Intimate Partner Violence and Use of Primary and Emergency Care: The Role of Informal Social Support.

Social support may encourage victims to disclose their experiences of intimate partner violence (IPV), but also to seek the appropriate help and care in the social and health services. Using data from a multicenter European project, DOVE (Domestic Violence Against women/men in Europe-prevalence, determinants, effects, and policies/practices), the present study aimed at measuring the frequency of primary care and emergency use according to IPV types of victimization, and to investigate whether victims receiving different levels of informal social support are using health care differently. Results suggested a significant association between IPV types and use of emergency services, and no association was found regarding primary care services. Victims of physical abuse and sexual coercion went to the emergency department (ED) more frequently (more than once a year). Also, victims of physical abuse receiving low social support visited an ED more frequently than those with high social support, whereas victims of sexual coercion with high informal social support went more often to the ED compared with victims of sexual coercion with low social support, even after controlling for other covariates. These results seem to suggest that social support has a significant role in the decision to use health care among victims of IPV.

Social support and the intimate partner violence victimization among adults from six European countries.

BACKGROUND: Social support may buffer the negative effects of violence on physical and mental health. Family medicine providers play an essential role in identifying the available social support and intervening in intimate partner violence (IPV). OBJECTIVE: This study aimed at assessing the association between social support and the IPV victimization among adults from six European countries. METHODS: This is a cross-sectional multi-centre study that included individuals from Athens (Greece), Budapest (Hungary), London (UK), Östersund (Sweden), Porto (Portugal) and Stuttgart (Germany). Data collection was carried out between September 2010 and May 2011. The sample consisted of 3496 adults aged 18-64 years randomly selected from the general population in each city. The revised Conflict Tactics Scales was used to assess IPV victimization. Social support was assessed with the Multidimensional Scale of Perceived Social Support. RESULTS: Participants reporting physical assault victimization experienced lower social support (mean ± SD) than their counterparts, 66.1 ± 13.96 versus 71.7 ± 12.90, P < 0.001, for women; and 67.1 ± 13.69 versus 69.5 ± 13.52, P = 0.002 for men. Similar results were found regarding sexual coercion victimization, 69.1 ± 14.03 versus 71.3 ± 12.97, P = 0.005 for women and 68.0 ± 13.29 versus 69.3 ± 13.62, P = 0.021 for men. This study revealed lower levels of social support among participants reporting lifetime and past year victimization, independent of demographic, social and health-related factors. CONCLUSION: Results showed a statistically significant association between low social support and IPV victimization. Although the specific mechanisms linking social support with experiences of violence need further investigation, it seems that both informal and formal networks may be associated with lower levels of abusive situations.

The impact of intimate partner violence on forgone healthcare: a population-based, multicentre European study.

BACKGROUND: To examine the relationship between forgone healthcare and involvement in intimate partner violence (IPV) as victims, perpetrators or both. METHODS: This cross-sectional multicentre study assessed community non-institutionalized residents (n = 3496, aged 18-64) randomly selected from six European cities: Athens, Budapest, London, Östersund, Porto, Stuttgart. A common questionnaire was used, including self-reports of IPV and forgone healthcare ('Have you been in need of a certain care service in the past year, but did not seek any help?'). Odds ratios (ORs), 95% confidence intervals (CIs) were computed fitting logistic regression models adjusted for city, chronic disease, self-assessed health status and financial strain. RESULTS: Participants experiencing past year IPV (vs. no violence) reported more often to forgone healthcare (n = 3279, 18.6% vs. 15.3%, P = 0.016). IPV experienced as both a victim and perpetrator was associated with forgone healthcare (adjusted OR, 95%CI: 1.32, 1.02-1.70). CONCLUSION: IPV was associated with forgone healthcare, particularly for those experiencing violence as both victims and perpetrators. Results suggest that preventing IPV among adults may improve timely healthcare uptake.

Intimate partner violence and health-related quality of life in European men and women: findings from the DOVE study.

