Psychosocial effects of physical and verbal abuse in postmenopausal women.

PURPOSE: The purpose of this study was to examine the psychological effects of physical and verbal abuse in a cohort of older women. METHODS: This observational cohort study was conducted at 40 clinical sites nationwide that are part of the Women's Health Initiative (WHI) Observational Study. We surveyed 93,676 women aged 50 to 79 years using the mental health subscales and the combined mental component summary (MCS) score of the RAND Medical Outcomes Study 36-item instrument. RESULTS: At baseline, women reporting exposure to physical abuse only, verbal abuse only, or both physical and verbal abuse had a greater number of depressive symptoms (1.6,1.6, and 3 more symptoms, respectively) and lower MCS scores (4.6, 5.4, and 8.1 lower scores, respectively) than women not reporting abuse. Compared with women who had no exposure to abuse, women had a greater increase in the number of depressive symptoms when they reported a 3-year incident exposure to physical abuse only (0.2; 95% confidence interval [CI], -0.21 to 0.60), verbal abuse only (0.18; 95% CI, 0.11 to 0.24), or both physical and verbal abuse (0.15; 95% CI, -0.05 to 0.36); and they had a decrease in MCS scores when they reported a 3-year incident exposure to physical abuse only (-1.12; 95% CI, -2.45 to 0.12), verbal abuse only (-0.55; 95% CI, -0.75 to -0.34), and both physical and verbal abuse (-0.44; 95% CI, -1.11 to -0.22) even after adjustment for sociodemographic characteristics. CONCLUSION: Exposure to abuse in older, functionally independent women is associated with poorer mental health. The persistence of these findings suggests that clinicians need to consider abuse exposure in their older female patients who have depressive symptoms. Clinicians caring for older women should identify women at risk for physical and verbal abuse and intervene appropriately.

Intimate partner violence: office screening for victims and perpetrators of IPV.

Intimate partner violence (IPV) affects more than 12 million individuals annually. Power and control are central concepts underlying abusive relationships. Physicians may see IPV victims, perpetrators, and their children for annual examinations, as well as for injuries and health conditions associated with abuse. In 2013, the US Preventive Services Task Force recommended that women of childbearing age (ie, 14 to 46 years) be screened for IPV. Brief, validated screening tools, such as the 4-item Hurt, Insult, Threaten, and Scream (HITS), can be used to facilitate screening. Physicians should always assess patients whose medical histories or presenting symptoms or injuries are consistent with abuse. Risk factors for IPV and consequences of abuse include general health conditions (eg, asthma, irritable bowel syndrome), reproductive issues (eg, gynecologic disorders, unintended pregnancies), psychological conditions (eg, depression, sleep disturbances), and risky health behaviors (eg, substance use, poor health care adherence). Tools for identifying perpetrators are under investigation. To prepare the practice to address IPV, physicians should educate themselves and staff and learn about community and national resources. By identifying and responding to IPV, clinicians may be able to reduce IPV and interrupt the intergenerational cycle of violence.

Intimate partner violence: counseling, community resources, and legal issues for IPV victims and perpetrators.

The family physician's office is a potentially safe place to discuss intimate partner violence (IPV). RADAR (Remember to ask routinely, Ask directly [in private], Document findings, Assess safety, Review options) is a tool for identifying and responding to IPV. Physicians should ask permission to document abuse, consider using a body map, and ensure confidentiality. They should also assess immediate safety by asking about weapons in the home, children's safety, and the likelihood that the perpetrator will harm him- or herself or others. Federal privacy laws require physicians to inform patients about health information disclosure. Because mandatory reporting varies by state, physicians should communicate clearly the office's responsibilities. Interventions are based on an advocacy model that requires appropriate training and establishment of links to community-based resources. Brief advocacy includes providing information cards, whereas intensive intervention includes IPV education, danger assessment, prevention options, safety planning, and community referrals. The Stages of Change Model may help physicians understand a patient's readiness and ability to make a change. For the IPV survivor who has left an abusive partner, physicians should be aware of the challenges of safety, health, legal, and financial issues; protection orders are a possible safety strategy. The most common intervention for perpetrators is a batterer intervention program. Couples counseling by family physicians is contraindicated.

Intimate partner violence: childhood exposure to domestic violence.

Children who are exposed to domestic violence (DV) may experience many short- and long-term negative effects. They are up to 3.8 times more likely to become perpetrators or victims in adulthood than are children not exposed to DV. They also are at high risk of health problems, risky health behaviors, violence, and social functioning problems. Girls who witness intimate partner violence (IPV) are more likely to experience depression, anxiety, and trauma symptoms, and boys exposed to IPV are more likely to exhibit aggression and delinquent behaviors. To prepare the practice to identify and assist children exposed to DV, physicians should undergo training, implement screening protocols, use caution when documenting findings, collaborate with local agencies, and learn about the state's reporting laws. State and local DV service programs or other community resources can provide assessment and intervention assistance. Social workers, mental health professionals, and child and DV advocates can assist in providing treatment for children exposed to violence. Physicians should schedule follow-up appointments for children who need treatment, monitor behavior, and coordinate intervention services.

Intimate partner violence: IPV in the LGBT community.

Nationally, the rates of intimate partner violence (IPV) among lesbian, gay, bisexual, or transgender (LGBT) individuals are similar to or greater than rates for heterosexuals. Many have experienced psychological and physical abuse as sexual minorities, making it difficult for them to seek help for IPV. Physician behavior, such as not assuming that all patients are heterosexual, being nonjudgmental, and using inclusive language, can empower LGBT patients to disclose IPV. Also, physicians should ascertain the degree to which the patient is out. The threat of being outed can be an aspect of the power and control exerted by an abusive partner and a significant barrier to seeking help. Physicians should screen for IPV and intervene in a similar manner with LGBT and non-LGBT patients, but they should be aware of potential limitations in resources for LGBT patients, such as shelters. As sexual minorities experiencing IPV, LGBT individuals are at greater risk of depression and substance abuse than are non-LGBT individuals. Minority stress, resulting from stigmatization and discrimination, can be exacerbated by IPV. Physicians should learn about legal issues for LGBT individuals and the availability of community or advocacy programs for LGBT perpetrators or victims of IPV.

Prevalence and 3-year incidence of abuse among postmenopausal women.

OBJECTIVES: We examined prevalence, 3-year incidence, and predictors of physical and verbal abuse among postmenopausal women. METHODS: We used a cohort of 91,749 women aged 50 to 79 years from the Women's Health Initiative. Outcomes included self-reported physical abuse and verbal abuse. RESULTS: At baseline, 11.1% reported abuse sometime during the prior year, with 2.1% reporting physical abuse only, 89.1% reporting verbal abuse only, and 8.8% reporting both physical and verbal abuse. Baseline prevalence was associated with service occupations, having lower incomes, and living alone. At 3-year follow-up, 5.0% of women reported new abuse, with 2.8% reporting physical abuse only, 92.6% reporting verbal abuse only, and 4.7% reporting both physical and verbal abuse. CONCLUSIONS: Postmenopausal women are exposed to abuse at similar rates to younger women; this abuse poses a serious threat to their health.