Jacquelyn C. Campbell

Health consequences of intimate partner violence

Intimate partner violence, which describes physical or sexual assault, or both, of a spouse or sexual intimate, is a common health-care issue. In this article, I have reviewed research on the mental and physical health sequelae of such violence. Increased health problems such as injury, chronic pain, gastrointestinal, and gynaecological signs including sexually-transmitted diseases, depression, and post-traumatic stress disorder are well documented by controlled research in abused women in various settings. Intimate partner violence has been noted in 3-13% of pregnancies in many studies from around the world, and is associated with detrimental outcomes to mothers and infants. I recommend increased assessment and interventions for intimate partner violence in health-care settings.

Risk factors for femicide in abusive relationships: results from a multisite case control study.

OBJECTIVES This 11-city study sought to identify risk factors for femicide in abusive relationships. METHODS Proxies of 220 intimate partner femicide victims identified from police or medical examiner records were interviewed, along with 343 abused control women. RESULTS Preincident risk factors associated in multivariate analyses with increased risk of intimate partner femicide included perpetrators access to a gun and previous threat with a weapon, perpetrators stepchild in the home, and estrangement, especially from a controlling partner. Never living together and prior domestic violence arrest were associated with lowered risks. Significant incident factors included the victim having left for another partner and the perpetrators use of a gun. Other significant bivariate-level risks included stalking, forced sex, and abuse during pregnancy. CONCLUSIONS There are identifiable risk factors for intimate partner femicides.

The intersections of HIV and violence: directions for future research and interventions.

The purpose of this paper is to review the available literature on the intersections between HIV and violence and present an agenda for future research to guide policy and programs. This paper aims to answer four questions: (1) How does forced sex affect womens risk for HIV infection? (2) How do violence and threats of violence affect womens ability to negotiate condom use? (3) Is the risk of violence greater for women living with HIV infection than for noninfected women? (4) What are the implications of the existing evidence for the direction of future research and interventions? Together this collection of 29 studies from the US and from sub-Saharan Africa provides evidence for several different links between the epidemics of HIV and violence. However, there are a number of methodological limitations that can be overcome with future studies. First, additional prospective studies are needed to describe the ways which violence victimization may increase womens risk for HIV and how being HIV positive affects violence risk. Future studies need to describe mens perspective on both HIV risk and violence in order to develop effective interventions targeting men and women. The definitions and tools for measurement of concepts such as physical violence, forced sex, HIV risk, and serostatus disclosure need to be harmonized in the future. Finally, combining qualitative and quantitative research methods will help to describe the context and scope of the problem. The service implications of these studies are significant. HIV counseling and testing programs offer a unique opportunity to identify and assist women at risk for violence and to identify women who may be at high risk for HIV as a result of their history of assault. In addition, violence prevention programs, in settings where such programs exist, also offer opportunities to counsel women about their risks for sexually transmitted diseases and HIV.

MENTAL AND PHYSICAL HEALTH EFFECTS OF INTIMATE PARTNER VIOLENCE ON WOMEN AND CHILDREN

The battering of female partners and the concomitant emotional abuse that is almost always part of the coercive control have significant mental and physical health consequences for the women who experience this type of violence. Children who live in households fraught with the conflict, violence, and unpredictable danger of domestic violence often witness the battering of their mothers and may also be victims of child abuse themselves. This article highlights current knowledge regarding the mental and physical health effects of intimate partner violence on women and their children, and discusses needed directions for screening, intervention, research, and changes in the health care system.

HIV-Positive Women Report More Lifetime Partner Violence: Findings From a Voluntary Counseling and Testing Clinic in Dar es Salaam, Tanzania

OBJECTIVES Experiences of partner violence were compared between HIV-positive and HIV-negative women. METHODS Of 340 women enrolled, 245 (72%) were followed and interviewed 3 months after HIV testing to estimate the prevalence and identify the correlates of violence. RESULTS The odds of reporting at least 1 violent event was significantly higher among HIV-positive women than among HIV-negative women (physical violence odds ratio [OR] = 2.63; 95% confidence interval [CI] = 1.23, 5.63; sexual violence OR = 2.39; 95% CI = 1.21, 4.73). Odds of reporting partner violence was 10 times higher among younger (< 30 years) HIV-positive women than among younger HIV-negative women (OR = 9.99; 95% CI = 2.67, 37.37). CONCLUSIONS Violence is a risk factor for HIV infection that must be addressed through multilevel prevention approaches.

