The Epidemiology of Domestic Violence
Thomas Songer, PhDCristie Glasheen, MPHUniversity of Pittsburgh
Key Points
1. What is being measured?
2. What is NOT being measured?
3. How does this affect the results?
Definition of Violence
How would you define domestic violence?
…...To understand violence, you need to define violence
Defining Domestic ViolenceDefining Domestic Violence
• domestic violencedomestic violencenoun:noun: violence committed by one member violence committed by one member of a family or household against anotherof a family or household against another
• The National Research Council defines The National Research Council defines violence as:violence as:
- behaviour by individuals that - behaviour by individuals that intentionally threaten, attempt, or inflict intentionally threaten, attempt, or inflict physical harm on others physical harm on others
Who is Affected by Domestic Violence?Who is Affected by Domestic Violence?
• ChildrenChildren
• Intimate Partners (IP)Intimate Partners (IP)
• EldersElders
Data SourcesData Sources
You are planning to do a study of domestic You are planning to do a study of domestic violence using pre-existing data.violence using pre-existing data.
Where would you look?Where would you look?
• Medical sourcesMedical sources• State sources State sources
• Government surveysGovernment surveys
Surveillance in Domestic Violence• Hospital Admissions
• Trauma Center Admissions
• Emergency Department Admissions
• State-based Reporting Systems
• Government Surveys– National Criminal Victimization Survey– National Incidence Survey– Behavioral Risk Factor Survey– National Violence Against Women Survey
Medical SourcesMedical Sources
• Hospital RecordsHospital Records
• Trauma Center Trauma Center RecordsRecords
• Emergency Emergency DepartmentDepartment
Recommended: Rudman WJ. Coding and Documentation of Domestic Violence.December, 2000. Available at: http://endabuse.org/programs/healthcare/files/codingpaper.pdf
Definition of Health Care Events Related to Domestic Violence
• Based on N-codes and E-codes– 995.80 to 995.85 adult physical abuse
– 995.50 child abuse
– E coding to distinguish domestic violence is relatively poor
– E967.x
State Based ReportingState Based Reporting
• State-based ReportingState-based Reporting– Child Protective ServicesChild Protective Services
– Uniform Crime ReportsUniform Crime Reports
– National Incident-Based Reporting System National Incident-Based Reporting System (NIBRS)(NIBRS)
– Supplementary Homicide Report (SHR)Supplementary Homicide Report (SHR)
State-based Programs Related to Domestic Violence
• Based on reporting to state agencies– most frequently for child maltreatment
– definition of violence is not standard across the states
– reporting is subject to knowledge of the issues to medical, educational, and legal personnel
Government SurveysGovernment Surveys
• Government SurveysGovernment Surveys– National Crime Victimization Survey (NCVS)National Crime Victimization Survey (NCVS)
– National Violence Against Women Survey (NVAW)National Violence Against Women Survey (NVAW)
Surveys Related to Domestic Violence
• Self-report of violence based upon interviews– Aside from the NCVS, these surveys are
not regularly collected
– Definition of violence in surveys is not standard
– There may be extensive under-reporting of violence
Epidemiology of Child AbuseEpidemiology of Child Abuse
• Maltreatment Maltreatment – ““behavior towards another person, which a) is outside behavior towards another person, which a) is outside
the norms of conduct, and b) entails a substantial risk the norms of conduct, and b) entails a substantial risk of causing physical or emotional harm” of causing physical or emotional harm”
» Physical AbusePhysical Abuse» Sexual AbuseSexual Abuse» Emotional & Psychological AbuseEmotional & Psychological Abuse» NeglectNeglect
Types of Maltreatment• Physical abuse: physical acts by a parent, guardian
or caretaker that caused physical injury to the child.• Neglect (including medical neglect): the failure by
the caretaker to provide needed, age-appropriate care (or provide for the health care) of the child.
• Sexual abuse: the involvement of a child in incest, or sexual assault by a relative or caretaker, includes fondling and exposure to indecent acts.
