Abstract & Commentary
Synopsis: Abused women are more likely to suffer adverse physical health consequences.
Source: Campbell J, et al. Arch Intern Med. 2002;162:1157-1163.
To investigate health problems among women who had experienced intimate partner violence (IPV), this group from Johns Hopkins mailed invitations to participate in a survey of women’s health to 21,426 women who were members of a Washington, DC health maintenance organization. The 2535 women who responded were phoned to describe the survey and were informed that they would be questioned about abuse. After appropriate exclusion, 2005 women were enrolled.
The study was conducted from January 1, 1995, through December 31, 1997, but the abuse could have occurred as far back as 1989. The study group was administered a modified version of the Abuse Assessment Screen. Defining IPV as "physical and/or sexual assault by a husband, partner, ex-husband, or ex-partner," Campbell and colleagues identified 201 women who answered affirmatively to 1 or more of 3 questions: "Have you ever as an adult been physically abused by a husband, boyfriend, or female partner? Have you ever been hit, slapped, kicked, pushed or shoved, or otherwise physically hurt by a current or previous husband, boyfriend, or female partner? Have you ever been forced into sexual activities by a husband, boyfriend, or female partner?" From the group of women who answered no to the questions and who were in an intimate relationship, 240 were randomly selected. These 2 groups were then interviewed in depth. They were administered the general health perceptions subscale of the Medical Outcomes Study 36-Item Short-Form Health Survey and the Miller Abuse Physical Symptom and Injury Scale, and were queried about specific gynecologic, chronic stress-related, and central nervous system problems.
The 2 groups were similar in age, but otherwise significantly different. The abused women were more likely African-American, divorced or separated, less well educated, and have household incomes less than $50,000. (These demographic variables are likely not independent. That is, women are more likely to leave an abusive relationship than one where they are happy and subsequently have reduced household income. Similarly, lower education is reasonably related to lower household income.) The abused women were more likely to rate their health as poor and less likely to rate it excellent. They had more headaches, back pain, sexually transmitted diseases, vaginal bleeding, vaginal infections, pelvic pain, painful intercourse, urinary tract infections, loss of appetite, abdominal pain, and digestive problems.
The group of abused women was subdivided into those who had been sexually abused and those who were not. Women who were sexually abused reported more chronic stress-related and central nervous system problems than women who were abused, but not sexually, and women who were not abused.
Comment by Allan J. Wilke, MD
This study is not without its weaknesses. There was no information provided about the nearly 19,000 women who chose not to answer the invitation. This is a potential flaw that could indicate bias (ie, the women who responded may be different from the women who didn’t). The women’s health problems and abuse were self-reported. There was no information on abuse occurring in childhood, which presumably could have had an effect on current health status. Despite this, this article adds to the growing literature of IPV. The Family Violence Prevention Fund (endabuse.org) estimates that annually there are 960,000 incidents of domestic violence to 3 million women. This compares to the 107,300 new cases of colon cancer the American Cancer Society estimates occur annually. Whether it is called IPV, domestic violence, or battering or spousal abuse, it has reached epidemic proportions. As conscientious primary care physicians, we screen for many illnesses and conditions, including colon cancer. It is high time that we screen for IPV. Campbell et al recommend that we ask 3 previously validated questions:1
1. Thinking back over the past year, on any occasion were you hit, slapped, kicked, raped, or otherwise physically hurt by someone you know or knew intimately, such as a spouse, partner, ex-spouse or partner, boyfriend, girlfriend, or date?
2. Considering your current partners or friends, or any past partners or friends, is there anyone who is making you feel unsafe now?
3. In the past year, have the police ever been called to your home because of a fight or argument, no matter who was fighting or who was at fault? n
Dr. Wilke, Assistant Professor of Family Medicine, Medical College of Ohio, Toledo, OH, is Associate Editor of Internal Medicine Alert.
Reference
1. Koziol-McLain J, et al. Am J Prev Med. 2001;21(2):93-100.
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