In a random sample of more than 3,400 women members of Group Health Cooperative, nearly half--44 percent--reported having experienced IPV during their adult lifetime.
"This is an epidemic," said Robert S. Thompson, MD, senior investigator, Group Health Center for Health Studies, lead author of one paper. "But it flies under the radar, because of the stigma and shame associated with it--as well as the fear that many health care providers have of opening what some call a 'Pandora's Box' of difficult problems that they are unsure how to address."
This study is the first to find that the more recent a woman's IPV, and the longer it has gone on, the worse her physical and mental health and social network are likely to be.
"IPV harms women's physical and mental health even more than do other common conditions, such as back pain and even several forms of cancer," said Amy E. Bonomi, PhD, MPH, research associate, Group Health Center for Health Studies, lead author of the other paper. Compared to women with no IPV, women with recent physical IPV were four times as likely to report symptoms of severe depression, nearly three times as likely to report poor or fair health and more than one additional symptom. They also reported lower social functioning by several measures.
Previous estimates ranged from a quarter to a half of women experiencing IPV during their adult lifetimes, depending on how researchers defined IPV and whom they sampled, with young, low-income women reporting more IPV. Interestingly, this study (reporting a prevalence of nearly one half) involves health plan enrollees who tend to be older and have higher incomes and more education than average, making it clear that IPV is an equal-opportunity problem.
Bonomi and Thompson found the effects of physical abuse (slapping, hitting, kicking, or forced sex) to be stronger than those of nonphysical abuse (threats, chronic disparaging remarks, or controlling behavior) alone. But they also found that both physical and nonphysical IPV significantly damage women's health, and that physical abuse often accompanies nonphysical abuse.
IPV persisted for more than 20 years in 5 percent to 13 percent of the women, with more than one partner perpetrating IPV on 11 percent to 21 percent of them, with these ranges depending on the type of abuse. Prevalence was 15 percent in the last five years, and 8 percent in the last year, for any IPV.
"We are at a point with IPV that seems similar to where we were with cigarette smoking and alcoholism 20 years ago," said Bonomi. "To prevent IPV from starting and continuing, we need interventions that span individual, community, and social levels." She and Thompson suggest that these interventions should include inquiring routinely about IPV and linking those with positive responses to appropriate services.
The Agency for Health Research and Quality funded the study. The other authors of the papers about the study are Group Health Center for Health Studies affiliate scientific investigator Frederick P. Rivara, MD, MPH, of Harborview Injury Prevention and Research Center and the University of Washington; and Melissa Anderson, MS; Robert J. Reid, MD, PhD; Jane A. Dimer, MD; David Carrell, PhD, of Group Health--all in Seattle.
Two commentaries accompany the papers about the study: one by James S. Marks, MD, MPH, and Elaine F. Cassidy, PhD, of the Robert Wood Johnson Foundation, in Princeton, NJ; and the other by Ann L. Coker, PhD, of the University of Texas Health Science Center, in Houston.
About Group Health Center for Health Studies
Founded in 1947, Group Health is a consumer-governed, nonprofit health care system that coordinates care and coverage. Based in Seattle, Group Health and its subsidiary health carriers, Group Health Options, Inc. and KPS Health Plans, serve more than 574,000 members in Washington and Idaho. Group Health's commercial and Medicare plans have received the top rating of "Excellent" from the National Committee for Quality Assurance (NCQA). Group Health encompasses medical and specialty centers, hospitals (including a full service community hospital), a nationally recognized research center, and a charitable foundation. Group Health and Group Health Permanente (its multispecialty medical group practice) combined employ more than 9,000 staff.
Group Health Center for Health Studies conducts research related to prevention, diagnosis, and treatment of major health problems. It is funded primarily through government and private research grants.
Journal
American Journal of Preventive Medicine