By- Anthony Ng, MD
Domestic abuse is a public health crisis that has recently gained more attention. In a report from the US Preventative Services Task Force (USPSTF), published in the recent Annals of Internal Medicine, it recommended that all women of childbearing age be screened for abuse, and women who screen positive should be provided or referred to intervention services. A survey from CDC in 2011 which interviewed about 16500 adults in 2010 showed 1 in 3 women was a victim of domestic violence. It is suspected that this number may actually on the low side as there may be widespread under-reporting of abuse. Last year, domestic violence accounted for almost half of all homicide cases in the state of Maine.
Domestic abuse comes in many forms. They may include not only physical abuse, but also sexual and emotional abuses, intimidation, stalking and even economic deprivation. Additionally, while this report focused on women of childbearing age, it is important to recognize that domestic violence also known as spousal abuse or intimate partner violence (ITF) can occur in any person including males. Domestic abuse is often under-reported. Reasons may include victims minimizing the abuse. There may be stigma to being identified as a victim of domestic abuse. Such abuses can occur in all walks of life. Some victims may fear reporting domestic abuse may lead to more abuse and violence or perhaps abandonment from the abusers. Some victims may actually blame themselves for the abuse, thinking it is their fault for the abuse. There may also be under-detection and screening for domestic abuse. Lastly, there may not be enough resources in communities, such as shelters for victims, to address the issue of domestic abuse even when such abuses are identified. Domestic abuse is not limited to women. Males are also at risk of domestic abuse. However the data in this group remains sparse. It is widely under-reported with stigma likely being a major reason.
There are some identifiable risk factors for abuse. They include individuals with physical or emotional disabilities being victims, young age, substance abuse, marital conflict and instability, economic and work stress. Domestic abuse can lead to significant physical and emotional concerns. Victims of domestic abuse can lead to increased risk of physical injuries and illnesses. It can also lead to depression, anxiety, post traumatic stress disorder and substance abuse.
To intervene in domestic abuse, the approach needs to be from multiple avenues. First, there needs to be greater education to communities of the extent of the problem of domestic abuse. It is a major health problem that needs early recognition so that intervention can be effective. Identifying the risk factors and stress that can cause and worsen domestic abuse would be paramount. For example, if a couple is experiencing marital stress or stress from economic hardships, counseling early on may prevent domestic abuse. Better screening is needed, especially by primary care physicians. According to the recent USPTSF guidelines, primary care physicians are strongly encouraged to screen closely for signs of domestic abuse. This may include asking for stress at home and further questioning about psychological distress, as well as repeated physical injuries. For victims of domestic abuse, there are some shelters that are available. In the Bangor area, Spruce Run is a shelter for victims of domestic abuse and violence. In some instances, law enforcement may also need to be involved to protect the victims.
Domestic abuse is a major health problem in Maine and the United States. It can lead to a rippling of other health and mental health problems if not treated. Greater awareness and early interventions can help both the abuser and the victim. So, don't be surprised if your doctor starts to ask more questions about the presence of domestic abuse.
Resources:
Spruce Run
Tel: 1-800-863-9909
Website: http://www.sprucerun.net/
Maine Department of Health and Human Services
Tel: 1-866-834-4357 (HELP)
Center for Disease Control on Intimate Partner Violence
Website: http://www.cdc.gov/violenceprevention/intimatepartnerviolence/index.html
Maine Office of Attorney General
Website: http://www.maine.gov/ag/children_families/domestic_violence.html
Maine Coalition to End Domestic Violence
Website: http://mcedv.org/
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