Domestic Violence – What Healthcare Providers Should Know

October is Domestic Violence Awareness Month.  As healthcare professionals, it is our duty to keep alert for signs of domestic abuse.  Physical therapists especially need to be aware of this topic as we tend to develop more personal relationships with our patients due to the longer plan of care and one-on-one sessions. While asking “Do you feel safe at home?” during an evaluation is a great start, there is more that should be learned.

Is Domestic Violence really as big of a deal for healthcare providers?

  • ~ 20 people per minute (or 10 million/yr) are physically abused by an intimate partner in the US.
  • In 2000, 66% of the women killed by their current/former partner had suffered from domestic violence (DV) prior to being killed; 50% of them made previous visits to emergency rooms as a result of domestic violence injuries.
    • 67% of women who visit emergency rooms after abuse have symptoms of a head injury
      • 30% of vicitims have had at least one loss of consciousness
    • 81%- 94% of women who visit emergency rooms after DV have facial injuries.
      • Thirty-three percent of orbital fractures, some of which were sight-threatening,
    • ~ 68% of victims of domestic violence are strangled at least once; the average is 5.3 times per victim
    • ~ 34% of victims who are injured by intimate partners receive medical care for their injuries
  • 30% of DV starts during pregnancy:
    • 65% reported having experienced either verbal or physical abuse by their male partner or another family member during their pregnancies.
    • ~ 4–8% of women are physically abused at least once during pregnancy
      • 5.5–6.6% of all pregnancies have some trauma to both the woman and fetus
      • 13% – 25% of pregnancy-related deaths are femicides (deliberate murder of a female)
  • Domestic victimization is correlated with a higher rate of depression and suicidal behavior.
    • Moderate violence -> 2.5x the amount of emotional distress/suicidal thoughts and 3x the amount of suicide attempts
    • Severe violence -> 4x the amount of emotional distress/suicidal thoughts and 8x the amount of suicide attempts
  • Domestic violence is linked to physical, mental, and sexual and reproductive health issues including: adolescent pregnancy, unintended pregnancy, miscarriage, stillbirth, nutritional deficiency, neurological disorders, chronic pain, disability, anxiety and post-traumatic stress disorder (PTSD)
    • Estimated prevalence for PTSD among female victims of DV is 74–92% 
    • Female victims have a higher risk of contracting HIV or other STI’s due to forced intercourse or long-term exposure to stress
    • DV increases risk for hypertension, cancer, and cardiovascular diseases.
    • Victims of DV are also at higher risk for developing addictions to alcohol, tobacco, or drugs
  • Domestic violence adds another $5.2 billion in health care spending to the already high costs of depression, anxiety, and other distresses.
    • Following an assault, ~ 26% of victims speak with a psychologist, psychiatrist, or other mental health professional. They average 12.9 visits to a mental health professional with an average cost of $78.86/visit (total cost: $1,017). The victim herself pays 1/3 of the cost.
    • Annual healthcare costs are 42% higher for physically abused women
    • Annual healthcare costs are 33% higher for mentally abused women

How can healthcare providers help victims of domestic violence?

First, learn the symptoms of domestic violence.  My previous post covers the symptoms as well as other important facts about this of domestic violence.  These symptoms are important to know because a patient may appear noncompliant and irresponsible when they are actually being prevented from attending appointments without their abuser.  Victims of DV may present with chronic and persistent somatic complaints; these often respond poorly to typical treatment.  DV is a hidden risk factor or contributing factor for many women’s health issues, but it is often missed due to the 3 main barriers within the healthcare system.  

  1.  Personal Barriers

  • Healthcare professionals can be limited by their personal attitudes and perceptions that DV is a private issue
  • Fear of offending patient, especially those who are not experiencing abuse
    • When asked, the majority of women actually want healthcare providers to ask them about abuse
      • They reported that if asked directly, they would disclose
      • Even those who felt uncomfortable when asked about DV agreed that it was vital to ask
  • Fear of patient’s abuser
    • In a 2012 study, 23% of healthcare professionals were concerned for their own safety when asked about screening DV
  • Lack of understanding of abuse
    • 9% of providers reported believing that abuse is rare; some even thought the woman was at fault for the abuse
  • Low confidence or lack of training on DV screening techniques
    • Those who are confident with screening are more likely to complete it
    • In 2012, 55% of healthcare professionals were uncomfortable discussing DV
    • 50% of healthcare professionals believe it isn’t their role to screen for DV

2.  Interpersonal Barriers

  • These are barriers that healthcare providers feel when interacting with patients.  Examples include:
    • Language and Cultural Barriers
    • Misunderstanding about why victims stay with their abuser
    • Perception that people experiencing psychological difficulties are hard to screen
  • These barriers can be resolved through education and training healthcare professionals about:
    • The dynamics of abuse and how to screen for it
    • How to effectively and sensitively identify victims and refer them for help
    • Developing cultural competency
    • Developing policies and procedures within their practice setting
  • Identifying victims of DV during a healthcare visit provides a great opportunity for patients to communicate with available community resources to address and protect those affected by DV
    • This is especially important since 70-93% of victims don’t know where to help and how to safely ask for help

  3.  Organizational and Resource Barriers 

  • These barriers include: time constraints, lacking resources and support, lack of referrals and adequate screening
    • 68% of healthcare professionals lack knowledge, education, training, screening, and referring patients affected by DV
    • Some facilities lack clear policies about screening patients for abuse, how to refer or intervene for patients who disclose
      • This limits the professional’s ability and willingness to screen
    • Some electronic medical records (EMR) platforms do not have a narrative section which is ideal for recording victim’s stories or a map of the victim’s body to record injuries

I hope that this entry helps those in the healthcare profession realize the severity of domestic violence, and why you may feel ‘uncomfortable’ asking patients about topic.

The next blog post will come out on Tuesday, October 23rd.  It details how to perform an ideal screening for domestic violence. 

Here are some additional resources as well as the references that I have used:

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Much of what I have learned about physical therapy and online health/wellness, I have learned from Greg Todd, the founder of Physical Therapy Builder.  He is a fantastic physical therapist whose mission is to help physical therapy students and physical therapists provide patient focused care without becoming overwhelmed.  Greg Todd is also known as a “social media guru,” and I have a lot of thank him for.  I highly suggest his courses, especially Smart Success PT.  In May, I attended Smart Success PT Live, a business, marketing, and branding course by some of the top PT entrepreneurs in the field.

 

 

 

 

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