Intimate Partner Violence and Comorbid Mental Health Conditions Among Urban Male Patients

Abstract

PURPOSE We wanted to explore the associations between intimate partner violence (IPV) and comorbid health conditions, which have received little attention in male patients.METHODS Using a computer-based self-assessment health questionnaire, we screened sequential emergency department patients who were urban, male, and aged 18 to 55 years. We then examined associations between types of IPV disclosures, co-occurring mental health symptoms, and adverse health behaviors. RESULTSOf 1,669 men seeking nonurgent health care, 1,122 (67.2%) consented to be screened, and 1,026 (91%) completed the screening; 712 (63%) were in a relationship in the past year. Of these men, 261 (37%) disclosed IPV: 20% (n = 144) disclosed victimization only, 6% (n = 40) disclosed perpetration only, and 11% (n = 77) disclosed bidirectional IPV (defi ned as both victimization and perpetration in their relationships). Men disclosing both victimization and perpetration had the highest frequencies and levels of adverse mental health symptoms. Rates of smoking, alcohol abuse, and drug use were likewise higher in IPV-involved men.CONCLUSIONS A cumulative risk of poor mental health and adverse health behaviors was associated with IPV disclosures. Self-disclosure by men seeking acute health care provides the potential for developing tools to assess level of risk and to guide tailored interventions and referrals based on the sex of the patient. 2009;7:47-55. DOI: 10.1370/afm.936. Ann Fam Med INTRODUCTIONI ntimate partner violence (IPV), defi ned as a pattern of assaultive and coercive behaviors in intimate relationships, remains a major public health concern in the United States.1,2 The health care system advocates screening women for victimization and referring them to legal and community-based advocacy services. Both men and women, however, perpetrate a wide range of emotional and physical violence against their intimate partners, and 3-5 bidirectional IPV may be more common than generally recognized in medical settings. 6,7 Substance abuse and mental health problems have been found to be major cofactors in IPV, [8][9][10] and there is reason to believe that interventions aimed at reducing violent behavior will be only marginally effective if co-occurring mental health and substance abuse problems are ignored. [11][12][13][14][15] Recent research targeting substance use along with IPV behavior is promising. [16][17][18] The US Preventative Service Task Forces ranked the evidence in favor of routine screening for family violence as inconclusive and raised concerns for possible harm from retaliatory IPV after disclosure. Although it is reasonable to consider whether IPV-involved men could benefi t from treatment Karin V. Rhodes, MD 48 IN T IM AT E PA R T NER V IOL ENC Eunder a medical model, the topic requires more study. Numerous studies quantify the co-occurrence of IPV and adverse mental health symptoms and substance use in women patients, [19][20][21] but fewer address these issues in IPV-involved men. 22 In fact, there are few venues for ...

Current Controversies within Intimate Partner Violence: Overlooking Bidirectional Violence

“…Whitaker, Haileyesus, Swahn & Saltzman, 2007). Rhodes et al (2009) found men disclosing both perpetration and victimisation had a greater prevalence of adverse health conditions including PTSD symptoms, depression and suicidality. However, even in acknowledging bidirectional abuse, some scholars still choose to only focus on the impact for men or women (e.g.…”

Characteristics of Men Who Perpetrate Intimate Partner Violence

“…20 We chose these mental health variables because of IPV perpetration associations in previous research. 8,20 We dichotomized the responses.…”

“…7 History of violence including witnessing parental IPV and child abuse victimization are associated with IPV. 7 Mental illness, including depression 7,8 and posttraumatic stress disorder (PTSD), 9 and substance use disorders, including alcohol abuse 8,9 and illicit drug abuse, [7][8][9] are all associated with IPV. To address IPV perpetration in primary care settings, an expert opinion-based clinical guideline outlines steps to identify male IPV perpetration, assess safety, and make referrals to mental health and substance use treatment programs, as well as community batterer treatment programs.…”

Violência e sofrimento mental em homens na atenção primária à saúde

“…1,11,16 The majority of them focus on one particular type of violence: IPV (intimate partner violence). There is little scientific output on urban and community violence.…”

“…11,14 In terms of assaults, episodes of domestic and urban violence are dealt with. 3,11 Rhodes et al 16 show that men involved in situations of intimate partner violence (IPV), seen in hospitals in the USA, presented higher rates of psychiatric problems; 18.4% showed symptoms of severe or moderate depression, while 3.3% of those not involved showed the same symptoms (p = 0.001). Those involved had a 10.3% prevalence of post-traumatic stress disorder, 1.1% for those not involved (p < 0.001).…”