Abstract
Patients often do not disclose domestic violence (DV) to healthcare providers in emergency departments and other healthcare settings. Barriers to disclosure may include fears and misconceptions about whether, and under what circumstances, healthcare providers report DV to law enforcement and immigration authorities. We sought to assess undocumented Latino immigrants (UDLI), Latino legal residents/citizens (LLRC) and non-Latino legal residents/citizens (NLRC) beliefs about disclosure of DV victimization to healthcare providers and healthcare provider reporting of DV to law enforcement and immigration authorities. From 10/2018-2/2020, we conducted this survey study at two urban emergency departments (EDs) in California. Participants, enrolled by convenience sampling, responded to survey questions adapted from a previously published survey instrument that was developed to assess undocumented immigrant fears of accessing ED care. Our primary outcomes were the proportions of UDLI, LLRC and NLRC who knew of someone who had experienced DV in the past year, whether these DV victims were afraid to access ED care, reasons DV victims were afraid to access ED care, and rates of misconceptions (defined according to current California law) about the consequences of disclosing DV to healthcare providers. Of 667 patients approached, 531 (80%) agreed to participate: 32% UDLI, 33% LLRC, and 35% NLRC. Of the 27.5% of respondents who knew someone who experienced DV in the past year, 46% stated that the DV victim was afraid to seek ED care; there was no significant difference in this rate between groups. The most common fears reported as barriers to disclosure were fear the doctor would report DV to police (31%) and fear that the person perpetrating DV would find out about the disclosure (30.3%). Contrary to our hypothesis, UDLI had lower rates of misconceptions about healthcare provider and law enforcement responses to DV disclosure than LLRC and NLRC. Fear of disclosing DV and misconceptions about the consequences of disclosure of DV to healthcare providers were common, indicating a need for provider, patient, and community education and changes that lower barriers to help-seeking.
Highlights
Domestic violence (DV), called “intimate partner violence”, is a hidden epidemic that results in a myriad of adverse health effects including acute injuries, chronic pain, mental health disorders, increased risk of sexually transmitted infections, and poor overall health [1,2,3]
Most (67%) of the undocumented Latino immigrants (UDLI) participants had been living in the US for more than 10 years and 14% stated that they were brought to the US as children; the vast majority (94%) had Spanish as their primary language and 69% reported little to no English proficiency; UDLI were less likely to have health insurance (UDLI 62.9% vs legal residents/citizens (LLRC) 82.3%: difference 19.4%, 95% confidence intervals (CIs) 10.0– 28.4%; UDLI 62.9% vs non-Latino legal residents/citizens (NLRC) 86.0%: difference 23.2%, 95% CI 14.1–31.9%)
We found that misconceptions about police reporting of people experiencing DV victimization to immigration authorities were quite a bit more prevalent than misconceptions about physician reporting of DV to immigration authorities; anti-immigration statements made by politicians [21], publicity about law enforcement cooperation with immigration authorities in non-Sanctuary locations [49], and instances of law enforcement cooperation with immigration authorities in Sanctuary locations likely seed these beliefs [52]
Summary
Domestic violence (DV), called “intimate partner violence”, is a hidden epidemic that results in a myriad of adverse health effects including acute injuries, chronic pain, mental health disorders, increased risk of sexually transmitted infections, and poor overall health [1,2,3]. People experiencing DV victimization have many reasons not to disclose DV to healthcare providers including fear of the person perpetrating DV, worry about unhelpful actions or reactions from the healthcare provider, shame, and lack of familiarity with laws or helpful resources [10,11,12,13,14,15]. These barriers are present to a greater degree among immigrant minority women, especially undocumented women or women from mixed documentation status families [16,17,18]. Misconceptions about physician reporting of DV to police and immigration authorities may deter people experiencing DV from seeking medical care
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