Individual and Contextual Determinants of Domestic Violence in North India

OBJECTIVES We examined individual- and community-level influences on domestic violence in Uttar Pradesh, North India. METHODS Multilevel modeling was used to explore domestic violence outcomes among a sample of 4520 married men. RESULTS Recent physical and sexual domestic violence was associated with the individual-level variables of childlessness, economic pressure, and intergenerational transmission of violence. A community environment of violent crime was associated with elevated risks of both physical and sexual violence. Community-level norms concerning wife beating were significantly related only to physical violence. CONCLUSIONS Important similarities as well as differences were evident in risk factors for physical and sexual domestic violence. Higher socioeconomic status was found to be protective against physical but not sexual violence. Our results provide additional support for the importance of contextual factors in shaping womens risks of physical and sexual violence.

Nursing assessment for risk of homicide with battered women.

The Danger Assessment is a clinical and research instrument that has been designed to help battered women assess their danger of homicide. Completing the Danger Assessment with a nurse is conceptualized as a means of increasing the self-care agency of battered women, according to Orems nursing conceptual framework. The instrument was used in a study of 79 battered women. Results of this study, which give initial support for the reliability and validity of the Danger Assessment, are reported. The instrument is available from the author on request.

Intimate Partner Homicide Review and Implications of Research and Policy

Current rates of intimate partner homicide of females are approximately 4 to 5 times the rate for male victims, although the rates for both have decreased during the past 25 years. The major risk factor for intimate partner homicide, no matter if a female or male partner is killed, is prior domestic violence. This review presents and critiques the evidence supporting the other major risk factors for intimate partner homicide in general, and for intimate partner homicide of women (femicide) in particular, namely guns, estrangement, stepchild in the home, forced sex, threats to kill, and nonfatal strangulation (choking). The demographic risk factors are also examined and the related phenomena of pregnancy-related homicide, attempted femicide, and intimate partner homicide-suicide

Forced Sex and Intimate Partner Violence Effects on Women's Risk and Women's Health

A volunteer community sample of 159 primarily (77%) African American battered women were interviewed about forced sex by their partner (or ex-partner). Almost half (45.9%) of the sample had been sexually assaulted as well as physically abused. Except for ethnicity, there were no demographic differences between those who were forced into sex and those who were not, and there was no difference in history of child sexual abuse. However, those who were sexually assaulted had higher scores on negative health symptoms, gynecological symptoms, and risk factors for homicide even when controlling for physical abuse and demographic variables. The number of sexual assaults (childhood, rape, and intimate partner) was significantly correlated with depression and body image.

Screening for Intimate Partner Violence in Health Care Settings: A Randomized Trial

CONTEXT Whether intimate partner violence (IPV) screening reduces violence or improves health outcomes for women is unknown. OBJECTIVE To determine the effectiveness of IPV screening and communication of positive results to clinicians. DESIGN, SETTING, AND PARTICIPANTS Randomized controlled trial conducted in 11 emergency departments, 12 family practices, and 3 obstetrics/gynecology clinics in Ontario, Canada, among 6743 English-speaking female patients aged 18 to 64 years who presented between July 2005 and December 2006, could be seen individually, and were well enough to participate. INTERVENTION Women in the screened group (n=3271) self-completed the Woman Abuse Screening Tool (WAST); if a woman screened positive, this information was given to her clinician before the health care visit. Subsequent discussions and/or referrals were at the discretion of the treating clinician. The nonscreened group (n=3472) self-completed the WAST and other measures after their visit. MAIN OUTCOME MEASURES Women disclosing past-year IPV were interviewed at baseline and every 6 months until 18 months regarding IPV reexposure and quality of life (primary outcomes), as well as several health outcomes and potential harms of screening. RESULTS Participant loss to follow-up was high: 43% (148/347) of screened women and 41% (148/360) of nonscreened women. At 18 months (n = 411), observed recurrence of IPV among screened vs nonscreened women was 46% vs 53% (modeled odds ratio, 0.82; 95% confidence interval, 0.32-2.12). Screened vs nonscreened women exhibited about a 0.2-SD greater improvement in quality-of-life scores (modeled score difference at 18 months, 3.74; 95% confidence interval, 0.47-7.00). When multiple imputation was used to account for sample loss, differences between groups were reduced and quality-of-life differences were no longer significant. Screened women reported no harms of screening. CONCLUSIONS Although sample attrition urges cautious interpretation, the results of this trial do not provide sufficient evidence to support IPV screening in health care settings. Evaluation of services for women after identification of IPV remains a priority. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00182468.