Intimate Partner Violence: Perspectives on Universal Screening for Women in VHA Primary Care

Sweeney, Alison; Weitlauf, Julie C.; Manning, Elizabeth A.; Sze, Jocelyn; Waldrop, Angela E.; Hasser, Caitlin

doi:10.1016/j.whi.2012.12.004

Cited by 13 publications

(8 citation statements)

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“…Although IPV identification is important in all patient populations (Sweeney et al 2013), it may be especially important among adult women determined by healthcare providers to be obese. We found that obesity was associated with both non-physical IPV and physical IPV.…”

Section: Resultsmentioning

confidence: 99%

Association of intimate partner violence and health-care provider-identified obesity

et al. 2015

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We examined the association of physical and non-physical IPV (intimate partner violence) with obesity. Women (n=1,179) were surveyed regarding demographics, obesity, and IPV exposure using HARK (humiliate-afraid-rape-kick), an IPV screening tool. A three-level lifetime IPV exposure variable measured physical, non-physical or no IPV. Healthcare provider-identified obesity was defined if participants were told by a medical provider within the past 5 years that they were obese. Bivariate analyses examined obesity by IPV and demographics. Multivariable logistic regression assessed odds of obesity by IPV type, adjusting for age, race/ethnicity, education and marital status. Among participants, 44% reported lifetime IPV (25% physical, 19% non-physical), and 24% reported healthcare provider-identified obesity. In unadjusted analyses, obesity was more prevalent among women exposed to physical IPV (30%) and non-physical IPV (27%), compared to women without IPV (20%, p=0.002). In multivariable models, women reporting physical IPV had 1.67 times greater odds of obesity (95% confidence interval [CI] 1.20, 2.33), and women reporting non-physical IPV had 1.46 times greater odds of obesity (95% CI 1.01, 2.10) compared to women reporting never exposure. This study extends prior data by showing not only an association between physical IPV and obesity, but also an association between obesity and non-physical IPV.

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Section: Resultsmentioning

confidence: 99%

Association of intimate partner violence and health-care provider-identified obesity

et al. 2015

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“…Use of electronic medical records to facilitate IPV screening is promising because scoring can occur automatically and prompt providers to engage in specific follow-up care (e.g., provide risk assessment and the domestic violence hotline number, request contract information for a safe relative or friend who may know the patients' contact information in the event that patient has to move or change phone numbers, and place referrals). As argued elsewhere, 36,37 successful IPV screening within VHA must include mechanisms for appropriate and comprehensive responses to positive screens, including validation, education, and risk assessment, as well as coordination of primary care, mental health, social work, legal services, and victim advocacy both within the VHA and in the community. …”

Section: Discussionmentioning

confidence: 99%

Clinical Utility of an Intimate Partner Violence Screening Tool for Female VHA Patients

