Brian I. O'Toole

Prevalence Study of Domestic Violence Victims in an Emergency Department

STUDY OBJECTIVEnIn 1992, a study of the prevalence and predictors of domestic violence victims among individuals who presented to a major public hospital emergency department was conducted to replicate a study conducted by the authors in the same setting 12 months previously. The second study aimed to investigate more accurately the presentation of current victims of domestic violence to the ED.nnnMETHODSnIn a retrospective, cross-sectional study, a screening questionnaire was administered to participants to establish the prevalence of a history and current presentation of domestic violence problems among patients who presented to the ED of a major public hospital. The study group comprised a representative sample of 670 male and 553 female adults (older than 16 years) who presented to all sections of a public hospital ED during 53 randomly selected 8-hour nursing shifts over an 8-week period in 1992.nnnRESULTSnThe results of the second prevalence study confirmed those of the first study. Of the 1,223 respondents in the study, 15.5% disclosed a history of adult domestic violence (8.5% of men, 23.9% of women). Women were at greater risk than men for abuse as adults (raw relative risk [RR], 3.27; 95% confidence interval [CI], 2.23 to 4.79; RR adjusted for age, history of child abuse, and country of birth, 4.13; CI, 2.86 to 5.95). Women were at greater risk than men for being doubly abused (as a child and as an adult)(raw RR, 2.17; CI, 1.33 to 3.53). The second prevalence study confirmed what had been indicated in the first study: that 2.0% of women who presented to the ED (11.6% of all women with a history of adult domestic violence) were current victims of domestic violence and that these women presented mainly between the hours of 5 pm and 8 am, when no social work services were available for referral of victims.nnnCONCLUSIONnThese Australian studies support the findings of prevalence studies of domestic violence victims in ED in the United States. The prevalence and risk factors indicate the need for training of physicians and nurses in the ED about domestic violence and for provision of appropriate backup referral services such as after-hours social work services.

Domestic violence in the emergency department: I: Two case-control studies of victims

The object of this study was to compare the diagnoses and characteristics of self-reported domestic violence victims with a random sample of nonvictim controls who were selected from attendees at the Emergency Department (ED) of a major public hospital in Australia. Comparisons were made at index presentation and for the 5 years prior to index presentation. Subjects were drawn from two screening studies carried out 1 year apart which were conducted to assess the prevalence of domestic violence among attendees at the ED. From these groups, the medical records of all individuals who had disclosed domestic violence were examined and compared with the medical records of a random sample of nondisclosers, matched for age (+/- 10 years), sex, and type of entry into the ED (acute vs nonacute). The two case-control studies, conducted 12 months apart, showed that there were statistically significant differences between the diagnoses and characteristics of victims and nonvictims. Victims made more visits to the ED and Outpatients Department than nonvictims; victims had more psychiatric index presentations; more victims had evidence of treatment of psychiatric conditions, both as inpatients and outpatients, in the previous 5 years than nonvictims; victims had greater rates of attempted suicide and alcohol problems than nonvictims at index presentation and for the previous 5 years. The findings indicate the need for the prevention and treatment of psychiatric conditions of domestic violence victims, including drug and alcohol problems and suicidal ideation. The findings form the basis of hypotheses for further studies to investigate the association between domestic violence and psychiatric illness.

Impact of an education program about domestic violence on nurses and doctors in an Australian emergency department

OBJECTIVEnTo increase the knowledge of nurses and doctors in an emergency department about the topic of domestic violence; to change any negative practices and attitudes toward victims; to increase knowledge of the referral processes for psychosocial aspects of domestic violence; and to increase knowledge of community resources for domestic violence victims.nnnMETHODSnIdentical knowledge, attitude, and practice surveys were conducted with nurses and doctors in an emergency department before and after an educational intervention program about domestic violence. A matched-pair analysis of those respondents who answered both pretest and posttest surveys was conducted to measure the impact of the program on nurses and doctors.nnnRESULTSnNurses and doctors had a reasonable knowledge of the topic of domestic violence before the education program (correct answers: nurses, 61.6%; doctors, 63.4%). However, the program had a positive impact on their knowledge (correct answers posttest: nurses, 71.5%; doctors, 72.4%), with more significant changes for nurses than for doctors. The program affected both nurses and doctors attitudes (of 10 positive attitudinal statements: pretest, 7.9; posttest, 8.6). On both the pretest and posttest, nurses and doctors did not subscribe to a number of the myths about domestic violence that have been described in the domestic violence literature. These findings should be treated with caution because of the low response rates to the surveys from doctors (28.0%, n = 20) and nurses (53.0%, n = 48).nnnDISCUSSIONnFurther research is needed into the beliefs and practices of nurses and doctors about domestic violence. The impact of this education program highlights the necessity for introducing training programs for health professionals on domestic violence problems.

Determinants of condom use by Australian Secondary School students

PURPOSEnTo identify factors that are associated with condom use to aid in the understanding of how to change the behavior of those young people who have sex without using condoms.nnnMETHODSnThe article reports data from 932 sexually active grade 10-12 students from a sample of 72 public secondary schools in seven Australian states and territories. The data were collected using a cross-sectional, self-report questionnaire.nnnRESULTSnBoys were more likely than girls to report that a condom was used the last time they had sex. For boys and girls, communication with a partner about avoiding infection with HIV/STDs, the belief that more peers use condoms, and a higher perceived risk of becoming infected with HIV/STDs were associated with using a condom, as was lower knowledge of STDs. The use of oral contraception and the unavailability of condoms were reported by the students as prominent reasons for non-use of condoms. Number of sexual partners in the past year and type of relationship with partner on the most recent occasion were not associated with condom use.nnnCONCLUSIONSnAdolescents are more concerned with unwanted pregnancy than with disease prevention. School students more at risk are not more likely to take the necessary precautions to protect themselves from HIV/STDs.

