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Show Table 1. Demographic Characteristics of Respondents with One-year IPA. lYearlPA + (n = 35) 1 Year IPA - (n = 325) Mean Age (Years) ± SD 30.1 ±9.1 40.5 ± 16.1 Marital Status (%) Single 12 (34.2) 90(27.7) Married 10 (28.6) 151 (46.5) Domestic Partner 2 (5.7) 25 (7.7) Separated 5 (14.3) 6 (1.8) Divorced 5 (14.3) 28 (8.6) Widowed 1 (2.9) 21 (6.5) No Marital Status Entry 0 4 (1.2) Primary Home Language (%) \/o) English 30 (85.7) 298 (91.7) Spanish 0 13 (4.0) Other 0 8 (2.5) No Language Entry 5 (14.3) 6 (1.8) Years Of School Completed (%) <12 4 (11.4) 48 (14.8) High School 11 (31.5) 81 (24.9) Some College 13(37.1) 116 (35.7) College Graduate 5 (14.3) 52 (16.0) Post-Graduate 2 (5.7) 22 (6.8) No School Entry 0 6 (1.8) Household Income per Year(%) Under $10K 16 (45.7) 62 (19.1) $10K to $25K 5 (14.3) 76 (23.4) $26K to $40K 7 (20.0) 59 (18.2) $41K to $55K 2 (5.7) 40 (12.3) Over $55K 3 (8.6) 61 (18.7) No Income Entry 2 (5.7) 27 (8.3) Ethnicity (%) Asian-American 0 5 (1.5) Pacific Islander 1 (2.9) 6 (1.8) Hispanic or Latino 5 (14.3) 35 (10.8) African-American 1 (2.9) 3 (0.9) Native American 4 (11.4) 9 (2.8) Caucasian 21 (60.0) 255 (78.5) Other 0 4 (1.2) No Ethnicity Entry 3 (8.6) 8 (2.5) Richardson, 1987; Carmen, Rieker, & Mills 1984; Gleason, 1993; Liebschutz, Mulvey & Samet 1997; Atwood, 1991). Suicidal attempts may be the most dramatic and harmful manifestations of psychiatric illness associated with IPA. The lifetime prevalence of suicide attempts is thought to be between 3 and 4% (Dube et al., 2001). Exposure to IPA is likely to increase this risk three to five-fold (Stark & Flitcraft, 1995). One author has described a three-fold increase in suicide attempts among women who presented to a University ED with IPA versus women who did not report exposure to IPA (Abbott et al., 1995). Another has concluded that IPA is the most significant risk factor for suicide attempts among adult women (Stark & Flitcraft, 1995). The increased suicidality among victims of IPA parallels the increased risk for suicide seen among children victimized by physical or sexual abuse (Brodsky et al., 2001; Brown & Anderson 1991; Dube et al. 2001). Clearly, the consequences of abuse at any time of life are insidious, pervasive, and persistent. The one-year and lifetime rates of IPA in our emergency department based survey are consistent with rates found at other academic and community hospitals around the nation. As in other studies, all women, regardless or age, ethnicity, income, or education, appear to be at risk for IPA. We did not ask about religious affiliation, or alcohol use in the survey. The rate of suicidal ideation was surprisingly high in this survey. Four out of every ten respondents to the survey with one-year IPA reported thoughts of killing themselves within the preceding year. While we did not attempt to assess whether those thoughts were acted upon, the results may be two to three times that which would be expected based upon the existing literature. Of note, 8.3% of survey respondents without one-year IPA also reported thoughts of killing themselves over the preceding year. This rate is also double that expected and may indicate a selection bias in the population studied. To our knowledge, this is the only study that exclusively surveyed ED patients in an attempt to associate IPA and suicidality. Further focused studies might confirm these higher than expected rates. It is also possible that the survey questions used to assess suicidality were imprecise. Certainly, they had not been formally tested or validated in previous controlled ED settings. Our research group is attempting to confirm these initial results with more targeted questions that link IPA with both suicidal thoughts and actions. hi March 2001 the ED at LDS Hospital evaluated 1,373 women 18 years of age and older. According to ICD-9 cause codes E950-E958.9, six of these were seen (coded) for suicidal events for a rate of 0.44%. During calendar year 2001, 140 of 15,937 (0.88%) women age 18 years and older were coded for suicidal events in the ED at LDS Hospital. Of course, there is no ICD-9 code for "suicidal thoughts," and thus clinical data relating to suicidal ideation would be impossible to verify or link to this survey. Nevertheless, this background data seems to suggest that the survey was indeed overly sensitive for suicidality. It should no longer be acceptable to ask our patients about IPA only when abuse is suspected. Universal screening should be the goal of every hospital, clinic, and provider. Both the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) and the federal government through the U.S. Public Health Service's Healthy People 2000 direct hospitals and clinics to institute policies and programs to identify and treat victims of IPA. Despite this charge, it is estimated that less than 4% of all victims of IPA seen in emergency departments nationwide are accurately identified (Abbott, 1995). In 2003, there remains no ED in Utah that consistently performs universal screening for IPA among its patients. There are many barriers to universal screening. Health care providers may feel there is a lack of time, education, or support resources in order to effectively screen potential victims of IPA (Sugg, Thompson. Thompson, Maiuro & Rivara, 1999; Lam-berg, 2000; Gremillion & Kanof, 1996; Eisenstat & Bancroft, 1999). Victims of IPA may be reluctant to disclose abuse, fear retribution from their partners, or be mistrustful of those who ask (Campbell, Pliska, Taylor & Sheridan, 1994; Ellis, 1999; Ger-bert, Caspers, Bronstone, Moe & Abercrombie, 1999). However, several studies have shown that women are not generally offended when health professionals ask about IPA, are grateful to be asked directly in a confidential setting, and believe universal screening would make it easier for victims of IPA to get the help they need (Hayden, Barton & Hayden, 1997; Ellis, 1999). While some believe there is no real basis to support the efficacy of screening (Cole, 2000). there appears to be increasing evidence that universal screening for IPA does indeed make a positive difference for patients (Muelleman & Feighny, 1999; Gremillion & Kanof, 1996; Flitcraft, Hadley & Hendrics-Matthewsm 1992). Before screening programs are designed and implemented however, each institution or provider should establish relevant care, referral, and reporting mechanisms by protocol. It doesn't help to ask if you don't know what to do when the answer is "yes." There are multiple State and community resources available, including educational materials and programs referable through the Department of Health or the Utah Domestic Violence Advisory Council. Mandatory reporting of domestic abuse is a complex and controversial topic that is beyond the scope of 58 Utah's Health: An Annual Review Volume LX |
