Intimate Violence Hurts Health

In America, one in four women and one in nine men suffers physical or
emotional violence at the hands of an intimate partner. This harms their
long-term health, the CDC reports.

The new data come from the largest-ever survey of intimate-partner violence
-- a range of behaviors that includes physical violence, sexual violence,
unwanted sex, emotional abuse, threats, and stalking. Perpetrators include
spouses, ex-spouses, boyfriends, girlfriends, and dates.

CDC researchers asked adult participants in the 2005 Behavioral Risk Factor
Surveillance System survey if they would answer questions about
intimate-partner violence. More than 70,000 Americans -- just over half
those asked -- agreed.

The results:

• 23.6% of women and 11.5% of men reported at least one lifetime episode of
  intimate-partner violence.


• In households with incomes under $15,000 per year, 35.5% of women and 20.7%
  of men suffered violence from an intimate partner.


• 43% of women and 26% of men in multiracial non-Hispanic households suffered
  partner violence.


• 39% of women and 18.6% of men in American Indian/Alaska Native households
  suffered partner violence.


• 26.8% of women and 15.5% of men in white non-Hispanic households suffered
  partner violence.


• 29.2% of women and 23.3% of men in black non-Hispanic households suffered
  partner violence.


• 20.5% of women and 15.5% of men in Hispanic households suffered partner
  violence.

Shocking as these numbers seem, they do not represent an upward trend. A
decade ago, the last large survey of partner violence came up with similar
rates, Black says. Other data bear this out, says Peter Sherman, MD, director
of the residency program in social pediatrics at New York's Montefiore Medical
Center.

"If anything, the rates for domestic violence have been decreasing in the past
years," Sherman tells WebMD. "Laws have been changed to make it easier
to get a response from police, and in many areas there are more resources
ranging from domestic violence services to hotlines and shelters."

So why are we surprised by how common domestic violence is? Sherman says
it's because the size of the problem is far out of proportion to our
response.

"If this were an infectious disease, we would have a treatment center in
every neighborhood," Sherman says. "There is a huge disconnect between
the prevalence of domestic violence and what is done in the health
system."

Intimate Violence Linked to Long-Term Health Problems

Intimate-partner violence is definitely linked to chronic health problems,
Black says.

"We found a number of outcomes related to intimate-partner violence,
including current disability and activity limitations, asthma, stroke , arthritis , and, in women, heart disease ," Black tells WebMD. "And a number
of risk behaviors are linked to intimate-partner violence: infection with HIV
or STDs, smoking , and heavy or binge drinking."

Black is quick to note that survey data do not show whether partner violence
caused these health problems. But she says previous studies have found high
stress levels in people with abusive spouses -- and that high stress levels are
linked to chronic health problems.

Stress isn't the only health issue for victims of domestic violence.

"The perpetrator of domestic violence often controls household financial
resources," Sherman says. "Part of the control may be limiting that
person's access to health care. Or the abused individuals may feel depressed or
disempowered, making it hard for them to get to the help they nee or to adhere
to medications ."

Because of the link to health problems, the CDC recommends that doctors ask
patients about intimate-partner violence. That may be harder to do than it
would seem.

"If you are a provider in a busy clinic, do you want to ask? Do you have
the time? And if you ask, you open a complicated issue that takes even more
time you don't have," Sherman says. "I like the philosophy of asking,
but the health care system has to develop the resources. One reason docs don't
ask is they don't feel all the resources they need are in place. You'll find
that where there are domestic-violence resources, the levels of asking are
higher."

Black says that contrary to common assumptions, patients being abused by an
intimate partner want their doctors to ask them about it.

"Those asked about intimate-partner violence do respond very well by
making changes in individual behaviors and reducing their safety risk,"
Black says. "They respond very well to being asked about intimate-partner
violence by their doctor. It builds rapport with the doctor. People do think
they should be asked and appreciate it when they are asked."

The CDC's ultimate goal is to prevent intimate-partner violence in the first
place. Last year the CDC launched the multimedia "Choose Respect"
initiative to encourage 12- to 14-year-old adolescents to learn about positive
relationship behaviors.

"We try to teach these things early, before people are dating, before
norms for partner violence are established," Black says.

Domestic violence has other victims beyond the abused partner.

"One thing not paid enough attention to is the effect on children,"
says Sherman, a pediatrician. "There are children in most households with
intimate-partner violence. There is an enormous impact on these kids' emotional
and physical health -- and on how they will respond to relationships as adults,
either by being perpetrators or victims of domestic violence."

The CDC report appears in the Feb. 8 issue of Morbidity and Mortality
Weekly Report.

By Daniel DeNoon
Reviewed by Louise Chang
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