et al. 2013

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OBJECTIVES: Female Veterans are at high risk for physical, sexual, and psychological forms of intimate partner violence (IPV) victimization. This study evaluated the accuracy of a brief IPV victimization screening tool for use with female Veterans Health Administration (VHA) patients. DESIGN: Participants completed a paper-and-pencil mail survey that included the four-item Hurt/Insult/ Threaten/Scream (HITS) and the 39-item Revised Conflict Tactics Scales (CTS-2). Operating characteristics, including sensitivity and specificity, were calculated using the CTS-2 as the reference standard for pastyear IPV. PARTICIPANTS: Female veterans from a roster of randomly selected female patients of the New England VA Healthcare System. Women must have reported being in an intimate relationship in the past year to be included. MAIN MEASURES: Primary measures included the HITS (index test) and the CTS-2 (reference standard). KEY RESULTS: This study included 160 women. The percentage of women who reported past-year IPV, as measured by any physical assault, sexual coercion, and/or severe psychological aggression on the CTS-2, was 28.8 %. The receiver-operator characteristic curve demonstrated that the HITS cutoff score of 6 maximizes the true positives while minimizing the false positives in this sample. The sensitivity of the optimal HITS cutoff score of 6 was 78 % (95 % CI 64 % to 88 %), specificity 80 % (95 % CI 71 % to 87 %), positive likelihood ratio 3.9 (95 % CI 2.61 to 5.76), negative likelihood ratio 0.27 (95 % CI 0.16 to 0.47), positive predictive value 0.61 (95 % CI 0.47, 0.73), and negative predictive value 0.90 (95 % CI 0.82, 0.95). CONCLUSIONS: For a low-burden screen, the HITS demonstrated good accuracy in detecting past-year IPV relative to the CTS-2 in a sample of female VHA patients with an optimal cutpoint of 6. The HITS may help VHA and other health-care providers detect past-year IPV and deliver appropriate care for female Veterans. I ntimate partner violence (IPV) refers to actual or threatened physical, sexual, and psychological abuse by a current or former intimate partner. 1 IPV is a major public health problem that causes and exacerbates physical health problems, including cardiovascular, respiratory, chronic pain, gynecological disorders, and adverse pregnancy outcomes. [2][3][4] Similarly, IPV increases risk for psychiatric conditions such as posttraumatic stress disorder (PTSD), other anxiety disorders, depression, substance misuse, eating disorders, and suicidality. [3][4][5] Relative to civilians, female veterans are at higher risk for physical and sexual forms of IPV (33.0 % vs. 23.8 % lifetime prevalence). 2 Although the reasons for elevated risk among female Veterans remain unknown, some theorize that women's exposure to violence-prone environments, such as violent childhood homes and the military, may elevate women's risk for IPV. 6,7 IPV may be particularly common among women seeking care at Veterans Health Affairs (VHA) health-care facilities. 6,8,9 Studies have found lifetime reports of IPV a...

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“…For example, all VHA facilities have a full‐time women veterans program manager, whose role is to assist women in accessing and coordinating services within VHA and the community (VHA, ) and VHA has designated points of contact for identification and care coordination for veterans who have had unwanted sexual experiences during military service (Kimerling et al, ). Similar infrastructure can be developed to more comprehensively address IPV (Sweeney et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…Improving the health and health care of women veterans is an important VHA research priority (Hayes, ). Although VHA has been a leader in evidence‐based care for a variety of complex health issues, such as PTSD and military sexual trauma (unwanted sexual experiences during military service; Karlin et al, ; Kilbourne et al, ; Kimerling, Gima, Smith, Street, & Frayne, ), strategies have yet to be systematically focused on the identification and treatment of IPV within VHA (Iverson, ), and universal IPV screening programs do not yet exist in VHA (Sweeney et al, ). The Patient Protection and Affordable Care Act (), Institute of Medicine () and US Preventive Services Task Force () recommend routine screening for IPV as a standard part of preventative care for women, because screening and response interventions can lead to improvements in women's health and safety (Nelson, Bougatsos, & Blazina, ).…”

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confidence: 99%

Women Veterans' Preferences for Intimate Partner Violence Screening and Response Procedures Within the Veterans Health Administration

et al. 2014

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Intimate partner violence (IPV) is a significant health issue faced by women veterans, but little is known about their preferences for IPV-related care. Five focus groups were conducted with 24 women Veterans Health Administration (VHA) patients with and without a lifetime history of IPV to understand their attitudes and preferences regarding IPV screening and responses within VHA. Women veterans wanted disclosure options, follow-up support, transparency in documentation, and VHA and community resources. They supported routine screening for IPV and articulated preferences for procedural aspects of screening. Women suggested that these procedures could be provided most effectively when delivered with sensitivity and connectedness. Findings can inform the development of IPV screening and response programs within VHA and other healthcare settings.

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Intimate Partner Violence: Perspectives on Universal Screening for Women in VHA Primary Care

Cited by 13 publications

References 50 publications

Association of intimate partner violence and health-care provider-identified obesity

Association of intimate partner violence and health-care provider-identified obesity

Clinical Utility of an Intimate Partner Violence Screening Tool for Female VHA Patients

Women Veterans' Preferences for Intimate Partner Violence Screening and Response Procedures Within the Veterans Health Administration

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