Building data systems for monitoring and responding to violence against women. Recommendations from a workshop.
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This report provides recommendations regarding public health surveillance and research on violence against women developed during a workshop, "Building Data Systems for Monitoring and Responding to Violence Against Women." The Workshop, which was convened October 29-30, 1998, was co-sponsored by the U.S. Department of Health and Human Services and the U.S. Department of Justice. (+info)
The impact of severe stalking experienced by acutely battered women: an examination of violence, psychological symptoms and strategic responding.
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Stalking has been relatively understudied compared to other dimensions of intimate partner violence. The purpose of this article was to examine concurrent and subsequent intimate partner abuse, strategic responses and symptomatic consequences of severe stalking experienced by battered women. Thirty-five battered women classified as "relentlessly stalked" and 31 infrequently stalked battered women were compared. Compared to infrequently stalked battered women, relentlessly stalked battered women reported: (a) more severe concurrent physical violence, sexual assault and emotional abuse: (b) increased post-separation assault and stalking; (c) increased rates of depression and PTSD; and (d) more extensive use of strategic responses to abuse. Results underscore the scope and magnitude of stalking faced by battered women and have implications for assessment and intervention strategies. (+info)
Somatic symptom reporting in women and men.
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Women report more intense, more numerous, and more frequent bodily symptoms than men. This difference appears in samples of medical patients and in community samples, whether or not gynecologic and reproductive symptoms are excluded, and whether all bodily symptoms or only those which are medically unexplained are examined. More limited, but suggestive, literature on experimental pain, symptom reporting in childhood, and pain thresholds in animals are compatible with these findings in adults. A number of contributory factors have been implicated, supported by varying degrees of evidence. These include innate differences in somatic and visceral perception; differences in symptom labeling, description, and reporting; the socialization process, which leads to differences in the readiness to acknowledge and disclose discomfort; a sex differential in the incidence of abuse and violence; sex differences in the prevalence of anxiety and depressive disorders; and gender bias in research and in clinical practice. General internists need to keep these factors in mind in obtaining the clinical history, understanding the meaning and significance that symptoms hold for each patient, and providing symptom relief. (+info)
Primary care physicians' attitudes to battered women and feelings of self-competence regarding their care.
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BACKGROUND: Previous descriptive studies have demonstrated the problematic nature of physicians' attitudes toward battered women. However, little empirical research has been done in the field, especially among the various medical specialties. OBJECTIVES: To compare the approach and feelings of competence regarding the care of battered women between primary care and non-primary care physicians. The non-primary care physicians who are likely to encounter battered women in the ambulatory setting are gynecologists and orthopedists. METHODS: A self-report questionnaire formulated for this study was mailed to a random sample of 400 physicians working in ambulatory clinics of the two main health maintenance organizations in Israel (300 primary care physicians, 50 gynecologists and 50 orthopedists). RESULTS: In both physician groups, treating battered women tended to evoke more negative emotional states than treating patients with infectious disease. The most prevalent mood state related to the management of battered women was anger at her situation. Primary care physicians experienced more states of tension and confusion than non-primary care physicians and had lower perceived self-efficacy and self-competence in dealing with battered women. CONCLUSIONS: Though both physician groups exhibited negative feelings when confronting battered women, the stronger emotion of the primary care physicians may indicate greater sensitivity and personal awareness. We believe that more in-service training should be introduced to help physicians at the undergraduate and postgraduate levels to cope both emotionally and professionally with these patients. (+info)
The health of children in refuges for women victims of domestic violence: cross sectional descriptive survey.
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OBJECTIVES: To describe the health and developmental status of children living in refugees for women victims of domestic violence and to investigate their access to primary healthcare services. DESIGN: Cross sectional survey. SETTING: Women's refugees in Cardiff. PARTICIPANTS: 148 resident children aged under 16 years and their mothers. MAIN OUTCOME MEASURES: Completeness of records on the child health system (register of all children that includes data on the child's health) for named health visitor, named general practitioner, and immunisation uptake; satisfactory completion of child health surveillance; Denver test results for developmental status; Rutter test scores for behavioural and emotional problems; reports of maternal concerns. RESULTS: 148/257 (58%) children living in refugee between April 1999 and January 2000 were assessed. Child health system data were incorrect (general practitioner and/or address) or unavailable for 85/148 (57%) children. Uptake of all assessments and immunisations was low. 13/68 (19%) children aged <5 years had delayed or questionable development on the Denver test, and 49/101 (49%) children aged 3-15 years had a Rutter score of >10 (indicating probable mental health problems). Concerns were expressed by mothers of 113/148 (76%) children. After leaving the refuge, 22 children were untraceable and 36 returned home to the perpetrator from whom the families had fled. CONCLUSIONS: The children had a high level of need, as well as poor access to services. Time spent in a refuge provides a window of opportunity to review health and developmental status. Specialist health visitors could facilitate and provide support, liaison, and follow up. (+info)
Domestic violence: prevalence among women in a primary care center--a pilot study.
