Author
MACY Rebecca J.; FERRON Joelle; CROSBY Carmen;
Partner violence and survivors’ chronic health problems: informing social work practice.
Journal citation/publication details
Social Work, 54(1), January 2009, pp.29-43.
Summary
Evidence from 28 US studies confirms that partner violence can have chronic mental and physical health effects that can persist even after the end of an abusive relationship. While abuse survivors may often seek help, they do not necessarily receive the most appropriate treatment, and recommendations are made at both the policy and practice levels.
Context
A quarter of women in the USA will report physical or sexual assault by a spouse, partner or date at some time in their lives, sometimes with significant long term physical and mental health consequences. As many such women seek help from mainstream social or health services, rather than specialised domestic violence services, social workers need to be aware of evidence about these chronic health consequences.
Methods
What sources were used?
The authors searched databases ‘including’ PsycINFO, PubMed and Social Work Abstracts from early 2000 to the autumn of 2006.
What search terms/strategies were used?
Search terms ‘included’: domestic violence; intimate partner violence; health; physical health; mental health. The reference lists of relevant studies were also checked.
What criteria were used to decide on which studies to include?
Eligible studies were empirical, peer reviewed, covered adult women in the USA and ‘indicated strong statistical power’ through the use of samples of 500 or more, or a longitudinal design with good sample sizes. The prime focus of eligible studies was partner violence victimisation, with health as a further focus. Studies focusing on acute injuries and on violence during pregnancy were excluded.
Who decided on their relevance and quality?
The searches delivered over 3,500 references. No details of how these were filtered are reported. The inclusion criteria indicate some assessment of methodological aspects but no further quality assessment seems to have been conducted.
How many studies were included and where were they from?
Twenty-eight papers, summarised in Table 1, met the inclusion criteria, in some cases reporting on common data sets although with different investigatory aims. All studies, by definition, were conducted in the USA.
How were the study findings combined?
The review is narrative.
Findings of the review
The studies are based on large random samples, nationally based samples or large survey datasets, many with sub-samples based on ethnicity, sexual orientation, socioeconomic status, age and other factors. Many also report on health findings by comparing those from women experiencing domestic violence with those who did not.
The risk of chronic physical and mental health problems is heightened in several circumstances: if the abuse is recent; if it is chronic or severe; or if it is experienced alongside other forms of violence such as sexual assault or child abuse. Psychological and sexual abuse may be particularly detrimental.
Physical health
Physical health problems can include chronic pain (headache, migraine, arthritis, pelvic pain), sexually transmitted infections, gastrointestinal disorders (stomach ulcers, spastic colon, gastric reflux, indigestion, diarrhoea), heart disease and hearing loss. Abused women are also more likely to report significant daily stress. The evidence is largely correlational, however, so that it is impossible to say precisely how and why these health problems arise.
Mental health
Partner violence is also associated with depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal ideation and attempts. One study suggests that abused women may also be more likely to suffer from co-morbid mental health conditions, such as depression and PTSD. Another study indicates that women with more assets such as higher self-esteem or greater economic resources may be protected from negative mental health consequences, but that these buffering effects cease to operate with more severe levels of violence.
Substance abuse
Women subjected to partner violence are more likely to abuse illicit and prescription drugs, and to smoke, all of which can have negative long term physical effects. Five studies also found a relationship with alcohol use although one found no relationship with partner violence and another that women dependent on alcohol had a reduced risk of such violence. The authors suggest that these diverse findings may reflect the reluctance of women to give potentially stigmatising answers to questions about alcohol use.
HIV
The relationship between HIV and partner violence is also ambiguous. One study found that abused women were less likely to use condoms, more likely to have multiple sex partners, and more likely to have sexually transmitted infections. However, another study found no difference between HIV-positive and HIV-negative women in respect of partner violence, although this finding may be explained by the fact that 65% of the sample as a whole reported such violence.
Use of health services
Three studies showed that abused women made greater use of health care, hospital and mental health services, but three further studies indicated barriers to accessing appropriate care. In part, this may result from their failure to identify themselves as violence survivors when seeking help.
Authors' conclusions
Overall, the review finds that women subjected to any form of partner violence are more likely to suffer from physical and mental health problems than women who are not so abused, and that they may face difficulties in accessing appropriate services. The review also identifies some gaps in the evidence base where further research is needed, in particular: how women’s personal characteristics and resources influence the health effects of partner violence; and the health effects on disadvantaged and marginalised women.
Implications for policy or practice
The health problems of abused women typically decline in severity once the abuse stops, indicating that interventions can be effective. The authors recommend that those working with abused women expand their safety strategies to include health, helping them to overcome health problems that can have an adverse impact on their ability to ‘work toward safety’. These issues should be addressed not just in the immediate aftermath of abuse but also long term, to help prevent the emergence of disabling conditions from, for example, smoking and illicit substance abuse. Many women suffer health problems long after they have left an abusive relationship, and may either not recognise their association with abuse or be reluctant to disclose their experiences. Social workers need ‘to assess clients’ violence histories appropriately and sensitively’, and several of the studies covered by this review provide practical guidance.
At the policy level, the review highlights the need for greater collaboration at the practice level between physical and mental health services, and domestic violence services. A move away from the separate provision of services towards a more integrated delivery model is needed, and this will require both policy and funding changes.
Related references
None