department. Cureus. https://doi.org/10.7759/cureus.6493

World Health Organization. (2012). Intimate partner violence. Retrieved December 18, 2022, from https://apps.who.int/iris/bitstream/handle/10665/77432/WHO_RHR_12.36_eng.pdf;sequence=1