Manon Ceelen

Male Victims of Domestic Violence

Most studies regarding DV focused mainly on female victims. To gain more insight into the problems male victims encounter, this study investigated the characteristics of this group in the Netherlands. Adult male victims of DV filled out an online questionnaire regarding the characteristics of the abuse (N = 372). When men are victims of DV, they are physically as well as psychologically abused with the female (ex)-partners often being their perpetrator. The most important reason for men not to report the abuse is the belief the police would not take any action. Our findings suggest society should be aware that men are also victims of DV and feel the need to talk about it and desire support.

Detainees in Amsterdam, a target population of the Public Mental Health System?

The Forensic Medical Service of the Public Health Service offers health care to detainees in police cells in Amsterdam. This study describes the registered mental health, addiction and social problems and compares them to the self-reported problems among a sample of detainees. Registers of the Forensic Medical Service are related to information from registers of police detention episodes. A general assessment of substance use, mental health and social problems is obtained by interviewing a sample of 264 detainees. The Forensic Medical Service was contacted in 24% of the 17,321 detention episodes. In 14% of the episodes mental or substance related disorders were observed. Within the sample 59% scored positively on indicators of substance abuse or mental health problems, 35% had additional social problems (debts, unemployment, housing). This proportion increased with age. It is concluded that substance abuse and mental health problems combined with social problems are highly prevalent among detainees, especially among the older ones. This urges for a close cooperation between Public Mental Health Care and Forensic Medical Services.

Health care seeking among detained undocumented migrants: a cross-sectional study

BackgroundAs in many European countries, access to care is decreased for undocumented migrants in the Netherlands due to legislation. Studies on the health of undocumented migrants in Europe are scarce and focus on care-seeking migrants. Not much is known on those who do not seek care.MethodsThis cross-sectional study includes both respondents who did and did not seek care, namely undocumented migrants who have been incarcerated in a detention centre while awaiting expulsion to their country of origin. A consecutive sample of all new arrivals was studied. Data were collected through structured interviews and reviews of medical records.ResultsAmong the 224 male migrants who arrived at the detention centre between May and July 2008, 173 persons were interviewed. 122 respondents met inclusion criteria. Only half of the undocumented migrants in this study knew how to get access to medical care in the Netherlands if in need. Forty-six percent of respondents reported to have sought medical help during their stay in the Netherlands while having no health insurance (n = 57). Care was sought most frequently for injuries and dental problems. About 25% of these care seekers reported to have been denied care by a health care provider. Asian migrants were significantly less likely to seek care when compared to other ethnic groups, independent from age, chronic health problems and length of stay in the Netherlands.ConclusionThe study underlines the need for a better education of undocumented patients and providers concerning the opportunities for health care in the Netherlands. Moreover, there is a need to further clarify the reasons for the denial of care to undocumented patients, as well as the barriers to health care as perceived by undocumented migrants.

Screening for Mental Illness Among Persons in Amsterdam Police Custody

OBJECTIVE Research on the mental health of police detainees is scarce. This study aimed to identify the proportion of persons detained by the Police Service Amsterdam-Amstelland who screened positive for a serious mental condition. METHODS A survey conducted in 2009 among 264 randomly selected detainees assessed demographic characteristics and general medical and mental health and included use of the Brief Jail Mental Health Screen (BJMHS) (N=248). RESULTS Almost 40% of survey respondents screened positive on the BJMHS, indicating a need for further evaluation. This rate was lower than the rate reported for police detainees in Australia but substantially higher than the rates reported for persons incarcerated in U.S. jails. CONCLUSIONS More systematic research is needed to examine reasons for reports of different rates of mental illness among detainees in different countries.

Enhancing the Visibility of Injuries with Narrow-Banded Beams of Light within the Visible Light Spectrum

The use of narrow‐banded visible light sources in improving the visibility of injuries has been hardly investigated, and studies examining the extent of this improvement are lacking. In this study, narrow‐banded beams of light within the visible light spectrum were used to explore their ability in improving the visibility of external injuries. The beams of light were induced by four crime‐lites® providing narrow‐banded beams of light between 400 and 550 nm. The visibility of the injuries was assessed through specific long‐pass filters supplied with the set of crime‐lites®. Forty‐three percent of the examined injuries improved in visibility by using the narrow‐banded visible light. In addition, injuries were visualized that were not visible or just barely visible to the naked eye. The improvements in visibility were particularly marked with the use of crime‐lites® “violet” and “blue” covering the spectrum between 400–430 and 430–470 nm. The simple noninvasive method showed a great potential contribution in injury examination.

