Domestic violence victims in a hospital emergency department.

OBJECTIVE: To determine the prevalence and predictors of domestic violence victims among attenders at the emergency department at Royal Brisbane Hospital in 1991. DESIGN: Cross-sectional study in which randomly selected nursing shifts were used to screen attenders. RESULTS: Of all attenders at the emergency department, 14.1% disclosed a history of domestic violence. Women were more likely than men to disclose domestic violence ("raw" relative risk, 2.31; 95% confidence interval [CI], 1.83-2.91; relative risk adjusted for age and history of child abuse, 4.50; 95% CI, 3.02-6.71). The greatest risks for being an adult victim of domestic violence were being female and having experienced abuse as a child. Most of those who had experienced domestic violence within the last 24 hours (1.1% of attenders) came to the department after-hours when social work staff were unavailable for referral. CONCLUSIONS: The prevalence and risk factors have implications for the training of doctors and nurses in domestic violence problems and for the provision of adequate resources to deal with the psychosocial aspects of domestic violence.

Intergenerational transmission of child abuse: rates, research, and clinical implications.

OBJECTIVE: The author reviews current wisdom concerning the rates and mechanisms of intrafamilial components of intergenerational transmission of child abuse and illustrates the unreliability of basic data and of assumptions made by reviewers and partisan advocates, most of whom underestimate the importance of intrafamilial factors in child abuse. METHOD: The information in the report was derived from original research plus a recently prepared compilation of 60 studies, mainly from the United States and the United Kingdom. RESULTS: The crude rates of intergenerational transmission of child abuse according to the studies reviewed are as follows: one-third of child victims grow up to continue a pattern of seriously inept, neglectful, or abusive rearing as parents. One-third do not. The other one-third remain vulnerable to the effects of social stress on the likelihood of their becoming abusive parents. Intrafamilial factors appear to be the cause of personally directed, as opposed to culturally condoned, child abuse. Broad social factors, and some medical and psychiatric conditions, lower or raise thresholds in which family and personal vulnerabilities and propensities operate. CONCLUSIONS: There is no justification for any extremist advocacy in apportioning responsibility between the "sins of the parents" and the failings of society. The contention that clinical research on abuse is inferior to, and must give way to, large-scale or statistically balanced self-report and questionnaire surveys is plausible, popular, convincing, and wrong.

Family violence and homelessness: the relevance of trauma histories in the lives of homeless women.

Studies of homeless women reveal high lifetime rates of childhood physical and sexual abuse and of assault by intimate male partners. The extent of family violence in the lives of homeless women is examined, as are parallels between the long-term effects of childhood abuse and characteristics identified in homeless women. Implications for research and service provision are discussed.

Domestic violence.

Domestic violence is an enormous health care issue that primary care physicians are powerfully suited to address. Rarely, however, do primary care physicians recognize that many of the patients who regularly and routinely present to them are victims of abuse. This article is designed to empower America's front-line doctors to recognize and appropriately treat the many victims of domestic violence who currently suffer from this silent epidemic. The reader will come to understand that it is via relatively simple-to-learn techniques that physicians can significantly impact the health and well-being of their communities.

Community responses to violence.

Community level efforts are effective in the reduction of violence. Community-level interventions have three goals: to prevent the escalation of risk for violence among the families in the community, to assist families at risk of or using violence, and to protect victims of abuse. To prevent violence or reduce its prevalence, community groups need to collaborate to reduce the community-level risk factors. Assisting families and protecting victims of violence requires coordination of community services, including law enforcement, schools, therapists, courts, child care, and social services. All of these goals can best be achieved through the efforts of a community level, multidisciplinary council or board that directs the programs. A community process to establish an integrated program involves several steps. The leaders that are identified need to represent all the disciplines and the entire geographic area involved in the project. Once the leaders start meeting, the baseline information and plan can be developed. Then the project itself can be undertaken, with the support of the media and other appropriate organizations. Several examples of effective projects document this process and its success; the best efforts involve coalitions of private and governmental agencies working together. Physicians are integral to this process. The practice of medicine provides opportunities every day to prevent and intervene in potential cases of abuse and violence. Also, by participating actively in the community, physicians can be effective leaders to change attitudes and behaviors and institute programs toward reducing violence.

Wife battering in Nigeria.

OBJECTIVE: To determine the prevalence, types and regularity of spouse abuse among Nigerian women. The effects of socio-economic status, education and alcohol consumption were also investigated. METHOD: Questionnaire survey of 1000 randomly chosen Nigerian women was undertaken. RESULT: Wife abuse was found to be as prevalent in Nigeria as in other parts of the world, 81.0% of the respondents had suffered either verbal abuse (68.6%) or both physical and verbal abuse (31.4%); occasionally (77.4%), regularly (16.2%) or always (6.0%), Almost half of them (46.2%) were abused in the presence of their children. Education and occupation were found to influence the prevalence, type and regularity of abuse and their children witnessing the abuse. CONCLUSION: Wife battering has been found to be very prevalent in Nigeria. However, further research is needed to identify the causes and the psychological effects on these women and their children. This information will be invaluable for designing appropriate medico-social rehabilitation for them.

Children fathered by previous partners: a risk factor for violence against women.

PIP: This article assesses the possible association between stepfatherhood and violence against wives in Hamilton, Ontario. The sample population comprised women who sought refuge from abusive male partners at a shelter for abused women and their children during 1986-87. Comparing shelter data for 1986-87 with survey data for 1983, results showed that steprelationship was not a correlate of either socioeconomic status or the woman's age. Young wives were over-represented among shelter clients, as they were among homicide victims. However, the over-representation of steprelationships was independent of this fact. Although the data did not demonstrate conclusively that women who had children from previous unions were assaulted especially often, they showed that men were significantly more likely to have assaulted the children as well as the women. Steprelationship, poverty, and the woman's age were distinct additive risk factors for child abuse. In conclusion, excess risks and lethal risks extend to wives, and attention to this issue is urgently needed.^ieng

[Abuse in marriages and living-together relationships]. / Mishandling i ekteskap og samboerforhold.

