The NIMH community violence project: II. Children's distress symptoms associated with violence exposure.

The rising tide of violence in American cities has placed the causes and consequences of violence squarely on the public health agenda. The U.S. Government's Year 2000 National Health Promotion and Disease Prevention Objectives includes a full chapter devoted to violence issues and delineates a number of goals and programs aimed at reducing the number of deaths and injuries associated with violence (Public Health Service 1990). Notably absent from these objectives, however, is attention to the possible adverse psychological consequences of exposure to acute or chronic violence. Nonetheless, in light of numerous media reports of children's exposure to community violence and recent reports documenting high levels of exposure even among very young children (Richters and Martinez 1993), it is reasonable to question whether the risks of exposure extend beyond death and physical injury to psychological well-being.

Why battering during pregnancy?

This exploratory study was designed to determine the reasons men might beat their female partners during pregnancy from the perspectives of women who had experienced this form of violence. Seventy-nine battered women were recruited by newspaper advertisement and bulletin board postings to take part in a larger study of women's responses to relationship problems. Women battered in their relationships were asked if they had ever been beaten during pregnancy. The 27 (34%) women who had a pregnancy with the abusive partner as the father and had experienced physical abuse during the pregnancy were compared with 24 (30%) women who also had been pregnant by the abuser but had not been abused during pregnancy. The only significant difference between the two groups was that the women battered during pregnancy were more frequently and severely beaten throughout the course of the relationship. Those abused during pregnancy were asked why they thought that had happened. Their answers were thematically analyzed into the categories: (1) jealousy of the unborn child; (2) anger toward the unborn child; (3) pregnancy-specific violence not directed toward the unborn child; and (d) "business as usual." Implications for nursing assessment and interventions for abuse during pregnancy are derived from this analysis.

Physical abuse as cause of injury in women: information for orthopaedic nurses.

With the frequency and severity of violence against women, it is critically important to empower nurses and physicians with information on physical abuse as a cause of injury in women. The specific aim of this descriptive study was to determine if the cause of injury was from abuse in women presenting to the Emergency Department (ED) with injuries. This research describes the nature and mechanisms of injury by women who reported that their injury was from physical abuse by men. Recognizing domestic violence as a cause of injury and gaining an awareness of the type and mechanism of injury resulting from abuse will help empower orthopaedic nurses to be active in the prevention and treatment of domestic violence against women.

Homeless women. The context of an urban shelter.

The role of the nurse in a shelter has just begun to emerge. The prevalence of homeless women is escalating, and nurses are playing primary roles in teaching, health care, social support, and case finding for women in shelters. This article describes some of the health, social, and psychologic issues facing women in a large urban shelter from the perspective of a senior nurse psychologist at Boston's Long Island Shelter.

[Social network, alcohol drinking habits and injuries caused by violence among women and men in the county of Akershus. Results from anonymous questionnaires among persons aged 40-42 years. 1990-91]. / Sosialt nettverk, alkoholvaner og voldsskader hos kvinner og menn i Akershus fylke. Resultater fra anonym spørreundersøokelse blant 40-42-åringer 1990-91.

All residents aged 40-42 in Akershus county were invited to screening for cardiovascular risk factors in 1990-91 as part of a prevention programme. Of the 13,607 attendants, 8,960 answered an anonymous questionnaire about social network, drinking habits, and injuries due to violence. Compared with data from the Central Bureau of Statistics, our material included a high percentage of persons with a higher education, a high percentage of married persons, and a low percentage of persons living alone. Results in respect of social network and drinking habits roughly agreed with those of other studies. Of the males, 15.7% had been injured at least once as a result of violence, most often assault and robbery. Of the females, the corresponding percentage was 18.1. Here the dominating forms of violence were maltreatment, threats and sexual assault. Females were more often exposed than males to repeated violence and more often suffered persisting problems as a result of maltreatment. Compared with other studies, we found a high prevalence of injuries from violence among females, suggesting underreporting of experiences of violence by females in studies based on personal interview or the hospitals' injury register.

Marital aggression. Impact, injury, and health correlates for husbands and wives.

The overall aim of the current study was to comprehensively evaluate the prevalence, impact, and health correlates of marital aggression in a clinical sample of maritally discordant couples seeking psychological treatment. Participants were 93 consecutively presenting clinic couples and 16 maritally satisfied matched control couples from the community. Overall, 71% of clinic couples reported at least one act of marital aggression during the past year. Although 86% of the aggression reported was reciprocal between husbands and wives, impact and injuries sustained as a function of this aggression differed between husbands and wives. Specifically, wives were more likely than husbands to be negatively affected and to sustain severe injuries (eg, broken bones, broken teeth, or injury to sensory organs). Additionally, wives who experienced marital aggression reported clinical levels of depressive symptomatology. Recommendations are offered and risk markers are identified to improve detection by physicians of patients who may be involved in violent marriages.

