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Show Giles, 2001), the risk is less well defined for adults experiencing IPA who present to an ED (Jacobson & Richardson, 1987; Carmen, Rieker & Mills, 1984; Stark & Flitzcraft,1995; Abbott et al., 1995). We therefore sought to (1) define the one-year and lifetime prevalence rates of IPA and (2) estimate the association between one-year and lifetime exposure to IPA and suicidal ideation in women who presented to the ED of a community hospital in Utah. MATERIALS AND METHODS This prospective study was conducted in the emergency department of an urban community hospital during March of 2001. LDS Hospital is a large community hospital that serves as the tertiary referral center for Intermountain Health Care. The emergency department has an annual census of 36.500 visits per year. Our target survey population consisted of all women age 18 years or greater, without critical medical illness, who presented to the ED. Specific exclusion criteria included age less than 18 years, Glasgow Coma Score of less than or equal to 14, primary psychiatric diagnosis at initial nurse triage assessment, medical instability defined as systolic blood pressure less man 90, heart rate greater than 150 beats per minute, temperature greater than 39.5° Celsius, or pulse oximetry less than 90% saturated on room air, and refusal to provide informed consent. Research personnel gave eligible patients a written survey during 28 randomly selected 6-hour time blocks in March 2001. A computer program randomly generated the surveyed time blocks. Because of acoustic limitations in our department, the survey was designed to be read in private by the study participant during her stay in the ED. Prior to presenting the survey, the research assistant or treating physician would ask all other persons to wait in a designated area. The survey instrument was then given to the participant and informed consent was obtained. Answers to the survey were circled or entered on the survey sheets. The survey was also available in the Spanish language. Every patient enrolled into the study received an offer for specialized counseling or other assistance if desired. Prior to the start of the study the research assistants received at least 2 hours of training regarding partner abuse, and survey administration. During the study they kept a log of all registered women, eligible women, excluded women, and the reason(s) for a patient's exclusion. The survey was also tested for clarity prior to the research period using a group of 20 women residing at a local women's shelter who had directly experienced IPA. The survey was refined based upon their recommendations. The survey queried information in four basic categories: demographics, risk factors, exposure to IPA, and suicidality. IPA one-year prevalence was determined by an affirmative response to one of the following questions: (1) "Have you been hit, kicked, punched, strangled, injured with an object or otherwise hurt by your husband, boyfriend, partner (ex-husband, ex-boyfriend, ex-partner) in the past year? (2) "Are you here today due to injuries from a husband, boyfriend, or partner (ex-husband, ex-boyfriend, ex-partner)?" or (3) "Are you here today because of illness or stress related to threats, violent behavior, or fears due to a husband, boyfriend, or partner (ex-husband, ex-boyfriend, ex-partner)?" The IPA lifetime prevalence rate was calculated by a positive response to the IPA one-year questions or an affirmative answer to the question, "Over your lifetime, have you ever been the victim of physical or sexual violence from a husband, boyfriend, or partner (ex-husband, ex-boyfriend, ex-partner)?" The question "Have you thought about killing yourself in the past year?" was used to assess one-year suicidal ideation. Study personnel abstracted survey data into an Access (Microsoft Corporation, Bellevue, Washington, USA) database file. Random checks were performed to ensure data integrity. One-year and lifetime prevalence rates were calculated along with 95% confidence intervals (CI) according to a stratified random sampling technique. C2 or Fisher's exact test were used as appropriate to demonstrate association between one-year and lifetime IPA and risk factors, as well as suicidal ideation. The institutional review board of LDS Hospital approved the study. RESULTS Three hundred and sixty of 530 eligible women completed the survey (67.9%). 104 women refused participation, and 4 women were not surveyed because of language barriers. Study personnel missed surveying 66 otherwise eligible women during the period of study. Thirty-four women presented with a primary psychiatric complaint during the period of the study and were therefore not surveyed. The one-year prevalence rate for IPA was 9.7% (95% CI 7.9 - 13.5%). The lifetime rate was 36.4% (95% CI 31.6 -40.3%). 40.0% of women with one-year IPA and 23.2% of women with lifetime IPA had considered suicide in the last year, compared with control rates of 8.3% and 5.3% in women who screened negative for one-year and lifetime IPA (p < 0.001 for both). Women with one-year IPA exposure were significantly more likely to feel unsafe in their current relationship (27.0% versus 3.9%; p < 0.001) or because of a previous partner (33.3% versus 7.0%; p < 0.001). In addition, women with one-year IPA were less likely to have association with a general practitioner, and more likely to have multiple ED visits and hospital admissions (p < 0.05 for all). There was no association with education level, ethnicity, or income. Because of local cultural factors we did not ask survey participants about personal or partner alcohol use. Demographic details for survey respondents are shown in Table 1. DISCUSSION Despite increased medical attention directed toward IPA, partner abuse continues to be a major problem facing patients and medical professionals, hi fact, IPA is the number one public health problem facing women in the United States today (CDC, n.d; Fhtcraft, Hadley & Hendrics-Matthews, 1992). One-year prevalence rates for IPA range between 2 and 14% and have not substantially changed since formal screening began (Abbott et al., 1995; Muelleman, Lenaghan & Pakieser, 1996; Olson et al.,1996; Roberts et al.. 1996; Feldhaus et al., 1997). Personal and environmental risk factors for IPA are multiple and well studied (Eisenstat & Bancroft, 1999; Kyriacou. 1999). The consequences of IPA permeate throughout society and health care including increased cost of care (Wisner, Gilrner, Saltzman & Zink, 1999), ED utilization, hospitalizations (Kernic, Wolf & Holt, 2000), and homicide (Wadman & Muel-lerman, 1999; Parsons & Harper, 1999). Women who are exposed to IPA more often have exacerbation of chronic medical conditions, and poor compliance with medical treatments (Eisenstat & Bancroft, 1999). Although no distinct profile fits the battered woman, there is often an association between exposure to IPA and psychiatric illness. Various investigators have reported a high prevalence of depression, anxiety disorder, obsessive personality disorder, and substance abuse among samples of abused women (Jacobson & Utah's Health: An Annual Review Volume DC 57 |