The Epidemiology of Domestic Violence

1
The Epidemiology of Domestic Violence
Thomas Songer, PhD Cristie Glasheen,
MPH University of Pittsburgh
2
Key Points

1. What is being measured?
2. What is NOT being measured?
3. How does this affect the results?

3
Definition of Violence
...To understand violence, you need to define
violence
How would you define domestic violence?
4
Defining Domestic Violence

• domestic violencenoun violence committed by one
  member of a family or household against another
• The National Research Council defines violence
  as
• - behaviour by individuals that intentionally
  threaten, attempt, or inflict physical harm on
  others

5
Who is Affected by Domestic Violence?

• Children
• Intimate Partners (IP)
• Elders

6
Data Sources

• You are planning to do a study of domestic
  violence using pre-existing data.
• Where would you look?
• Medical sources
• State sources
• Government surveys

7
Which surveillance system is likely to provide
the best estimates for domestic violence?
8
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

9
Medical Sources

• Hospital Records
• Trauma Center Records
• Emergency Department

Recommended Rudman WJ. Coding and Documentation
of Domestic Violence. December, 2000. Available
at http//endabuse.org/programs/healthcare/files/
codingpaper.pdf
10
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

11
State Based Reporting

• State-based Reporting
• Child Protective Services
• Uniform Crime Reports
• National Incident-Based Reporting System (NIBRS)
• Supplementary Homicide Report (SHR)

12
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

13
Government Surveys

• Government Surveys
• National Crime Victimization Survey (NCVS)
• National Violence Against Women Survey (NVAW)

14
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

15
What do we know aboutChild Maltreatment?
16
Epidemiology of Child Abuse

• Maltreatment
• behavior towards another person, which a) is
  outside the norms of conduct, and b) entails a
  substantial risk of causing physical or emotional
  harm
• Physical Abuse
• Sexual Abuse
• Emotional Psychological Abuse
• Neglect

17
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.

18
Substantiated Cases of Child Maltreatment, Pennsyl
vania, 1976-1994
19
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
20
What do we know about Violence Against Women?
21
Terminology of IPV

• Intimate Partner Violence (IPV) relatively new
  term
• Also called domestic violence, domestic abuse,
  spousal abuse, battery, violence against women

22
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
23
Estimates of the Frequency of Domestic Violence
Against Women seen in Medical Settings
Sample
Trauma
One year
Lifetime
Study
Definition and Method
Size
from Abuse
Prevalence
Prevalence
Physical and sexual abuse reported
McCauley
1952
5.5
33
in physician practices
Physical and sexual abuse and
Gin
453
threats by current partner reported
14
28
in internal medicine clinics
Physical abuse reported in an urban
Goldberg
492
22
emergency department
Physical or sexual abuse reported in
Dearwater
3455
community hospital emergency
2.2
14.4
36.9
departments
Physical abuse identified in trauma
McLeer
412
patients in urban emergency
30
department
Physical abuse or threats reported in
Abbott
648
2.7
15.3
54.2
urban, acute care emergency
departments and clinics
Physical trauma identified in ten
Muelleman
9057
3.1
emergency departments
24
IPV
Source American Journal of Preventive
MedicineVolume 34, Issue 2, February 2008, Pages
112-118
25
WHO Multi-country Study on Womens Health and
Domestic Violence against Women
26
The Pyramid of Violence Against Women, U. S.
1418 murders
7 treated in emergency department
10 sought medical care
32 not treated for injury
51 had physical injuries
50 reported to police
1992-96 NCVS
960,000 women victimized
27
Trends in the rates of violent victimizations by
intimates, United States, 1992 - 1996
28
Possible Risk Factors
Intimate Partner Violence

• Gender
• Ethnicity
• Socio-Economic Status
• Age ?
• Alcohol ?
• Pregnancy ?
• Psychiatric problems ?

29
What do we know about Elder Abuse?
30
Research Methods

• You have decided that existing data sources are
  not adequate to answer your research question.
• You want to design a new study.
• What do you need to consider?

31
Who

• Who are you going to measure?
• Victims?
• Perpetrators?

32
What is Your Outcome?

• Physical Injury?
• Psychological Injury?

33
Physical Injury

• Easiest to identify
• Severity of injury
• What are you missing?
• Exposed with no injury

34
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

35
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

36
How are You Going to Measure It?

• Domestic Violence is wrought with ethical
  considerations unique to this field of research

37
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