Domestic Violence

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Basics

Description

  • Domestic violence (DV) is the behavior in any relationship that is used to gain or maintain power and control over an intimate partner.
  • May include physical, sexual, and/or emotional abuse; economic or psychological actions; or threats of actions that influence another person
  • Although women are at greater risk of experiencing DV, it occurs among patients of any race, age, sexual orientation, religion, gender, socioeconomic background, and education level.
  • Synonym(s): intimate partner violence (IPV); spousal abuse; family violence

Epidemiology

Incidence
In the United States, lifetime estimates of DV are 22–39% of women, with 10–69% reporting physical assault by an intimate partner at some point in their lifetime. DV affects both sexes, but women are more likely to be victims than men and are more likely to report partner violence.

Prevalence
  • DV occurs in 1 of 4 American families. Nearly 5.3 million incidents of DV occur each year among U.S. women aged ≥18 years and 3.2 million incidents among men.
  • DV results in nearly 2 million injuries and up to 4,000 deaths annually in the United States.
  • 14–35% of adult female patients in emergency departments report experiencing DV within the past year.
  • Costs of DV are estimated to exceed $5.8 billion annually, of which $4.1 billion are for direct medical and mental health services.
  • DV survivors have a 1.6- to 2.3-fold increase in health care use compared with the nonabused population.
Geriatric Considerations
  • 4–6% of elderly are abused, with ~2 million elderly persons experiencing abuse and/or neglect each year. In 90% of cases, the perpetrator is a family member.
  • Elder abuse is any form of mistreatment that results in harm or loss to an older person; may include physical, sexual, emotional, financial abuse, and/or neglect
Pediatric Considerations
  • >3 million children aged 3 to 17 years are at risk of witnessing acts of DV.
  • ~1 million abused children are identified in the United States each year.
  • Children living in violent homes are at increased risk of physical, sexual, and/or emotional abuse; anxiety and depression; decreased self-esteem; emotional, behavioral, social, and/or physical disturbances; and lifelong poor health.

Pregnancy Considerations
DV occurs during 7–20% of pregnancies. Women with unintended pregnancy are at 3 times greater risk of DV. 25% of abused women report exacerbation of abuse during pregnancy. There is a positive correlation between DV and postpartum depression.

Risk Factors

  • Patient/victim risk factors
    • Substance abuse
    • Poverty/financial stressors/unemployment
    • Recent loss of social support
    • Family disruption and life cycle changes
    • History of abusive relationships or witness to abuse as child
    • Mental or physical disability in family
    • Social isolation
    • Pregnancy
    • Attempting to leave the relationship
  • Perpetrator risk factors
    • Substance abuse (e.g., PCP, cocaine, amphetamines, alcohol)
    • Young age
    • Unemployment
    • Low academic achievement
    • Witnessing or experiencing violence as child
    • Depression
    • Personality disorders
    • Threatening to self or others
    • Violence to children or violence outside the home
    • Owns weapons
  • Relational risk factors
    • Marital conflict
    • Marital instability
    • Economic stress
    • Traditional gender role norms
    • Poor family functioning
    • Obsessive, controlling relationship

Geriatric Considerations
Factors associated with the abuse of older adults include increasing age, nonwhite race, low-income status, functional impairment, cognitive disability, substance use, poor emotional state, low self-esteem, cohabitation, and lack of social support.

Pediatric Considerations
Factors associated with child abuse or neglect include low-income status, low maternal education, nonwhite race, large family size, young maternal age, single-parent household, parental psychiatric disturbances, and presence of a stepfather.

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