Gwenneth Roberts

The impact of domestic violence on women's mental health.

This longitudinal study aimed to establish a firmer scientific basis for recognition and treatment of post‐traumatic psychiatric morbidity associated with domestic violence. The study used a sample of 335 women (mean age 45.5 years) recruited from the Royal Brisbane Hospital Emergency Department. This paper reports baseline data. The outcome measures of lifetime psychiatric diagnoses (DSM‐111–R classification), showed that women who reported lifetime adult intimate abuse (n=162) received significantly more diagnoses of generalised anxiety, dysthymia, depression, phobias, current harmful alcohol consumption and psychoactive drug dependence than those who reported no abuse ever (n=173). Of the 191 women tested for lifetime post‐traumatic stress disorder, those who reported lifetime abuse (n=115) received significantly more diagnoses than those who reported no abuse (n=76). Crude prevalence rates of psychiatric diagnoses for women who reported double abuse as child and adult were significantly higher than for women who reported adult intimate abuse only. Adjusted rates showed that doubly abused women had significantly greater risk of current harmful alcohol consumption and lifetime drug dependence than women who reported adult abuse only. A significant independent factor for lifetime psychiatric diagnoses was reporting abuse between a womans parents. Measurement of the population attributable risk found that one‐third of the psychiatric diagnoses were attributable to domestic violence.

Prevalence Study of Domestic Violence Victims in an Emergency Department

STUDY OBJECTIVE In 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. METHODS In 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. RESULTS The 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. CONCLUSION These 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.

How common is domestic violence against women? The definition of partner abuse in prevalence studies

Abstract: We systematically reviewed studies of the prevalence of domestic violence. Selected overseas community studies were compared with all Australian prevalence studies found to be published. Twelve‐month prevalence estimates of partner abuse in Australia varied from 2.1 per cent to 28.0 per cent, depending mainly on the definition of domestic violence used in each study. Implications of the lack of a precise definition result in varying operationalised definitions of partner abuse, from all types of violence in relationships (including a single minor violent incident), through to only those violent incidents that are classified as a crime. Recommendations for any future prevalence studies in this field include the need to collect frequency data which reflected the fact that partner abuse against women is a complex behavioural phenomenon involving emotional, physical and sexual abuse against a partner, not just simply physical incidents. (Aust N Z J Public Health 1998; 22: 49–54)

Prevalence of domestic violence among patients attending a hospital emergency department

Abstract: A cross‐sectional study was conducted to determine the prevalence of domestic violence victims among patients using emergency services at Sydneys Royal North Shore Hospital, in an affluent urban area of New South Wales. This study used a self‐administered questionnaire (used in a similar study at the Royal Brisbane Hospital) to investigate the history of domestic violence among patients attending the emergency department during 64 randomly selected nursing shifts in October‐November 1994. Adult domestic violence was reported by 19.3 per cent of females and 8.5 per cent of males, confirming the results of the Brisbane study. Evidence for underreporting was found: 4 per cent of females and 6.3 per cent of males who did not report being victims revealed experiences of abuse on nine measures of types of violence, including six taken from the Conflict Tactics Scale. Results supported evidence from other studies suggesting that experience of abuse as a child is a risk factor for being in abusive relationships as an adult. In the past, comparison of results has been limited because of variation in definitions of domestic violence; this has been overcome by intentional replication of the Brisbane study. The study was enhanced by inclusion of patients from non‐English‐speaking backgrounds and a cohort of parents of children attending. Similar prevalence estimates were found in these groups. Results have implications for the detection and treatment of victims of domestic violence across all strata of society and have potential to raise awareness and affect attitudes towards this significant community problem.

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.

Child sexual abuse II: treatment

Objective: To evaluate the scientific literature concerning the treatment of child sexual abuse. Method: A critical review of the scientific literature. Results: There are only nine published research studies in which subjects were randomly assigned to an index treatment or treatments and a comparison treatment or no-treatment control group. In seven of the studies, the index treatment exceeded the control or comparison group in regard to treatment outcome; in two studies it did not. The successful treatments involved group therapy, combined individual and group play therapy and cognitive behaviour therapy. Conclusions: Treatment should be based on an explicit conceptual model of the psychopathology of sexual abuse. The University of Queensland Sexual Abuse Treatment Project, which is based on a transactional model, is described.

Evaluating the Prevalence and Impact of Domestic Violence

In spite of the burgeoning interest and the increased number of journals that include articles on domestic violence, there remain numerous methodological inadequacies in the area of domestic violence research.* Many early research initiatives in domestic violence were poorly designed, were unrepresentative of a particular population, and lacked control groups. Measurement instruments were often not validated, and their psychometric properties were inadequate. Nonparametric or descriptive statistics replaced inferential statistics and experimental rigor. A particular difficulty which has been noted in psychiatric epidemiology is the measurement of post-traumatic stress disorder (PTSD) in the face of an ongoing stressor, such as domestic violence.