Domestic Violence Flashcards
Describe the prevalence of physical domestic violence in the UK (by men against women) both lifetime and in the past year.
Lifetime prevalence of physical violence
~ 1/3 (10-40%)
In past year
~ 1/10 (2-20%)
What are the major risk factors for poor health in women of reproductive age? (5)
Hypertension Obesity Hypercholesterolaemia Smoking Alcohol use
Intimate partner violence is the 2nd most common cause of…?
DALY lost globally in women aged 20 to 24 years
What percentage of total disease burden does intimate partner violence contribute? How does this compare to alcohol, body weight, smoking etc?
Almost 9%
Much higher, e.g. alcohol is about 3% and tobacco is less than 2%
Intimate partner violence is responsible for more ill-health and premature death in women under the age of 45 than any other of the well-known risk factors, including…?
High blood pressure, obesity and smoking
What’s the definition of domestic violence & abuse (DVA)?
Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality.
What types of abuse are there? (5)
psychological physical sexual financial emotional
What is the difference between DVA and IPA?
Domestic violence is done by any member of the family, whereas intimate partner abuse is done by an intimate partner (e.g. husband/wife or boyfriend/girlfriend)
What is included in the Power & Control Wheel? (8)
Using coercion and threats Using intimidation Using emotional abuse Using isolation Minimising, denying and blaming Using children Using male privilege Using economic abuse
Compare the prevalence rates of intimate partner violence in Europe, the Americas and Africa.
Europe 25.4%
Americas 29.8%
Africa 36.6%
In England and Wales, what is the lifetime prevalence of partner abuse (non-sexual) committed on women? What about any domestic abuse on women?
24%
31%
In 1027 women in 13 general practice waiting rooms, what lifetime experience of violence ever from a partner was reported?
41%
In 1027 women in 13 general practice waiting rooms, what experience of violence from a partner in the past year was reported?
17%
Past year prevalence of IPV in the UK is highest in what type of care? Then what is second and third?
General practice
Antenatal/postnatal care
Family planning
In Tower Hamlets, how many domestic violence offences are reported to police each year? How does this compare to the rest of the UK?
~6,000
One of highest levels in UK
What are the major risk factors for DVA? (4)
Which is the biggest one?
Gender (women) - biggest and most consistent one
Younger age
Relative poverty
Separation (serious harm and homicide)
89% of people who suffer 4 or more domestic violence assaults lifetime are…?
Women
Most common cause of injury in women <60 years old?
Domestic violence
How do women affected by DVA present?
Physical – chronic GI symptoms, diarrhea, abdo pain
Gynae problems – chronic pelvic pain, sexual dysfunction, vaginal bleeding, STIs, painful intercourse, recurrent UTIs
Psychosocial – anxiety, depression, eating disorders
Situational – frequent hospital admissions, frequent medication use, abuse of child in the family
Women exposed to IPV are twice as likely to…? (2)
Experience depression
Have alcohol use disorders
What’s the biggest physical health difference between abused & non-abused women?
More gynaecological problems
What is the most consistent, longest lasting and largest physical health difference with women who have suffered DV?
3x increased risk of gynaecological problems
What are the physical health consequences of DV? (5)
Chronic pain (e.g. headaches, back pain)
Increased minor infectious illnesses
Neurological symptoms (e.g. fainting and fits)
Gastrointestinal disorders (e.g. chronic IBS)
Raised blood pressure and coronary artery disease
What are the mental health consequences of DV? (4)
PTSD, alcohol abuse, suicidal thoughts, depression
How many % of women in violent relationships were assaulted for the first time in pregnancy?
25%
How is DV linked to birth weight?
Associated with lower birth weight
How should you respond to a DVA disclosure? (6)
"This is not your fault” “No one deserves to be treated this way” “I’m sorry you’ve been hurt” “I am concerned about your safety (and that of your children)” “Do you want to talk about it?” “Help is available to you”
What are unhelpful responses to a DVA disclosure? (6)
“Why don’t you just leave?”
“You’re being an awful mum”
“Why do you go back?”
“What did you do to make him/her so angry?”
“I can’t help you if you won’t do what I say”
How do we engage primary health care services?
IRIS - Identification and referral to Improve Safety
What are the NICE recommendations about DVA? (7)
Display information in waiting areas about the support on offer
Ensure it is available in a range of formats and locally used languages
Ensure people are given maximum privacy
Ensure frontline staff know about the services, policies and procedures and have formal referral pathways
Provide training and supervision for staff
Establish clear policies and procedures
Ensure staff have the opportunity to address issues relating to their own personal experiences
When should doctors ask about DV?
When women present with symptoms of depression, post-traumatic stress, anxiety, suicidal, self-harming, alcohol or other substance abuse. Or when they present with STIs, chronic unexplained health problems, non-specific symptoms, repeated consults, and during ante/pre-natal care & injuries.
What should doctors use to ask about DV?
HARK template
Humiliate, afraid, rape, kick, safety
How to ask? (3)
Ask safely (when women are alone)
Keep confidential
Ask sensitively
What should doctors do? (5)
Ask about abuse Non-judgmental support Check immediate safety Document Offer referral for advocacy
How do you assess patient’s safety? (4)
Is either the woman or her children in danger?
Has violence escalated recently?
Are there weapons in the home?
If the patient is not safe, does she have a safety plan?
How do you document your findings? (4)
In the patient’s medical record
In her own words
With specific details
With a body map/photographs if required (with consent)
Why ask about children?
Children may get caught in the ‘cross fire’/protect siblings or parent (about half the children in DV families have themselves been badly hit or beaten).
In 90% of cases of DV, what can be said about the children?
In same/next room
90% of child deaths through abuse feature…?
Domestic violence
How many % of children subject to a child protection plan live in households with DV?
75%