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
76 78 80 82 84 86 88 90 92 94
Substantiated Cases of Child Maltreatment,Pennsylvania, 1976-1994
The Pyramid of Child Maltreatment in Pennsylvania, 1994
53 deaths
33 head injuries
56 trauma center admissions
177 hospital admissions
2115 ED visits
7,038 substantiated cases
64,560 maltreatment events
Terminology of IPVTerminology of IPV
• Intimate Partner Violence (IPV) – relatively new term
• Also called: domestic violence, domestic abuse, spousal abuse, battery, violence against women
Who is an intimate?NCVS SHR NVAWS
Spouse Husband/wife Spouse
Ex-spouse Ex-husband/ex-wife Ex-spouse
Common-law husband or wife
Cohabitating partner
Boyfriend/girlfriend Boyfriend/girlfriend Boyfriend/girlfriend
Ex-boyfriend/ex-girlfriend
Same sex relationship Same sex relationship
Date
Study SampleSize Definition and Method Trauma
from AbuseOne year
PrevalenceLifetime
Prevalence
McCauley 1952Physical and sexual abuse reportedin physician practices 5.5% 33%
Gin 453Physical and sexual abuse and
threats by current partner reportedin internal medicine clinics
14% 28%
Goldberg 492Physical abuse reported in an urbanemergency department 22%
Dearwater 3455Physical or sexual abuse reported incommunity hospital emergency
departments2.2% 14.4% 36.9%
McLeer 412Physical abuse identified in traumapatients in urban emergency
department30%
Abbott 648Physical abuse or threats reported inurban, acute care emergencydepartments and clinics
2.7% 15.3% 54.2%
Muelleman 9057Physical trauma identified in tenemergency departments 3.1%
Estimates of the Frequency of Domestic Violence Against Women seen in Medical Settings
IPVIPV
Source: American Journal of Preventive MedicineVolume 34, Issue 2, February 2008, Pages 112-118
WHO Multi-country Study on Women’s Health and WHO Multi-country Study on Women’s Health and Domestic Violence against WomenDomestic Violence against Women
960,000 women victimized1992-96 NCVS
50% reported to police
51% had physical injuries
10% sought medical care
7% treated in emergency department
1418 murders
32% not treated for injury
The Pyramid of Violence Against Women, U. S.
Trends in the rates of violent victimizations by intimates*, United States, 1992 - 1996
0
2
4
6
8
10
12
1992 1993 1994 1995 1996
Rat
e pe
r 1,
000
popu
latio
n
Females Males
Possible Risk FactorsPossible Risk Factors
• Gender
• Ethnicity
• Socio-Economic Status
• Age ?
• Alcohol ?
• Pregnancy ?
• Psychiatric problems ?
Intimate Partner Violence
Research MethodsResearch Methods
You have decided that existing data sources You have decided that existing data sources are not adequate to answer your research are not adequate to answer your research
question.question.
You want to design a new study.You want to design a new study.
What do you need to consider?What do you need to consider?
WhoWho
• Who are you going to measure?Who are you going to measure?
– Victims?Victims?
– Perpetrators?Perpetrators?
What is Your Outcome?What is Your Outcome?
• Physical Injury?Physical Injury?
• Psychological Injury?Psychological Injury?
Physical Injury
• Easiest to identify
• Severity of injury
• What are you missing?– Exposed with no injury
Psychological Injury
• What is the threshold?
• When is it a psychological “bruise” and when is it a “trauma”?
• What does this mean for prevention– Primary– Secondary– Tertiary
What is your exposure?
• Experienced or potential for abuse?
• Officially reported, unreported, or both
• Suspected or confirmed
• Attempts or completions
• Type of exposure– Physical and/or Neglect– Sexual– Emotional
How are You Going to Measure How are You Going to Measure It?It?
Domestic Violence is wrought with Domestic Violence is wrought with ethical considerations unique to this ethical considerations unique to this
field of researchfield of research
Key Lecture Points
• Surveillance for the frequency of domestic violence is not at the same level of development as for other unintentional injuries and for criminal violence
• Several limitations, including differing definitions, poor coding, and under-reporting influence our knowledge of the frequency of domestic violence
• Risk factor analysis in this area is just starting
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