This program is brought to you by Emory University. >> Hello. Today we're going to talk about intimate partner violence, learn a little bit about statistics around it, associations, and why it's important to intervene. The actual definition that I tend to use is that intimate partner violence is a pattern of coercive behavior that leads to abuse this includes physical abuse, such as, hitting or kicking, sexual abuse, such as rape and psychological abuse which includes intimidation or threats. It's important to realize that this is one partner by the other and the partner can be a current or a past partner. And it can be a dating partner, husband or wife, or same sex partner. When you think about intimate partner violence it's important to keep this in the context of power and control. An example, lets talk about the cycle of violence. So there might be an incident where there's a violent occurrence where he hits her, after that there's the making up phase, and that's where you'll hear I'm so sorry, I won't do it again, I'm going to change, and she forgives him. Then there's the calm period, and that's where everything, you know, is back to why they're together. Unfortunately then it keeps going, because this is a cycle, and it goes into tension building, and that's when perhaps somebody's drinking or there's work pressures, and that escalates into violence again. Because it's a cycle it does continue unless we break it. The other thing to realize is the cycle expand. Kids can be involved either as actual victims of the abuse or witnessing it. Similarly, family members can be injured by this. So why do I care about this and why am I talking to you about this today? As an ER doc. This really hits home for me because it's the most common cause of injury to women in the United States. $6 billion for medical expenses and work productivity losses in the United States annually. And on average over 1200 women and 440 men are killed by a partner each year. Putting it in perspective looking at common conditions that affect women in the aged group 15 to 45, intimate partner violence is one of the most pub, common public health concerns. And when you look at rates, they're actually pretty high in emergency department patients with up to 50% of women reporting partner violence at some point in their lifetime. This can include both physical and nonphysical abuse. A population-based survey by the CDC, the National Violence Against Women Survey, focused mostly on physical and sexual abuse. And they found one in four women had been abused during their lifetime and about 8% of men had also experienced abuse. So now let's talk about race and ethnicity, as this is an important association to consider. A recent study by the CDC found that about 44% of black women, 37% of hispanic women, and 35% of white women reported partner violence. Another study done ten years earlier, found lower rates and pretty similar across demographic groups. The thing to realize about all these studies though is, when you control for socioeconomic status, this ethnic and racial difference usually goes away. Talking about gender, male and female perpetration of violence is equalizing. In a study I did found that women tend to report victimization more. Men still perpetrate more severe violence which makes sense if you look at their size and strength. And when you really compare what the result of violence is, women tend to sustain more injuries. And if you look at the actual psychological affect of it, they report more fear than their male counterparts. Other associations, I think one of the landmarks studies that was done in Colorado by Jean Abbott, about 20 years ago now, found that suicide attempts and depression were very much associated with partner violence. Some early alcohol use. She did not find any association with race like we just talked about. She also didn't find any association with education, income, pregnancy status, or presence of a gun in the house. When you add to that some other studies have been done by Jackie Campbell as well as studies I have done. We've also found that associations with cocaine use being abused as a child. And witnessing partner violence or being exposed to violence in the home can also be associated with partner violence. And, if you look specifically at mental health associations, the amount of abuse you have really impacts it. So, for example, if you're experiencing all three types of violence, physical, sexual and emotional. 18-fold increase that you are having suicidal symptoms. If you're talking about post-traumatic stress disorder, and you're only experiencing one type of abuse. So potentially physical abuse, 2.4 times more likely to have symptoms. And if you're experiencing all three, nine times more likely to have PTSD symptoms. So really important to also understand the types of abuse and the cumulative effect. Focusing on physical injuries. Head, neck, face. Really, you gotta think about partner violence. 24 times more likely if a female comes in with injuries to that body location that it's from partner violence than anything else alone. If you look at chest, belly, legs, arms, doesn't have the same correlation, but head, neck, face gotta think partner violence. So, what do you do with this information and how effective is screening for and identifying victims? And are there interventions that work? In the clinical setting, if you look at organizations many have recommended screening for partner violence. Recently, the Institute of Medicine recommended screening and counselling for all women and adolescent girls for interpersonal domestic violence as the point of care as part of preventative care services. On the flip side though, two systematic reviews have said that there really wasn't the evidence to support screening. So, what do I think? It's important. If you don't ask about it, you don't detect it. And there's really a lot of value in preventing future abuse as well as the long term sequelae of mental health symptoms and impact it can have on other family members and children. And it's low cost. It's a question. It's also low risk. As long as you ask in an appropriate manner and not in front of family members, and you're sensitive, it can be very low risk. Is screening effective? A study I did at a county hospital here in Atlanta found that, the majority of people felt they benefited from being screened and given referrals. And, in fact, most kept the resource information. What I think really changed my mind on screening and referral is that over a third of patients actually contacted a resource and many utilized domestic violence hotlines, shelters. And others actually underwent substance abuse treatment and mental health counseling so it does have an impact. So I also think it's important to talk about what are potential interventions for partner violence. Screening and recognizing violence is important, but can we do something to stop it? Or to prevent future issues with it? So, one thing that's under consideration is battered treatment programs. And these programs are important and have shown some efficacy. It is important to realize though that many of these treatment programs mandate participation. So you may not always have the most willing participants go through this. In addition they do tend to enroll lower income minority men and not the general population. Shelter advocacy and Lay outreach interventions have also shown some promise. However, most studies have shown, long term, they may not be effective. The CDC funded a safe date study, and this program has been show effective for teen dating violence that has not been applied, however, to true adult partner violence or as a shorter intervention. Substance abuse and aggression treatment have also been shown to be beneficial for both victims and perpetrators, and I think it's important to keep this is the holistic picture. That it's not just about the violence, but it may be about treating mental health or substance abuse as part of the picture. And finally, cognitive based therapy also shows some promise. This however is not truly an intervention for preventing violence. But, for preventing the sequelae of violence like post traumatic stress disorder. So, what happens if we don't stop it? Well, we talked about the impact it can have on children. The expenses that it can have in the work place. But there's also again the long term issues that result from partner violence. Depression, anxiety, sexually transmitted infections and even medical conditions you might not think of like, asthma, high blood pressure, and headaches. Chronic pain and physical injuries. So I think it's important to really focus our efforts on how do we prevent this violence before it even occurs. And for those that have experienced violence. How can we prevent the long term sequelae?
