Co-Occurrence of Multiple Risk Factors and Intimate Partner Violence in an Urban Emergency Department.

Raul Caetano,Christina Mair,Harrison J Alter,Carol B Cunradi

doi:10.5811/westjem.2019.10.44190

Abstract

IntroductionUrban emergency departments (ED) provide care to populations with multiple health-related and overlapping risk factors, many of which are associated with intimate partner violence (IPV). We examine the 12-month rate of physical IPV and its association with multiple joint risk factors in an urban ED.MethodsResearch assistants surveyed patients regarding IPV exposure, associated risk factors, and other sociodemographic features. The joint occurrence of seven risk factors was measured by a variable scored 0–7 with the following risk factors: depression; adverse childhood experiences; drug use; impulsivity; post-traumatic stress disorder; at-risk drinking; and partner’s score on the Alcohol Use Disorders Identification Test. The survey (N = 1037) achieved an 87.5% participation rate.ResultsAbout 23% of the sample reported an IPV event in the prior 12 months. Logistic regression showed that IPV risk increased in a stepwise fashion with the number of present risk factors, as follows: one risk factor (adjusted odds ratio [AOR] [3.09]; 95% confidence interval [CI], 1.47–6.50; p<.01); two risk factors (AOR [6.26]; 95% CI, 3.04–12.87; p<.01); three risk factors (AOR = 9.44; 95% CI, 4.44–20.08; p<.001); four to seven risk factors (AOR [18.62]; 95% CI, 9.00–38.52; p<001). Ordered logistic regression showed that IPV severity increased in a similar way, as follows: one risk factor (AOR [3.17]; 95% CI, 1.39–7.20; p<.01); two risk factors (AOR [6.73]; 95% CI, 3.04–14.90; p<.001); three risk factors (AOR [10.36]; 95%CI, 4.52–23.76; p<.001); four to seven risk factors (AOR [20.61]; 95% CI, 9.11–46.64; p<001).ConclusionAmong patients in an urban ED, IPV likelihood and IPV severity increase with the number of reported risk factors. The best approach to identify IPV and avoid false negatives is, therefore, multi-risk assessment.

Highlights

Urban emergency departments (ED) provide care to populations with multiple healthrelated and overlapping risk factors, many of which are associated with intimate partner violence (IPV)
We examine the 12-month rate of physical Intimate partner violence (IPV) and its association with multiple joint risk factors in an urban ED
Logistic regression showed that IPV risk increased in a stepwise fashion with the number of present risk factors, as follows: one risk factor; two risk factors (AOR [6.26]; 95% CI, 3.04-12.87; p

Summary

Introduction

Urban emergency departments (ED) provide care to populations with multiple healthrelated and overlapping risk factors, many of which are associated with intimate partner violence (IPV). IPV screening in urban emergency departments (ED) shows rates ranging from 9–37% for a 12-month timeframe, Co-Occurrence of Multiple Risk Factors and Intimate Partner Violence in Urban ED and as high as 46% for lifetime exposure.[8,9,10,11,12] A previous analysis of the data showed a rate of 23% for physical IPV, 4% for IPV perpetration only, 6% for victimization only, and 13% for mutual violence.[3] Moderate and severe IPV were present in 12% and 11% of the sample, respectively, and about 48% of all IPV was severe.[2] Identification of ED patients involved in IPV helps ED personnel to arrive at a better understanding of patients’ reasons for seeking care and to direct such patients to safe environments and support services

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Discussion

Conclusion