Health Impact of Violence Against Women - Women's Health Highlights: Recent Findings (continued)

Health Impact of Violence Against Women
An estimated 1.5 million women are physically abused by their intimate partners each year, and about one of every four women seeking care in emergency rooms has injuries resulting from domestic violence. There are many consequences of domestic violence, as reflected in the high use of health care services by abused women. In addition to physical injuries, women who are victims of domestic violence experience higher rates of depression, substance abuse, suicidal thoughts, and suicide attempts.

•Women who suffer abuse are more likely than those who have never been abused to use mental health services.
Researchers surveyed 3,333 women aged 18 to 64 in the Pacific Northwest and found that mental health service use was highest when the physical or emotional abuse was ongoing. However, women who had experienced abuse recently (within 5 years) or remotely (more than 5 years ago) still accessed mental health services at higher rates than women who were never abused. Women who were physically abused also used more emergency, outpatient, pharmacy, and specialty services. Women who were experiencing ongoing physical abuse had annual health care costs that were 42 percent higher than women who never suffered abuse. Bonomi, Anderson, Rivara, and Thompson, Health Serv Res 44(3):1-16, 2009 (AHRQ grant HS10909).

•Abused women are more likely to rely on condoms than pills for birth control.
A survey of 25 women in the Boston, MA, area found that a high rate of women who were victims of domestic violence did not use any form of birth control. Of the 115 women who reported being abused in the past year, 17 percent did not use birth control, compared with 11 percent of the women who were not abused. Abused women most often used condoms (33 percent) to prevent pregnancy, while women who were not abused most often used birth control pills (46 percent). Williams, Larsen, and McCloskey, Violence Against Women 14(12):1382-1396, 2008 (AHRQ grant HS11088).

•Duration and severity of domestic abuse predict whether women will seek medical and legal help.
Researchers in Seattle conducted phone interviews with 1,509 women who said they had experienced physical, sexual, or psychological abuse since reaching the age of 18. Those who were sexually or physically abused were more likely to seek medical care and legal assistance than those who reported only psychological abuse. The longer the abuse had continued, the more likely the woman was to seek help. Women who were psychologically abused were more inclined to seek legal assistance rather than medical services. Duterte, Bonomi, Kernic, et al., J Womens Health 17(1):85-95, 2008 (AHRQ grant HS10909).

•Women who are victims of abuse have worse health than other women, even years after abuse has stopped.
Thirty-four percent of women surveyed in a large health plan had suffered from physical and/or sexual intimate partner violence during their adult lifetime, and it took an enormous toll on their health. Their depression and physical symptoms persisted for many years after the abuse had stopped, according to this study. The researchers analyzed survey results from 3,429 women who were asked about their history of abuse and their mental, social, and physical health. Although 34 percent of the women had suffered from sexual and/or physical abuse, only 5 percent reported abuse within the previous year. For the others, it had been a median of 19 years since the last episode of abuse. Bonomi, Anderson, Rivara, and Thompson, J Women's Health 16(7):987-997, 2007. See also Rivara, Anderson, Fishman, et al., Am J Prevent Med 32(2):89-96, 2007 (AHRQ grant HS10909)

•Hispanic women who are abused while pregnant report high levels of stress.
Researchers surveyed 210 pregnant Latinas in Los Angeles in 2003-2004 to assess intimate partner violence, adverse social behavior, post-traumatic stress disorder (PTSD), depression, and other life situations. Nearly half (44 percent) of the women reported abuse and high levels of social undermining by their partners (criticism, anger, insults) and stress. Women who were abused were more likely to be depressed (41.3 percent) or to have PTSD (16.3 percent) compared with women who were not abused (18.6 percent and 7.6 percent, respectively). Rodriguez, Heilemann, Fielder, et al., Ann Fam Med 6(1):44-52, 2008 (AHRQ grant HS11104).

•Women who were abused as children use more health care than other women.
Researchers interviewed 3,333 women, grouped the women into one of four categories (no abuse, physical and sexual abuse, physical abuse only, and sexual abuse only), and examined the women's health care use over a 10-year period (1992-2002). Thirty-four percent of women said they were abused as children, and they were more likely to have smoked, used recreational drugs in the past year, have symptoms of depression, and have a higher body mass index than women who were not abused as children. Health care costs for women with a history of physical and sexual abuse were an average $800 higher annually, compared with women who were not abused ($3,203 vs. $2,413, respectively). Bonomi, Anderson, Rivara, et al., J Gen Intern Med 23(3):294-299, 2008 (AHRQ grant HS10909).

•Abused women describe partner interference with health care.
Researchers examined responses from a survey of 276 women at eight Boston area clinics who had been physically abused during the preceding year. Seventeen percent of the women reported that a partner had interfered with their health care. Women who had less than a high school education were three times as likely as other women to be victimized in this way. Also, women born outside the United States and those who visited the clinic with a man were twice as likely as other women to have a partner that interfered with their health care. Partner interference nearly doubled the odds of women having poor health. McCloskey, Williams, Lichter, et al., J Gen Int Med 22:1067-1072, 2007 (AHRQ grant HS11088).

•Location of shelters may increase risk of violence against homeless women.
Researchers interviewed 974 homeless women who visited 64 shelters and 38 meal programs serving homeless women in eight regions of Los Angeles county and screened them for substance abuse, mental illness, and history of childhood physical and sexual abuse. Results showed that homeless women living in or near skid row (crime ridden and dilapidated neighborhoods) were nearly twice as likely to be physically assaulted as homeless women in other areas of the city. The researchers conclude that seeking safer locations for shelters and other assistance programs could reduce violence against homeless women. Heslin, Robinson, Baker, and Gelberg, J Health Care Poor Underserved 18:203-218, 2007 (AHRQ grant HS08323).

•Intimate partner violence can occur at any age.
Domestic violence is generally thought to be a problem only in younger women, but this study found that it can happen to women at any age. Researchers surveyed 370 women aged 65 and older; over 2 percent of the women reported abuse within the previous year, and 3.5 percent reported being abused within the previous 5 years. Half of the women were aged 65 to 74, and half were aged 75 or older. Intimate partners included spouses, nonmarital partners, and former marital and nonmarital partners. About 18 percent of the women said they suffered sexual or physical abuse, and 22 percent were victims of nonphysical abuse, including being threatened, called names, or having their behavior controlled by their partner. Bonomi, Anderson, Reid, et al., Gerontologist 47(1):34-41, 2007 (AHRQ grant HS10909).

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Women's Health Highlights: Recent Findings (continued)