The authors have studied the type and frequency of cases of wife-battering attending an emergency outpatient clinic in Trondheim, Norway. Most patients were between 20 and 30 years old. They had multiple traumas, with a predominance of traumas near the head and neck region. Almost half (44%) of the abusers were unemployed, and most of them were 30-40 years old. Alcohol was reported as an important precipitating factor by 75% of the victims. Comparison with a corresponding study carried out ten years ago shows that the frequency of wife-battering seems to be almost unchanged.

Attitudes to reducing violence towards women: punishment or prevention?

AIM: To investigate the attitudes of abused and nonabused women to reducing physical and sexual violence in the community. METHOD: A random community sample of 3000 women was surveyed by postal questionnaire as part of the Otago Women's Health Survey. Seventy three percent (n = 1663) of those under 65 replied. As well as demographic, mental health and abuse information, responses to the question "what steps would you like to see taken to reduce the incidence of sexual and physical harm to women and children?" were analysed. RESULTS: Education was the most favoured approach to reducing violence in the community, followed by increased punishment of the offender. Women who had experienced sexual abuse, particularly as children, were more likely to advocate measures other than punishment. Rural women, those without formal qualifications and those who were not abused were more likely to advocate increased punishment, or made no comment. CONCLUSION: The finding that victims of sexual assault were likely to report a preference for prevention over punishment highlights the importance of representing the views of the community which appear to be at variance with more extreme views publicized in the media.

PIP: A random community survey on the prevalence and correlation of sexual abuse in childhood and adulthood was conducted to canvass the attitudes of abused and nonabused women in reducing physical and sexual violence. A postal questionnaire was given to 3000 women under age 65 seeking basic demographic, health, and abuse information. 73% of those under 65 years responded. Results showed that over one-third of these 73% reported some form of sexual abuse; 204 reported childhood sexual abuse; 208 reported sexual assault after age 16; and 191 had both child and sexual abuse experiences. It also showed that in reducing violence in the community, education was the most favored approach, followed by increased punishment of the offender. Women who experienced sexual abuse during their childhood were more likely to advocate measures other than punishment, while those rural women without formal qualifications and were not abused were more likely to advocate increased punishment or made no comment. In conclusion, victims of sexual assault prefer prevention rather than punishment.

[Women and violence: an everyday fact]. / Mujer y violencia: un hecho cotidiano.

In comparison with other countries, Mexico lacks information on the issue of violence against women, especially regarding the incidence and prevalence of battering and emotional abuse. The aim of this study was to determine the frequency and distribution of violence against women among both rural and urban populations in the state of Jalisco, Mexico. A cross-sectional study was conducted among two groups randomly selected; 1,163 rural women (RW) and 427 urban women (UW). Variables included: frequency of violence of family members against women and vice versa, socioeconomic variables and reason for violence. The results were: a) 44.2 per cent and 56.7 per cent rural and urban female population, respectively, suffered some form of violence; b) the principal aggressor was the husband in more than 60 per cent of the cases in both rural and urban areas. Significant statistical difference (p < 0.05) were found between rural and urban groups in relation to low education, middle-age and family size over 7 members.

The NIMH community violence project: I. Children as victims of and witnesses to violence.

The 1980s witnessed an extraordinary increase in community violence in most major cities across the United States. In 1990 the homicide rate in Boston increased by 45% over the previous year; in Denver, by 29%; in Chicago, Dallas, and New Orleans, by more than 20%; in Los Angeles, by 16%; in New York, by 11%. In Washington, DC, which has the highest per capita homicide rate in the country, the 1990 murder rate set an all time record in the District's history (Escobar 1991). Across the country, 1 out of 5 teenage and young adult deaths was gun related in 1988 - the first year in which firearm death rates for both Black and White teenagers exceeded the total for all natural causes of death combined. Also in 1988, the firearm homicide rate for young Black males increased by 35%, and Black male teens were 11 times more likely than their White counterparts to be killed by guns (Christofel 1990).

Family patterns and primary prevention of family violence.

Although services for victims and treatment programs for batterers have priority in efforts to ameliorate family violence, primary prevention programs are also essential. The importance of primary prevention lies not only in the suffering which can avoided, but also because it is unlikely that sufficient treatment resources can be allocated to match the magnitude of the problem. The latter point is illustrated by the results of a study of nationally representative samples of 2,143 families (studied in 1975) and 6,002 families (studied in 1985). These studies show that a minimum of 16% of American couples experienced an assault during the year of the study, and that about 40% of these involved severely violent acts, such as kicking, biting, punching, choking, and attacks with weapons. These studies also identified risk factors that can serve as the focus for primary prevention, for example, early marriage, male dominance in the family and use of physical punishment. Educational and therapeutic efforts, and economic changes, which encourage equality and which teach the skills necessary for an equal relationship, can help prevent family violence.

Abuse during pregnancy: the horror and the hope.

Physical violence against women is pervasive; and such abuse may begin during pregnancy. This article chronicles the clinical research on battering during pregnancy and focuses on a prospective study of 691 pregnant women; the study documented that one in six women are abused during pregnancy. Ethnic differences in the patterns of abuse are discussed, as are related findings of entry into prenatal care and characteristics of the abuser. Clinical implications are presented, with an emphasis on the usefulness of straightforward assessment with a three-question abuse assessment screen to identify abused women and intervene to prevent abuse during pregnancy.