July 11, 2002
(Center for the Advancement of Health) -- Despite the fact that only a small percentage of physicians screen new patients for domestic violence compared to other health problems, their interventions are more intensive, according to new findings.
"Only 19 percent of [of physicians surveyed] reported screening new patients for domestic violence compared with 98 percent for tobacco use, 90 percent for alcohol abuse, and 47 percent for HIV and sexually transmitted disease risks," says lead investigator Barbara Gerbert, Ph.D., from the University of California San Francisco.
However, once the problem of domestic violence was identified, the "respondents reported intervening at comparable or greater frequencies … compared with tobacco, alcohol, or HIV/STD risks," Gerbert reports. Her team's findings also indicate that physicians spent longer time periods counseling identified domestic violence victims than patients identified as having any of the other three health risks.
The study appears in the August issue of the American Journal of Preventive Medicine.
Previous research has shown that between 1.5 million and 3.9 million women are physically abused each year by their intimate partners, with domestic violence affecting an estimated 8 to 14 percent of primary care patients.
"In addition to death and immediate trauma, domestic violence results in a number of chronic health problems," Gerbert explains. These problems include depression, anxiety and substance abuse.
Despite these observations - as well as repeated findings that appropriate screening can be both effective and beneficial and recommendations for routine screening from medical organizations and domestic violence experts - Gerbert notes that investigators have repeatedly shown that only a small minority of physicians ask about domestic violence.
Previous research shows that physicians' attitudes and responses regarding domestic violence might affect screening rates, Gerbert and her colleagues note, so they compared physicians' beliefs and practices on domestic violence and other stigmatized health behaviors for which screening is recommended.
The researchers mailed questionnaires to a random, national sample of 1,200 physicians specializing in internal medicine or family practice. Questions on the 32-item survey centered on four health behaviors: domestic violence, tobacco use, alcohol abuse, and HIV/STD risks.
The 610 physicians who replied echoed previous reports of particularly low screening rates for domestic violence. At the same time, they reported knowing "less about how to screen for or intervene with domestic violence than the other health risks … and, compared with alcohol abuse and STDs, believe they lack appropriate referral resources," said Gerbert and the other authors.
The answers also indicated that while the majority of physicians (86 percent) believe that intervening with domestic violence is an essential or nearly essential part of their role, even more (at least 95 percent) feel that way about the other three problems.
Yet physicians' self-described interventions to domestic violence, once identified, were most intense. Gerbert notes that physicians were far more likely to "provide counseling, arrange for follow-up visits or calls, and refer patients to additional resources for domestic violence victims than … for patients identified with the other three health risks."