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BACKGROUND: Domestic violence is a prevalent problem with serious consequences, including the risk of death. The lifetime prevalence ranges from 21 to 34%, with 8-14% of them reporting abuse in the previous year. The incidence seen in primary care practice is about 8%. Despite this high rate, domestic violence is under-diagnosed in primary care. OBJECTIVES: To estimate the prevalence of domestic violence among women visiting a primary care center, to characterize them and to evaluate a screening tool. METHODS: A brief anonymous questionnaire (in Hebrew and Russian) for self-completion was used as a screening tool. During October 1998 we distributed the questionnaires in a primary care clinic in Beer Sheva to all women aged 18-60 years whose health permitted their participation. A woman was considered at high risk for domestic violence when she gave a positive answer to at least one of the three questions related to violence. The risk factors for domestic violence were calculated by odds ratio with 95% confidence intervals. RESULTS: The response rate was 95.7%. We found 41 women (30.8%) at high risk for violence. Women preferred talking about this issue with their family physician. Women at highest risk were older than 40 years, had emigrated from the former Soviet Union during the last 10 years, were living alone, and were unemployed. None of the women visited the Domestic Violence Center during the study period and 2 months thereafter. Only three women tore off the Center's address and phone number attached to the questionnaire. CONCLUSIONS: The anonymous questionnaire was well accepted and had a high compliance rate. Its disadvantages are that respondents must be literate and that it permits the woman to continue with her "secret-keeping" behavior. A high prevalence of domestic violence among women visiting a primary care clinic should convince family physicians to be more active in diagnosing the problem accurately among their patients, providing treatment and preventing further deterioration and possible danger. Further effort should be directed at improving the clinic staff's ability to detect domestic violence among patients, and at developing management programs in the health system to help combat domestic violence. (+info)
The Voices of survivors documentary: using patient narrative to educate physicians about domestic violence.
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This article describes a method of developing physician education materials using analysis of domestic violence patient experiences and patients' descriptions of their experiences. The process began with interviews of 21 domestic violence survivors, focusing on what they wanted to teach physicians. Qualitative analysis of these interviews identified 4 main themes regarding what survivors wanted physicians to understand about life in an abusive relationship: that domestic violence is universal, that it is more than just physical assaults, that it is all about power and control, and that it affects the entire family. Because what survivors wanted from physicians differed depending on where they were in their abusive relationships, recommendations were developed for each of 5 common situations: when a patient may not yet recognize the abuse, when s/he may not be ready or able to disclose the abuse, when s/he chooses to remain in an abusive relationship, when s/he is seeking care for an acute assault, and when s/he has left the relationship but not yet healed. Interview excerpts representing each of the identified themes are used to create a 30-minute educational documentary. A written companion guide covers the traditional aspects of domestic violence education. In teaching about domestic violence or other health problems where it is difficult for physicians to understand their patients intuitively, an educator's most important role may be to direct learners to listen to the experience and wisdom of patients. (+info)
Screening for abuse in Spanish-speaking women.
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BACKGROUND: Domestic violence is a major personal and public health concern affecting women of all walks of life. Physicians have reported the need for screening instruments to help recognize abuse; several have been validated in English. No screening tools thus far have been validated in other languages. METHODS: We translated a previously validated tool, the Woman Abuse Screening Tool (WAST), into Spanish. To assess for validity, we compared responses of Spanish-speaking abused and nonabused respondents drawn from a community health center and a battered women's shelter. There were 27 women in the abused group and 34 women in the nonabused comparison group. RESULTS: The scale was found to be reliable with a Cronbach alpha of 0.91. The mean WAST Spanish scores were significantly different between the two groups, indicating this tool would be a valid screening instrument. A short form using the two most reliable questions was developed as a more rapid screening tool for office use, achieving a specificity of 94% and a sensitivity of 89%. CONCLUSIONS: The Spanish version of the WAST successfully discriminated between Spanish-speaking nonabused and abused women. The short form might help physicians reliably screen for abuse in Spanish-speaking women. (+info)