Domestic violence in the emergency department: 2: Detection by doctors and nurses

This study was conducted in 1991 and 1992 to determine the detection rates of domestic violence victims by doctors and nurses at the Emergency Department (ED) of Royal Brisbane Hospital, a major public hospital in Australia. The objective was to determine the outcome of an education program about domestic violence conducted in 1991 for doctors and nurses in the ED. As part of two case-control studies, the self-reports of those who disclosed domestic violence on a screening questionnaire were compared with the recording of domestic violence on each individual medical record. Subjects were drawn from two screening studies carried out 1 year apart which were conducted to assess the prevalence of domestic violence among attendees at the ED. An education program about domestic violence was conducted for doctors and nurses in the ED between the two screening studies. The examination of the medical records showed that detection rates of victims of domestic violence were unchanged between the two case-control studies. Both studies found that 50.0% of those who reported the experience of domestic violence within the 24 hours prior to index presentation, on the screening questionnaire in the prevalence studies, were recorded as such in their medical records. The low detection rates indicate the requirement for doctors and nurses to receive appropriate training to identify and record the psychosocial aspects of domestic violence victims. As well as training, referral systems need to be set in place to address the psychosocial aspects of domestic violence victims.

Rescuers' psychological responses to disasters.

strongly associated with later epilepsy, particularly with complex partial seizures, was a focal febrile convulsion, which seems most likely to reflect a pre-existing focal abnormality. Three practical messages emerge. Parents should be reassured about the generally excellent prognosis of febrile convulsions. Prolonged convulsions should still be prevented,5 and to this end parents may give rectal diazepam, though the working party did not resolve whether this should be done as soon as a convulsion begins or only after five minutes.11 Prophylactic anticonvulsants are rarely needed, and there is no evidence that they have any long term benefit in febrile convulsions. ROGER J ROBINSON Emeritus Professor of Paediatrics, BM7, London WC1H 9JR

Australian Vietnam Veterans: Factors Contributing to Psychosocial Problems

Objective: The objective of the present paper is to present comprehensive models of the current psychosocial morbidity of Australian Vietnam veterans. Seldom has research in this area attempted to ‘untangle’ direct and indirect influences on current functioning via possible pre-army, Vietnam and homecoming pathways. Method: The Australian Vietnam Veterans Health Study gathered data on a sample of 641 veterans throughout Australia drawn randomly from army Vietnam tour lists of the era. The data arose from interview and army records of the era, and fall into four temporal categories: pre-army, Vietnam service, homecoming after Vietnam, and current state. Path analysis models of the veterans current psychological morbidities and social wellbeing are used to identify direct aetiological influences of earlier era constructs on current state, free of confounding by indirect (often selection) effects. Results: Our results indicate that psychological morbidity (particularly post-traumatic stress disorder) is largely influenced by combat and poor homecoming experiences, although pre-military characteristics do play some direct roles in symptomatology. Social dysfunction measures show smaller effects of the Vietnam War, which may be accounted for by an indirect association with Vietnam-related psychological morbidity. Some social measures show evidence of compensatory influences of combat, high combat leading to social dysfunction because of morbidity, but simultaneously being associated with healthier social disposition (possibly because of increased ex-service activity). Conclusions: For Australian Vietnam veterans, combat-related and homecoming effects persist on a range of psychosocial endpoints 20–30 years after exposure. These effects are not explicable in terms of veterans pre-Vietnam characteristics.

Postwar experiences and treatment-seeking behavior in a community counselling setting

Previous research investigating the impact of postwar experiences on Vietnam veterans has focused on veteran morbidity. This emphasis has meant that the impact of these factors on treatment-seeking behavior has received little empirical attention. This study examined the association between postwar factors and treatment-seeking behavior in a sample of 692 Australian Vietnam veterans. Logistic regression analyses were used to compute the odds ratios associated with postwar experiences and self-referral to a community-based counselling service. Results suggest that veterans who reported experiencing negative feelings toward others when they first arrived home were more likely to seek treatment. Other factors, such as a veterans perception of societal attitudes and the reception they received, were not associated with treatment-seeking behavior.

The Impact of a Counseling Service Program On the Psychosocial Morbidity of Australian Vietnam Veterans

The Vietnam Veterans Counselling Service (WCS) is a national counseling program for Australian Vietnam Veterans. The effectiveness of this service was evaluated by comparing the symptom levels of 146 VVCS clients with 546 matched nonclient controls. Multivariate linear regression techniques were used to control for differences between the two veteran groups prior to estimating the contribution of VVCS exposure to current symptom levels Health outcomes assessed ranged from depression and post-traumatic stress disorder to alcohol dependence and problems in dyadic adjustment. The positive influence of service-based counseling was most evident in the areas of alcohol dependence and dyadic adjustment These findings are consistent with the view that the major benefit of treatment programs such as the VVCS is that they facilitate veteran coping responses, thereby enabling them to live well with their symptomatology.