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Show Prevalence of Intimate Partner Abuse and Suicidal Ideation among Women in a Community Emergency Department Todd L. Allen, M.D., F.A.C.E.P.; Mark H. Stevens, M.D., F.A.C.S.; Lenora M. Olson, M.A.; Joy T. Koplin, R.N., B.S.N.; Roger K. Keddington, A.P.R.N., M.S.N.; Karen J. Chan, B.S.; Diana L. Handrahan, B.S.; Marlene J. Eggar Ph.D.; John C. Nelson, M.D. Study Objective: To determine the one-year and lifetime prevalence rates of intimate partner abuse (IPA) in women presenting to the emergency department (ED) of a community hospital, and to describe their characteristics including suicidal ideation. Methods: An anonymous survey administered to all consenting women over 18 years who presented to the ED during two weeks of March 2001. The Partner Violence Screen was used to determine IP A rates. Results: Three Hundred and sixty of 530 eligible women completed the survey (67.9%). 104 women refused participation and 66 women were missed. The one-year prevalence rate for IP A was 9.7% (95% confidence interval [CI] 7.9 - 13.5%). The lifetime rate was 36.4% (95% CI31.6 - 40.3%). 40.0% of women with one-year IP A and 23.3% of women with lifetime IP A 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 IP A (p < 0.001 for both). Women with one-year IP A were less likely to have association with a general practitioner, and more likely to have multiple ED visits and hospital admissions. There was no association with education level, household income, or ethnicity. Conclusion: Rates of IP A in a Utah community hospital are similar to other hospital types and locations, and exposure to IP A significantly impacts ED patients and their safety. Improved care programs are warranted. Despite increased education and awareness, intimate partner abuse (IPA) continues to be an important health risk factor for many women. Over the last decade, various studies have defined the prevalence of domestic abuse in women, but many of these studies have been completed in academic "inner-city" emergency departments. One-year IP A prevalence rates have ranged between 2 and 14% (Abbott, Johnson, Koziol-McLain, & Lowenstein, 1995; Feldhaus, Koziol-McLain, Amsbury. Norton, Lowenstein & Abbott, 1997; Muelleman, Lenaghan & Pakieser, 1996; Olson, Anctil, Fullerton, Brillman, Arbuckle & Sklar, 1996; Roberts, O'Foole, Raphael, Lawrence & Ashby, 1996), while lifetime prevalence rates for IPA have ranged between 10 and 54% (Abbott et al., 1995; Roberts et al., 1996; Wilt & Olson, 1996; Feldhaus et al., 1997). Only one study has been completed in a community emergency department (ED) and demonstrated IPA rates similar to urban EDs (Dearwater, Coben, Campbell, Nah, Glass, McLoughlin, et al.,1998). There is no Utah data to describe the prevalence of IPA among local emergency patients. Other medical settings including obstetrical clinics (Gazmararian, Lazorick, Spitz, Ballard, Saltzman & Marks, 1996; Helton. McFarlane & Anderson. 1987), primary care offices (Freund, Bak & Blackhall, 1996; Hamberger, Saunders & Hovey 1992), and psychiatry offices (Jacobson & Richardson, 1987; Carmen, Rieker & Mills. 1984) have defined similar rates of reported IPA. Indeed, despite all of the many efforts given toward the identification and reduction of IPA, the magnitude of the persistent health threat associated with IPA is sobering. ED identification of actual or potential victims of IPA remains difficult (McLeer & Anwar, 1989; Abbott et al., 1995; Gremillion & Kanof, 1996). Part of the problem has been the lack of a brief and validated screening instrument. Historically, questionnaires such as the Conflict Tactics Scale (CTS) (Straus, 1979) and the Index of Spouse Abuse (ISA) (Hudson & Mclntosh, 1981) have served as the gold standards for the identification of women at risk for IPA. These screening tools, however, are somewhat cumbersome, and not well suited to an ED setting where time and privacy are prime considerations. Feldhaus et al. (1997) attempted to solve this problem with the Partner Violence Screen (PVS). Her research group compared the sensitivity of the PVS with both the CTS and the ISA in order to define the ability of that instrument (PVS) to detect women at risk for IPA. The PVS found both its strength and weakness in its brevity. The PVS used only three questions to determine the one-year prevalence of IPA: (1) Have you been hit, kicked, punched, or otherwise hurt by someone within the past year? If so by whom? (2) Do you feel safe in your current relationship? And (3) Is there a partner from a previous relationship who is making you feel unsafe now? Because the sensitivity of the PVS was low compared to the CTS and ISA, the authors recommended adding a fourth question to the PVS to improve its utility as a screening tool. That question, "Are you here today due to injury or illness related to partner violence?" was suggested as means to identify acute problems related to IPA and thus maximize the sensitivity of the PVS as is required of screening tools. There are many social consequences associated with IPA. The risk of homicide is the most graphic example (Parsons & Harper, 1999; Wadman & Muellerman, 1999). According to Utah Department of Health statistics there were 21 homicides or suicides due to IPA in Utah in 2001, and 16 in 2002. There were 6 homicides or suicides due to IPA in Utah in only the first two months of 2003. Clearly, all Utahans are beginning to know the horrific effects of IPA. While an increased risk of suicidality is known to be associated with physical, sexual, or psychological abuse to children and adolescents (Brodsky, Oquendo, Ellis, Haas, Malone & Mann, 2001; Dube, Anda, Felitti, Chapman, Williamson & 56 Utah's Health: An Annual Review Volume DC |