Training doctors to ask about partner violence might aid victims, but finding the best way to reach out and treat them still eludes researchers
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More than one in three women and more than one in four men experience violence, stalking or rape by a partner during their lifetimes. Despite such prevalence and evidence that victims suffer accompanying mental and physical health problems such as post-traumatic stress disorder, health professionals have yet to nail down the best way to address intimate partner violence.
The roots of research on such violence extend back to the mid-1970s, when public awareness of the problem started to rise. Several decades of work by health professionals, behavioral and mental health researchers, and advocacy groups have attempted to define the problem and map its scope. Effective ways to help victims are still being hashed out, however, in part because there have been only a few clinical trials to assess whether one form of treatment works better than another.
Addressing and preventing such violence is complicated. For example, numbers such as those cited above rely on self-reporting in surveys, and as a result, abuse prevalence is likely higher. Even defining the abuse itself can be tricky. The term intimate partner violence encompasses not only physical abuse but also sexual or psychological harm by a current or former partner or spouse. Further clouding the issue is what exactly constitutes successful treatment. Children, finances and other factors complicate individuals? situations?for some people who are suffering intimate partner violence, the end of an abusive relationship is not victory.
Women experience such violence more frequently than men, but it is a mistake to treat the issue as a women?s problem. Intimate partner violence stains relationships between heterosexual and same-sex partners alike as well as partners who are not sexually intimate. Victims come from all backgrounds?affluent and educated communities included, says Allison Bressler, a co-founder of A Partnership for Change, a nonprofit dedicated to ending family abuse and intimate partner violence. Too often, doctors with affluent patients will not suspect abuse. Furthermore, victims who are not being physically assaulted often do not define their relationship as abusive, she says, but any fear of one?s partner should not be acceptable.
Typically, people talk to their family doctors about intimate partner violence first?if they talk at all. Leaflets and pamphlets are often available in doctor?s waiting rooms but that passive offer of help may not be enough. Some studies do recommend screening for intimate partner violence in health care settings, but very few health care providers have the tools or expertise to detect the problem in their patients. A 2012 review found that the most common barriers to screening included the doctors? personal discomfort and lack of knowledge and time.
A recent study by researchers based in Australia demonstrates exactly how challenging it is to design a program addressing intimate partner violence. The team was led by Kelsey Hegarty, an associate professor in the General Practice and Primary Health Care Academic Center at the University of Melbourne. Hegarty and her colleagues designed a screening and counseling program to identify and help women with signs of intimate partner violence. ?Our aim was to see if screening delivered by doctors can make a difference,? she says.
The researchers recruited 52 practicing clinicians and mailed all their female patients from the past year a lifestyle questionnaire. Of the women who completed and returned the survey, 272 gave responses that showed fear of their partners. The doctors and their patients were assigned randomly to either a control group (the women received a list of resources and normal physicians? care if needed; the doctors a basic education packet on intimate partner violence) or an experimental group. The doctors in the latter group took a short training course on how to help women who showed fear of a partner. The training included six hours of instruction and two one-hour role-play sessions. The women in the experimental group were offered between one and six free counseling sessions, depending on their need.
After the counseling, participants were asked to complete a survey that assessed their quality of life. The survey included questions that asked whether the women felt healthy, whether they enjoyed their lives, how safe they felt, how satisfied they were in their personal relationships and how often they had felt depressed or anxious in the past four weeks.
The team compared responses with a survey given at the beginning of the study. The intervention group did not have marked improvement when compared with the control group for most of the questions. The counseling, however, did decrease feelings of depression for the women. Additionally, doctors in the experimental group also inquired after the health of women and children more often. The results were published online in April in The Lancet.
Hegarty explains that the study does not support the use of a mailed invitation to partake in counseling. It doesn?t even show that screening within the context of health care is effective. She says the results do show that training doctors can make a difference, however. An accompanying commentary in the same journal agrees that it may be wise for doctors to ask about intimate partner violence under certain circumstances?for example, if the patient has mental health issues. Also, screening for perpetrators may be worthwhile.
A longer training program may show more striking results, Hegarty says. A big question is why many of the women who showed fear of their partners in the initial screen did not accept the offer for counseling. ?This [loss] is typical of a lot of studies in this area,? says Heidi Nelson, a research professor in medical informatics, clinical epidemiology and medicine at Oregon Health & Science University who was not involved in the study. The study was well done, she says, but teasing out effective treatments for social and medical problems is different from conducting a drug trial. ?There is definitely a role for physicians to be aware of this problem,? she adds.
Different health care systems and cultures further complicate finding a good program to identify intimate partner violence. A successful program should empower victims and doctors alike. It will likely involve multiple opportunities for people suffering abuse to seek help and offer places where such services are clearly available, Nelson says. The physician?s office is one place to expose violence that all too often goes on behind closed doors, but until more effective treatment programs are designed, many men and women will still live in fear.
Source: http://www.scientificamerican.com/article.cfm?id=people-suffering-intimate
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