What can we do about domestic violence?

Abstract

Domestic violence is a complex issue at both an individual and public health level. Barriers to disclosure often lie with the doctor rather than the victim. Assessment of risk and devising a safety plan are important steps for the doctor to undertake with the victim. Recommendations for joint counselling or marriage guidance for the couple are usually not appropriate. The efficacy of population screening for domestic violence has not yet been demonstrated. More limited opportunistic screening is recommended, especially in the emergency department, mental health and obstetric settings, and general practice. Health professionals can be a bridge to resources within the community, but this requires knowledge of and liaison with those services.

Is it acceptable for a psychiatrist to break confidentiality to prevent spousal violence?

“…About one woman in five in the Western world is subjected to domestic violence at some point in her life (de Vries Robbe et al, 1996;Roberts et al, 1998). The percentage of women assaulted by a partner in the twelve previous months varied from 3% in Australia (Mazza et al, 2000) to 9% in France (Jaspard and ENVEFF, 2001) to 12% in the United States (Rodriguez et al, 2001). Such violence results in a considerable number of deaths.…”

Domestic violence in South Australia: a population survey of males and females

“…D omestic violence is a significant public health problem with a range of important social, economic, political, emotional and physical ramifications. [1][2][3][4] The outcomes of domestic violence vary across the mental and physical health spectrum. Mental health effects include depression, anxiety, low self-esteem and post-traumatic stress morbidity.…”

“…5 Physical outcomes range from bruising or cuts to internal injuries, unconsciousness and death. 2,[4][5][6] Domestic violence often has long-term emotional and/or physical effects for those either experiencing it or witnessing it. One important outcome of any violent domestic situation is the flow-on consequence that affects other family members.…”

The surfacing portion of the Iceberg of the Domestic Violence Phenomenon—data from the Israeli National Trauma Registry

“…While women often hesitate to report violence, health care professionals often fail to suspect domestic violence and detect only 5% of battered women. For many abused women, the ED is the first and sometimes the only contact they have with health care clinicians [ 37 ]. Even if all women seeking care would be ready to report acts of domestic violence in the ED, these data will most likely represent only the most severe cases.…”