Domestic Violence

Question 1

Describe the prevalence of physical domestic violence in the UK (by men against women) both lifetime and in the past year.

Answer 1

Lifetime prevalence of physical violence
~ 1/3 (10-40%)
In past year
~ 1/10 (2-20%)

Question 2

What are the major risk factors for poor health in women of reproductive age? (5)

Answer 2

Hypertension
Obesity
Hypercholesterolaemia
Smoking
Alcohol use

Question 3

Intimate partner violence is the 2nd most common cause of…?

Answer 3

DALY lost globally in women aged 20 to 24 years

Question 4

What percentage of total disease burden does intimate partner violence contribute? How does this compare to alcohol, body weight, smoking etc?

Answer 4

Almost 9%

Much higher, e.g. alcohol is about 3% and tobacco is less than 2%

Question 5

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…?

Answer 5

High blood pressure, obesity and smoking

Question 6

What’s the definition of domestic violence & abuse (DVA)?

Answer 6

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.

Question 7

What types of abuse are there? (5)

Answer 7

psychological 
physical 
sexual 
financial 
emotional

Question 8

What is the difference between DVA and IPA?

Answer 8

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)

Question 9

What is included in the Power & Control Wheel? (8)

Answer 9

Using coercion and threats
Using intimidation
Using emotional abuse
Using isolation
Minimising, denying and blaming
Using children
Using male privilege
Using economic abuse

Question 10

Compare the prevalence rates of intimate partner violence in Europe, the Americas and Africa.

Answer 10

Europe 25.4%
Americas 29.8%
Africa 36.6%

Question 11

In England and Wales, what is the lifetime prevalence of partner abuse (non-sexual) committed on women? What about any domestic abuse on women?

Answer 11

24%

31%

Question 12

In 1027 women in 13 general practice waiting rooms, what lifetime experience of violence ever from a partner was reported?

Answer 12

41%

Question 13

In 1027 women in 13 general practice waiting rooms, what experience of violence from a partner in the past year was reported?

Answer 13

17%

Question 14

Past year prevalence of IPV in the UK is highest in what type of care? Then what is second and third?

Answer 14

General practice
Antenatal/postnatal care
Family planning

Question 15

In Tower Hamlets, how many domestic violence offences are reported to police each year? How does this compare to the rest of the UK?

Answer 15

~6,000

One of highest levels in UK

Question 16

What are the major risk factors for DVA? (4)

Which is the biggest one?

Answer 16

Gender (women) - biggest and most consistent one
Younger age
Relative poverty
Separation (serious harm and homicide)

Question 17

89% of people who suffer 4 or more domestic violence assaults lifetime are…?

Answer 17

Women

Question 18

Most common cause of injury in women <60 years old?

Answer 18

Domestic violence

Question 19

How do women affected by DVA present?

Answer 19

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

Question 20

Women exposed to IPV are twice as likely to…? (2)

Answer 20

Experience depression

Have alcohol use disorders

Question 21

What’s the biggest physical health difference between abused & non-abused women?

Answer 21

More gynaecological problems

Question 22

What is the most consistent, longest lasting and largest physical health difference with women who have suffered DV?

Answer 22

3x increased risk of gynaecological problems

Question 23

What are the physical health consequences of DV? (5)

Answer 23

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

Question 24

What are the mental health consequences of DV? (4)

Answer 24

PTSD, alcohol abuse, suicidal thoughts, depression

Question 25

How many % of women in violent relationships were assaulted for the first time in pregnancy?

Answer 25

25%

Question 26

How is DV linked to birth weight?

Answer 26

Associated with lower birth weight

Question 27

How should you respond to a DVA disclosure? (6)

Answer 27

"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”

Question 28

What are unhelpful responses to a DVA disclosure? (6)

Answer 28

“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”

Question 29

How do we engage primary health care services?

Answer 29

IRIS - Identification and referral to Improve Safety

Question 30

What are the NICE recommendations about DVA? (7)

Answer 30

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

Question 31

When should doctors ask about DV?

Answer 31

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.

Question 32

What should doctors use to ask about DV?

Answer 32

HARK template

Humiliate, afraid, rape, kick, safety

Question 33

How to ask? (3)

Answer 33

Ask safely (when women are alone)
Keep confidential
Ask sensitively

Question 34

What should doctors do? (5)

Answer 34

Ask about abuse  
Non-judgmental support 
Check immediate safety
Document
Offer referral for advocacy

Question 35

How do you assess patient’s safety? (4)

Answer 35

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?

Question 36

How do you document your findings? (4)

Answer 36

In the patient’s medical record
In her own words
With specific details
With a body map/photographs if required (with consent)

Question 37

Why ask about children?

Answer 37

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).

Question 38

In 90% of cases of DV, what can be said about the children?

Answer 38

In same/next room

Question 39

90% of child deaths through abuse feature…?

Answer 39

Domestic violence

Question 40

How many % of children subject to a child protection plan live in households with DV?

Answer 40

75%