Preventing Intimate Partner Violence before It Starts

Article excerpt

Removing female victims of intimate partner violence from their abusive environments is a temporary fix to a long-term problem. In fact, stopgap measures that fail to either address the underlying risk factors for victimization or to appreciate the societal norms that perpetuate victimization can undermine the long-term success of intervention efforts.

Defined as physical, sexual, and/or psychological abuse by an intimate partner in order to gain control and power, intimate partner violence (IPV) is widespread. Data from the Centers for Disease Control and Prevention suggest that U.S. women aged 18 and older experience an estimated 5.3 million IPV incidents per year, including 1.5 million who experience rape or physical assault.

Additionally, nearly 2 million injuries and 1,300 deaths nationwide--predominantly among women--can be attributed to IPV.

Multiple studies show that IPV incidents generally are not one-time events. Rather, they persist over time and through multiple relationships.

In a cohort study of 3,429 women aged 18-64 from a U.S. health maintenance organization conducted by the Seattle-based Group Health Cooperative's Center for Health Studies, 44% of the women reported having experienced at least one incident of physical, psychological, or sexual intimate partner violence during their lifetime.

Nearly half of those women reported being abused by more than one partner, and up to 13% reported that the incidents persisted for more than 20 years. As has been documented in previous studies, rates of IPV in this population were higher among younger women, women with lower income and less education, single mothers, and those who had been abused as children (Am. J. Prev. Med. 2006;30:447-57).

The public health implications of both the prevalence and chronicity of intimate partner violence in terms of women's physical, mental, and social functioning are considerable. A second study using the same HMO data set demonstrated that, compared with women who never experienced IPV, those with IPV exposure within the previous 5 years had significantly higher rates of both severe and minor depressive symptoms, a higher number of physical symptoms, and lower mental and social functioning scores.

Duration of IPV exposure was significantly associated with worse outcomes across all measures. Interestingly, women who had experienced recent or persistent physical and/or sexual IPV had mental and social functioning scores that were the same or lower than scores for individuals with chronic allergies, chronic back pain, cancer, diabetes, heart disease, hypertension, and osteoarthritis (Am. J. Prev. Med. 2006;30:458-66).

Health care use and annual total health care costs are significantly higher in women with a history of IPV, compared with those with no history. According to Dr. Frederick P. Rivara of the Harborview Injury Prevention and Research Center in Seattle: "Women with a history of IPV have increased utilization across all types of health services," including mental health, substance abuse, hospital outpatient care, emergency department care, and acute inpatient care during and after periods of IPV.

In a longitudinal cohort study of 3,333 women, Dr. Rivara and colleagues showed that the annual health care costs of women with a history of IPV were 19% higher than women without an IPV history, and that the increase persisted for more than 5 years after IPV had ended (Am. J. Prev. Med. 2007;32:89-96). With an IPV prevalence of 44% as indicated in the HMO study mentioned earlier, "for every 100,000 women enrollees [in the HMO], IPV is responsible for $19.3 million in excess health care costs each year," Dr. Rivara said.

Not included in this estimate are the emotional, physical, and economic costs associated with caring for the next-generation of IPV victims. A review of 31 studies related to children witnessing violence revealed strong evidence that children who see violence at home exhibit a variety of behavioral, emotional, cognitive, and longer-term developmental problems that substantially increase the public health burden (J. …