Sudden death victims <45 years: agreement between cause of death established by the forensic physician and autopsy results

PURPOSE The goal of this study was to ascertain accordance between cause of death established by the forensic physician and autopsy results in young sudden death victims in the Netherlands. METHODS Sudden death victims aged 1-45 years examined by forensic physicians operating in the participating regions which also underwent an autopsy between January 2006 and December 2011 were included (n = 70). Cause of death established by the forensic physician based on the external medicolegal examination was compared with autopsy findings using the ICD10-classification. RESULTS Autopsy findings revealed that the majority of sudden death victims have died from a cardiac disease (n = 51, 73%). Most of the presumed heart disease related cases were confirmed by autopsy (n = 13, 87%). On the contrary, a large number of deaths caused by circulatory diseases were not recognised by the forensic physician (n = 38, 75%). In most of these cases, the forensic physician was forced to report an undetermined cause due to the lack of a solid explanation for death. Cause of death reported by the forensic physician appeared to be in agreement with the autopsy results in 12 cases (17%). CONCLUSIONS Cause of death determination in young sudden death victims is a difficult task for forensic physicians due to the limited tools available during the medicolegal examination. An effort should be made to standardize extensive post-mortem investigation after sudden death in the young. Autopsy can provide valuable information regarding the cause of death, which is of great importance in view of the identification of inheritable diseases among decedents and their families.

Prevalence and medical risks of body packing in the Amsterdam area

AIM Body packing is a way to deliver packets of drugs across international borders by ingestion. The aim of the study was to provide an estimate of the medical risks of body packing, describe predictors for hospital referral in detained body packers and provide an estimate for the prevalence of body packing in the Amsterdam area. METHODS From May 2007 to December 2008, we studied medical records of body packers immediately detained after arrival at Amsterdam Schiphol airport, hospital records of both detained body packers and self-referrers at two emergency departments of hospitals in Amsterdam and records kept by forensic physicians in charge of post-mortem examinations of all unnatural deaths in the area (years 2005-2009). RESULTS In airport detainees, the hospital referral rate was 4.2% (30 out of 707 detained body packers), the surgery rate was 1.3%. Significant predictors of hospital referral were delayed production of drug packets after arrest, cigarette smoking and country of departure. The surgery rate in self-referrers was comparable to the rate observed in those referred from the detention centre to hospital (30% vs. 31%). In addition, from 2005 to 2009, 20 proven cases of lethal body packing were identified. Based on our data, it is estimated that minimally 38% of all incoming body packers were missed by airport controls. CONCLUSION The risk for lethal complications due to body packing is low on a population basis and comparable to other studies. This also applies for the hospital referral and surgery rates found in this study. Cigarette smoking has not yet been described in the literature as a potential predictor for hospital referral in detained body packers and therefore deserves attention in future research. A substantial fraction of body packers manages to remain undiscovered.

Post-mortem toxicological urine screening in cause of death determination

This study evaluated standard toxicology screening by forensic physicians during external post-mortem examination. Collected urine samples of decedents were screened on-site for the presence of 10 commonly used drugs by means of a rapid multidrug test. Urine samples of 53% of the cases appeared to be positive for one or more compounds. Importantly, several cases were revealed which were positive for toxicology screening without indications for use of these drugs at the scene of death or from medical history. Based on these (preliminary) results, further action to incorporate routine post-mortem toxicology as a tool in forensic death investigation is recommended.

Vrouwelijke slachtoffers van huiselijk geweld zoeken meestal geen hulp bij de huisarts

