Throughout their lifetimes, one out of four women and one out of 10 men will experience some form of intimate partner violence, including rape, physical abuse and stalking, according to the Centers for Disease Control and Prevention’s National Intimate Partner and Sexual Violence survey from 2010, the latest year with available data.
How doctors and nurses should screen patients for such intimate partner violence is the subject of updated recommendations issued Tuesday by the U.S. Preventative Services Task Force and published in the Journal of the American Medical Association.
The best estimates likely under-represent the true scope and scale of intimate partner violence because victims often are afraid to disclose what has happened to them. Roughly two-thirds of women who have been abused said they remained fearful and concerned for their safety after the abuse, the CDC reported, and half of these women said they developed symptoms of post-traumatic stress disorder, which can cause further physical health consequences.
Under the latest guidelines, physicians would ask women of reproductive age during appointments if they have experienced violence at the hands of someone they know. Women who indicate they have would then be referred for further services, such as counseling or home visits.
These recommendations bolster a set of guidelines initially released in 2013. Guidelines are reviewed every five years to adapt standing practices to new evidence.
In the #MeToo era, advocates suggest that, anecdotally, they have seen more victims empowered to speak out about what has happened to them. In the last year, the Domestic Violence Hotline reported a 30-percent rise in calls, the New York Times reported.
But unlike the many #MeToo experiences revealed on social media, survivors of domestic violence often are not ready to go public in part because of stigma and the idea that domestic violence occurs in a relationship between two consenting adults rather than a situation bound by fear, abuse and threats. Lisa James, director of health at Futures Without Violence, credits the movement with inviting people to be “more comfortable with disclosure.”
“That’s all the more reason why we want to have health care providers there, ready and trained on how to open up that conversation,” James said. Making it a routine part of a health checkup may help relieve the onus on victims to protect themselves by speaking out.
Here’s a closer look at these recommendations and how they can help women at risk.
What’s new about the guidelines?
Females of reproductive age — between adolescence and their 40s — are at potential risk for abuse, according to the guidelines. But other factors, including abuse during childhood, joblessness and difficulty paying bills, marital problems and substance use, raise the chances that a woman may endure violence from someone she knows.
The recommendations suggest clinicians ask all female patients in this age group screening questions, like: Have you ever been emotionally or physically abused by your partner or someone important to you? And, within the last year, have you ever been hit, slapped, kicked or otherwise physically hurt by someone?
If a woman indicates that she has been the victim of such violence, the clinician should to refer the patient for more intensive, ongoing support services, according to the new guidelines.
Handing a stack of brochures to a patient and suggesting she call a hotline phone number is not enough, said John Epling, a family physician in Roanoke, Virginia, who serves on the task force that developed these recommendations.
“Anybody experiencing intimate partner violence would need lots of support figuring their options,” he said.
Why weren’t men or seniors or other groups included in these screening recommendations?
These recommendations address intimate partner violence among adolescent and middle-aged women because the task force develops recommendations based on available research, Epling said. They acknowledge there is not enough evidence that assesses good screening practices to craft guidelines for men, seniors and vulnerable adult populations, even though it is a very common problem.
With more research in hand, he suggested the task force can revisit these issues in the years to come.
Will the guidelines help prevent violence?
The health care system can go further, James said, especially with the understanding that victims of intimate partner violence aren’t always ready to disclose the abuse they face. She suggested a universal education approach where every patient, including men who might be committing or targeted by intimate partner violence, is told about the impact on one’s health.
It will take time and more data and evidence to determine if these strategies lead to improved access to services for people who endure violence. Rather than waiting until physical and sexual abuse happen, James said these approaches could bolster efforts to prevent harm in the first place.
If you are experiencing domestic violence, call the National Domestic Violence Hotline at 1−800−799−7233 or TTY 1−800−787−3224.