DOMESTIC ABUSE: Fueling ER Visits By Women

      Just about one out of every seven women -- 14.4% -- visiting an emergency room have been physically or sexually abused by their "intimate partner" within the last year, according to a study in today's Journal of the American Medical Association. The survey of 3,455 women admitted to 11 hospital ERs in both rural and urban areas of California and Pennsylvania found that 2.2% of the women were actually in the ER seeking treatment for abuse, while more than one out of three women (36.9%) had been battered at least once in their lifetime. Primarily authored by Drs. Stephen Dearwater and Jeffery Coben of the Allegheny University of the Health Sciences, the study identified "four risk factors for reported physical, sexual or acute trauma from abuse within the past year." The risk factors are: being in the 18-39 age group; earning less than $1,000 a month; having children younger than 18; and ending a relationship within the last year (Dearwater et al, 8/5 issue). USA Today reports that Coben said women in this last category -- ending a relationship -- were seven times more likely to report abuse than women in other categories. "This suggests that the period when a relationship ends may be a risky time for women," he said (Sternberg, 8/5). "One of the things we need to do as health care providers, is if a woman says she is planing to leave, to make sure she does so safely. We need to tell her that it's a time of increased danger," said Jacquelyn Campbell, professor at Johns Hopkins University School of Nursing and the one of the study's lead investigators.

Societal Pattern?
      The Los Angles Times reports that the study "provides more concrete data than many previous studies of women in emergency rooms." Because the study was not limited to inner-city teaching hospitals, the researchers says this suggests the problem is more widespread than commonly thought. "This is not just an inner-city problem. There is a substantial number of people going to emergency departments due to domestic abuse, and it's not just at big referral hospitals," said Dr. Deirdre Anglin, associate professor of emergency medicine at University of Southern California. The Los Angeles Times cautions that "because the researchers studied women at emergency rooms, it is difficult to estimate what the study may mean for women in the general population." Campbell said, "We think that there's a slightly higher prevalence in emergency departments than there would be overall. Battered women's health is generally poor, so you'd expect to see a higher percentage of them in emergency rooms." The study found that California had a higher rate of domestic abuse than Pennsylvania. Coben said this may be due to Californians having "a heightened awareness of domestic abuse" and being "more apt to report it," or there really could be "an increased prevalence" of abuse in California (Yang, 8/5).

Greater Awareness Needed
      In their closing, the researchers write: "Emergency care providers in all health care settings should understand the widespread prevalence of this problem and establish protocols that initiate appropriate screening for [intimate partner abuse] and address timely plans of action for the treatment, documentation and referral of [these] cases to prevent recidivism and further health care problems" (JAMA, 8/5 issue). Click here to read an abstract of the study. In an editorial addressing a number of violence-related studies in today's JAMA, editors Annette Flanagin and Dr. Thomas Cole write: "Health professionals are expected to confront value-laden issues of freedom, human rights, responsibility, morality, life and death when these issues have a bearing on health" (8/5 issue).