SamenvattingDrijber BC, Reijnders UJL, Ceelen M.Vrouwelijke slachtoffers van huiselijk geweld zoeken meestal geen hulp bij de huisarts. Huisarts Wet 2008;51(1):6-10.Inleiding Met dit onderzoek wilden wij inzicht krijgen in de redenen van vrouwelijke slachtoffers van huiselijk geweld om wel of niet met hun huisarts over de mishandeling te spreken.Methode Van oktober 2005 tot oktober 2007 namen 576 volwassen vrouwelijke slachtoffers van huiselijk geweld deel aan het onderzoek. We vroegen hun of zij wel of niet met de huisarts over het geweld gesproken hadden en wat de redenen hiervoor waren. De slachtoffers die het geweld niet bespraken met de huisarts (de ‘niet-praters’) vroegen we of ze de huisarts voor andere klachten hadden bezocht en of ze er wél over zouden hebben gesproken als de huisarts er naar had gevraagd. Vrouwen die het geweld wel met de huisarts hadden besproken (de ‘praters’) vroegen we of dit contact bevredigend was verlopen.Resultaten Van de 576 deelnemende vrouwen sprak 37% met de huisarts over het geweld, 63% deed dat niet. De belangrijkste reden om het geweld niet met de huisarts te bespreken was schaamte. Ongeveer 60% van de niet-praters bezocht gedurende de periode van huiselijk geweld de huisarts. Dit gold vooral voor langdurig en veelvuldig mishandelde vrouwen (circa 80%). Ruim de helft van de niet-praters zou wel gesproken hebben als de huisarts er naar gevraagd had. Van de praters sprak bijna de helft met de huisarts in de hoop doorverwezen te worden. Driekwart van de praters was tevreden over het contact met de huisarts. Een kwart van hen was ontevreden, vooral vanwege gebrek aan tijd of kennis op dit gebied, of omdat ze zich niet serieus genomen voelden. Slechts 5% van de praters besprak het geweld omdat de huisarts het initiatief nam.Conclusie Veel vrouwelijke slachtoffers van huiselijk geweld bezoeken de huisarts in de periode dat het geweld plaatsvindt. Een groot deel van hen begint niet zelf over het geweld te praten. Schaamte is daarvoor de belangrijkste reden. De vrouwen die het wel bespreken, doen dat om doorverwezen te worden. Huisartsen moeten daarom huiselijk geweld vaker in de differentiële diagnostiek opnemen en er meer gericht naar vragen. Dat kan slachtoffers uit hun isolement halen, zodat ze adequaat geholpen kunnen worden.AbstractDrijber BC, Reijnders UJL, Ceelen M.Female victims of domestic violence do not generally seek help from their GP. Huisarts Wet 2008;51(1):6-10.Aim To investigate the reasons why female victims of domestic violence do or do not discuss the matter with their GP.Method During the period from October 2005 to October 2007 a total of 576 adult female victims of domestic violence participated in the study. They were asked whether or not they had discussed the matter with their GP and their reasons for discussing it or not. The victims who did not discuss the violence with their GP (‘non-talkers’) were asked if they had visited the GP for other complaints and whether they would have discussed the violence if the GP had asked them about it. Furthermore victims who did discuss the violence with their GP (‘talkers’) were asked whether the discussion was satisfactory.Results Of the 576 participating women, 37% had talked about the domestic violence with their GP while 63% had not. The main reason for not bringing up the subject of domestic violence with the GP was shame. Approximately 60% of the ‘non-talkers’ visited their GP while the violence was taking place. This applied particularly to women who had long been victims or who were subjected to frequent violence (approximately 80%). More than 50% of the ‘non-talkers’ would have brought up the matter of domestic violence if their GP had asked about it. Of the ‘talkers’ almost 50% brought up the matter with their GP in the hope that they would be referred for further help. Three-quarters of the ‘talkers’ were satisfied with the contact they had had with the GP. A quarter of them were dissatisfied with the part played by the GP mainly because of lack of time or knowledge of the subject or because they felt they were not being taken seriously. Only 5% of the ‘talkers’ discussed the violence because the GP had taken the initiative.Conclusion Many female victims of domestic violence visit their GP during the time when the violence is happening. A large proportion of these women do not take the initiative themselves to speak of the violence. Shame is the main reason for failing to bring up the matter with the GP. The women who do talk about the violence do so in order to be referred on. Thus GPs must include domestic violence more frequently in their differential diagnosis and ask more pointed questions about the matter. This can help victims to escape from their isolated position so that they can be given appropriate help.

Characteristics and Post-Decision Attitudes of Non-Reporting Sexual Violence Victims.

Although the physical and psychological consequences of sexual violence can be severe, many victims do not report the violence to the police force. The current study examined the characteristics and the post-decisional attitude of the non-reporting sexual violence victims. In total, 287 victims of sexual violence completed an anonymous online questionnaire that assessed characteristics of the violence, whether or not the crime was reported, reasons for not reporting, and aspects that would have convinced non-reporters to report in retrospect. Eighty percent of the victims did not report the most recent sexual violence incident to the police (n = 229). Nevertheless, 65% of the non-reporting victims (n = 148) in retrospect would have reported to the police (“potential reporters”). Specific reasons for non-reporting and incident characteristics appear to relate to the post-decision attitude of non-reporting victims of sexual violence. “Lack of evidence” and “feelings of shame, guilt, and other emotions” appear to be more frequently mentioned by potential reporters as reasons for their decision to not report as compared with the definitive non-reporters. Likewise, being raped or sexually assaulted is predictive of potential reporting. Our findings are useful for policy makers to develop strategies to increase reporting rates of sexual violence victims.