The effects of woman abuse on health care utilization and health status: a literature review.

Estimates of the physical abuse of women by husbands or boyfriends in the United States range from 85 per 1000 couples to 113 per 1000 couples per year. Victims of abuse are much more likely than nonvictims to have poor health, chronic pain problems, depression, suicide attempts, addictions, and problem pregnancies. Abused women use a disproportionate amount of health care services, including emergency room visits, primary care, and community mental health center visits. Despite its high prevalence and the disproportionate use of health care services it causes, woman abuse is rarely recognized by health care providers. Even when the abuse is recognized, health care professionals often provide inappropriate or even harmful treatment. Because many abused women pass through the health care system, it is important that providers learn how to identify those who are abused, treat all the effects of the abuse, and make appropriate referrals.

PIP: This article presents a literature review on the effects of abuse on health care utilization and health status of women in the US. The abuse of women is defined as any physical abuse of a woman by an intimate male partner. Several studies have estimated that abuse of women remains prevalent in the US and often results in serious physical and mental injuries. Victims are more likely to have poor health, chronic pain problems, depression, suicide attempts, addiction, and pregnancy problems. This review indicates that abused women use a disproportionate amount of health care services including emergency rooms visits, primary care, and community mental health center visits. Despite its high prevalence and the disproportionate use of health care services it causes, woman abuse is rarely recognized by health care providers. Even when health care professionals detect woman abuse, they often provide inappropriate or harmful treatment. Thus, health providers need to educate themselves about women abuse, know community and legal sources to which to refer abused women, and develop protocols for identifying and caring for such women.

Sexual and physical abuse in women with functional or organic gastrointestinal disorders.

STUDY OBJECTIVES: To determine the prevalence of a history of sexual and physical abuse in women seen in a referral-based gastroenterology practice, to determine whether patients with functional gastrointestinal disorders report greater frequencies of abuse than do patients with organic gastrointestinal diseases, and to determine whether a history of abuse is associated with more symptom reporting and health care utilization. DESIGN: A consecutive sample of women seen in a university-based gastroenterology practice over a 2-month period was asked to complete a brief questionnaire. MEASUREMENTS: The self-administered questionnaire requested information about demographics, symptoms, health care utilization, and history of abuse. Physicians indicated the primary diagnosis for each patient and whether she had ever discussed having been sexually or physically abused. RESULTS: Of 206 patients, 89 (44%) reported a history of sexual or physical abuse in childhood or later in life; all but 1 of the physically abused patients had been sexually abused. Almost one third of the abused patients had never discussed their experiences with anyone; only 17% had informed their doctors. Patients with functional disorders were more likely than those with organic disease diagnoses to report a history of forced intercourse (odds ratio, 2.08; 95% CI, 1.03 to 4.21) and frequent physical abuse (odds ratio, 11.39; CI, 2.22 to 58.48), chronic or recurrent abdominal pain (odds ratio, 2.06; CI, 1.03 to 4.12), and more lifetime surgeries (2.7 compared with 2.0 surgeries; P less than 0.03). Abused patients were more likely than nonabused patients to report pelvic pain (odds ratio, 4.05; CI, 1.41 to 11.69), multiple somatic symptoms (7.1 compared with 5.8 symptoms; P less than 0.001), and more lifetime surgeries (2.8 compared with 2.0 surgeries; P less than 0.01). CONCLUSIONS: We found that a history of sexual and physical abuse is a frequent, yet hidden, experience in women seen in referral-based gastroenterology practice and is particularly common in those with functional gastrointestinal disorders. A history of abuse, regardless of diagnosis, is associated with greater risk for symptom reporting and lifetime surgeries.

PIP: This study aims to determine the prevalence of sexual and physical abuse among women seen in a gastroenterology clinic. A total of 206 patients, who completed a self-administered questionnaire, were included in the analysis. Results indicated that 89 patients (44%) reported a history of sexual abuse or physical abuse in childhood or later in life; and all except one of the physically abused were also sexually abused. Among them, only 17% had informed their doctors about the abuse. Moreover, the 75 patients (36%) with functional gastrointestinal disorders were more likely than those with organic disease diagnosis to report a history of forced intercourse, frequent physical abuse, chronic or recurrent abdominal pain, and more lifetime surgeries. They were also more likely to be receiving psychological counseling for emotional concerns. Furthermore, abused patients were more likely than nonabused patients to report pelvic pain, multiple somatic symptoms, and more lifetime surgeries. In conclusion, this study discovered that there is a high prevalence of a history of sexual and physical abuse among women seen in a referral-based gastroenterology clinic, particularly those with functional gastrointestinal disorders.