PURPOSE: Little is known on the specific relation between being a perpetrator or both a victim and perpetrator of intimate partner violence (IPV) and health-related quality of life (HRQoL). We assessed the association between HRQoL and abuse, considering men and women as victims, perpetrators or reciprocally. METHODS: Participants were adult men and women (n = 3,496), randomly selected from the general population of six European cities. The Revised-Conflict-Tactics-Scales and the Medical-Outcomes-Study 36-item Short-Form Health Survey (SF-36) were used to measure IPV and HRQoL. The age-, education-, and city-adjusted mean scores[standard error] of the physical and of the mental SF-36 component summaries were used to compare victims-only, perpetrators-only, and those involved in both (bidirectional or reciprocal cases) with those not involved in past-year and lifetime physical assault and/or sexual coercion. RESULTS: The physical component summary was significantly lower in women involved in past-year bidirectional physical assault compared with non-abused women. The mental component summary in women not involved in IPV was significantly higher than in those physically abused, regardless of type of involvement. Women victims-only of past-year sexual coercion and victims or involved in bidirectional concomitant physical and sexual IPV also presented lower scores in the mental component summary than women not involved in IPV. In men, significantly lower scores in the mental component summary were found in the past-year bidirectional physically assaulted group and among those involved bidirectionally in both physical and sexual IPV compared with men not involved in IPV. CONCLUSION: Experiencing physical and sexual IPV is negatively associated with HRQoL. Lower scores in the mental component summary of the SF-36 are evident among female victims and among males and females involved in intimate partner violence as both victims and perpetrators when compared to females and males not involved in violence.

Contextual determinants of intimate partner violence: a multi-level analysis in six European cities.

OBJECTIVES: To assess whether city-level characteristics influence the risk of intimate partner violence (IPV) victimization across six European cities. METHODS: The DOVE study included 3496 participants from Athens-Greece, Budapest-Hungary, London-UK, Östersund-Sweden, Porto-Portugal and Stuttgart-Germany. IPV victimization was assessed using the Revised Conflict Tactics Scales, and several contextual variables were included: GINI coefficient, gender equality index, an index of social support, unemployment rate and proportion of residents with tertiary education. Multilevel models were fitted to estimate the associations (odds ratio, 95% confidence intervals) between each type of victimization and contextual and individual-level variables. RESULTS: 62.3% of the participants reported being a victim of IPV during the previous year, with large between-city differences (53.9%-72.4%). Contextual variables accounted for a substantial amount of this heterogeneity. Unemployment rates were associated with psychological (1.05, 1.01-1.08) and physical IPV (1.07, 1.01-1.13). GINI coefficient showed a positive association with any form of IPV (1.06, 1.01-1.11) and sexual coercion (1.13, 1.01-1.25). CONCLUSIONS: We found significant associations between contextual determinants and IPV, which emphasizes the importance of considering contextual socioeconomic conditions when policy measures are designed to address IPV.

Intimate partner violence: a study in men and women from six European countries.

OBJECTIVES: We aimed to assess intimate partner violence (IPV) among men and women from six cities in six European countries. METHODS: Four IPV types were measured in a population-based multicentre study of adults (18-64 years; n = 3,496). Sex- and city-differences in past year prevalence were examined considering victims, perpetrators or both and considering violent acts' severity and repetition. RESULTS: Male victimization of psychological aggression ranged from 48.8 % (Porto) to 71.8 % (Athens) and female victimization from 46.4 % (Budapest) to 70.5 % (Athens). Male and female victimization of sexual coercion ranged from 5.4 and 8.9 %, respectively, in Budapest to 27.1 and 25.3 % in Stuttgart. Male and female victims of physical assault ranged from 9.7 and 8.5 %, respectively, in Porto, to 31.2 and 23.1 % in Athens. Male victims of injury were 2.7 % in Östersund and 6.3 % in London and female victims were 1.4 % in Östersund and 8.5 % in Stuttgart. IPV differed significantly across cities (p < 0.05). Men and women predominantly experienced IPV as both victims and perpetrators with few significant sex-differences within cities. CONCLUSIONS: Results support the need to consider men and women as both potential victims and perpetrators when approaching IPV.

Intimate partner violence in Europe: design and methods of a multinational study.

OBJECTIVE: To describe the design, methods, procedures and characteristics of the population involved in a study designed to compare Intimate Partner Violence (IPV) in eight European countries. METHODS: Women and men aged 18-65, living in Ghent-Belgium (n = 245), Stuttgart-Germany (n = 546), Athens-Greece (n = 548), Budapest-Hungary (n = 604), Porto-Portugal (n = 635), Granada-Spain (n = 138), Östersund-Sweden (n = 592), London-United Kingdom (n = 571), were sampled and administered a common questionnaire. Chi-square goodness of fit and five-age strata population fractions ratios for sex and education were computed to evaluate samples' representativeness. RESULTS: Differences in the age distributions were found among women from Sweden and Portugal and among men from Belgium, Hungary, Portugal and Sweden. Over-recruitment of more educated respondents was noted in all sites. CONCLUSION: The use of a common research protocol with the same structured questionnaire is likely to provide accurate estimates of the general population IPV frequency, despite limitations in probabilistic sampling and restrictions in methods of administration.