With domestic violence in the headlines lately due to the Ray Rice video and the newly-crowned Miss America Kira Kazantsev's domestic violence platform, the Society for Women's Health Research believes it is time to highlight an important subject that's been missing.
There has been radio silence about the acute and chronic health conditions that affect women who suffer from this abusive behavior. Black eyes, bruises and broken bones are all what we expect to hear from victims who experience violence at the hand of a loved one.
There has been little to no attention, however, given to other health conditions, such as arthritis, hypertension [1], diabetes [2], high cholesterol [3] and asthma [3], just to name a few of the afflictions that may develop long after the violence has stopped. In addition to these physical health consequences, there are psychological effects and conditions that women may experience -- depression [4], anxiety [5] and Post-Traumatic Stress Disorder (PTSD) [6], all of which may indirectly give rise to other ailments.
Prior to domestic violence being front and center in the news, it has historically been a rather taboo subject. We know it happens, yet we rarely talk about it.
With 30 percent of women experiencing domestic violence during their lifetime [7], a number that experts believe is higher given that domestic violence is most likely under-reported [8], we need to start talking about it more often. Additionally, almost a quarter of pregnant women are abused [9], leading to medical complications during and after birth, including pre-eclampsia [10], preterm birth [11], low birth weight babies [12] and neonatal and perinatal death [13].
Currently, the United States Preventive Services Task Force recommends that all women between the ages of 14-46 years old be screened for domestic violence in a health care setting [14]. Today, though, this is largely up to the health care provider. Many women patients at the hospital or in a health care provider's office go unscreened and/or are given a temporary fix to their health problem, not knowing that the root cause may be waiting at home when they return.
In all but two states, there is no Continuing Medical Education requirement for health care providers [15], so they may not be knowledgeable of the current guidelines, screening tools, prevalence and chronic conditions associated with domestic violence. It is time that our society offer empathetic and effective care to these brave women to ensure their health and safety.
Your mother, your sister, your best friend, your daughter, your colleague all may have at one point been victims of domestic violence and even currently suffer from domestic violence-related health consequences, though they may not know it. Physical or sexual abuse, verbal abuse, nonverbal intimidation, financial exploitation and neglect can end up, directly or indirectly, causing a chronic disease. Addressing the full implications of domestic violence may prevent or lower that risk, ultimately saving money, time and, most importantly, lives.
The Society for Women's Health Research is actively studying the link between domestic violence and chronic disease. Find out more at www.SWHR.org.
By Aimee M. Gallagher, MPH, MS, SWHR Scientific Program Manager
Need help? In the U.S., call 1-800-799-SAFE (7233) for the National Domestic Violence Hotline.
References:
1) Jones RF, Horan DL. The American College of Obstetricians and Gynecologists: a decade of responding to violence against women. Int J Gynaecol Obstet. 1997;58(1):43-50.
2) Mason SM, Wright RJ, Hibert EN, Spiegelman D, Forman JP, Rich-Edwards JW. Intimate partner violence and incidence of hypertension in women. Ann Epidemiol. 2012;22(8):562-7.
3) Breiding MJ, Black MC, Ryan GW. Chronic disease and health risk behaviors associated with intimate partner violence-18 U.S. states/territories, 2005. Ann Epidemiol. 2008;18(7):538-44.
4) Coker AL, Davis KE, Arias I, Desai S, Sanderson M, Brandt HM, Smith PH. Physical and mental health effects of intimate partner violence for men and women. Am J Prev Med. 2002;23(4):260-8.
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8) Spivak HR, Jenkins L, VanAudenhove K, Lee D, Kelly M, Iskander J. CDC Grand Rounds: a public health approach to prevention of intimate partner violence. MMWR. 2014;63(2):38-41.
9) Chambliss LR. Intimate partner violence and its implication for pregnancy. Estimate by the American College of Obstetricians and Gynecologists. Clin Obstet Gynecol. 2008;51(2):389.
10) Sanchez SE, Qiu C, Perales MT, Lam N, Garcia P, Williams MA. Intimate partner violence (IPV) and preeclampsia among Peruvian women. Eur J Obstet Gynecol Reprod Biol. 2008;137(1):50-5.
11) Yost NP, Bloom SL, McIntire DD, Leveno KJ. A prospective observational study of domestic violence during pregnancy. Obstet Gynecol. 2005;106(1):61-5.
12) Murphy CC, Schei B, Myhr TL, Du Mont J. Abuse: a risk factor for low birth weight? A systematic review and meta-analysis. CMAJ. 2001;164(11):1567-72.
13) Janssen PA, Holt VL, Sugg NK, Emanuel I, Critchlow CM, Henderson AD. Intimate partner violence and adverse pregnancy outcomes: a population-based study. Am J Obstet Gynecol. 2003;188(5):1341-7.
14) Moyer, VA. Screening for intimate partner violence and abuse of elderly and vulnerable adults: U.S. preventive services task force recommendation statement. Ann Intern Med. 2013;158(6):478-86.
15) Susman E. Lack of training hampers domestic abuse screening. Medpage Today. Posted June 21, 2014. Accessed July 17, 2014. http://www.medpagetoday.com/MeetingCoverage/AANP/46432.