Elsevier

The Lancet

Volume 359, Issue 9314, 13 April 2002, Pages 1331-1336
The Lancet

Series
Health consequences of intimate partner violence

https://doi.org/10.1016/S0140-6736(02)08336-8Get rights and content

Summary

Intimate partner violence, which describes physical or sexual assault, or both, of a spouse or sexual Intimate, is a common health-care issue. In this article, I have reviewed research on the mental and physical health sequelae of such violence. Increased health problems such as injury, chronic pain, gastrointestinal, and gynaecological signs including sexually-transmitted diseases, depression, and post-traumatic stress disorder are well documented by controlled research in abused women in various settings. Intimate partner violence has been noted in 3–13% of pregnancles in many studies from around the world, and is associated with detrimental outcomes to mothers and infants. I recommend increased assessment and interventions for intimate partner violence in health-care settings.

Section snippets

Health-care settings

In investigations in health-care settings (mainly from the USA), yearly prevalence of intimate partner violence has varied between 4 and 23%, with middle-level socioeconomic and well educated groups having the lowest prevalence, and poorer women the highest (figure 1).1, 3 Intimate partner violence might be higher in health-care settings than in most US populationbased samples because samples would be expected to include a substantial proportion of battered women. Furthermore, the same studies

Physical health effects

Women who are abused are frequently treated within health-care systems, however, they generally do not present with obvious trauma, even in accident and emergency departments.3 Intimate partner violence has long-term negative health consequences for survivors, even after the abuse has ended.4, 5 These effects can manifest as poor health status, poor quality of life, and high use of health services.6, 7, 8 Battering is a significant direct and indirect risk factor for various physical health

Forced sex

Gynaecological problems are the most consistent, longest lasting, and largest physical health difference between battered and non-battered women. Differential symptoms and conditions include sexually-transmitted diseases, vaginal bleeding or infection, fibroids, decreased sexual desire, genital irritation, pain on intercourse, chronic pelvic pain, and urinary-tract infections.5, 6, 8, 22, 23, 24, 25, 27, 30, 31, 32 In one of the best-sampled (good sampling techniques, high representation, good

Abuse during pregnancy

In a large review of US studies of prevalence of abuse during pregnancy, Gazmararian and colleagues44 noted a range of 0·9–20·1%; in most studies a range of 3·9–8·3% was recorded. Prevalence of such abuse in other industrialised and non-industrialised nations are similar: 6·4% during the past year and 2·5% overall in the UK (7·8% including threats),45 5·5–6·6% in Canada,46, 47 at least 6·8% in South Africa,48 11% in Sweden (21% including symbolic violence and threats),49 and 13% in Nicaragua.50

Mental-health effects

Depression and post-traumatic stress disorder, which have substantial comorbidity, are the most prevalent mental-health sequelae of intimate partner violence (figure 3).2, 8, 20, 65, 66, 67, 68, 69 In a comprehensive meta-analysis of mainly US studies, Golding20 showed that the risk for depression and post-traumatic stress disorder associated with intimate partner violence was even higher than that resulting from childhood sexual assault. Depression in battered women has also been associated

Use of medical care

Analysis of the relations between partner abuse, health status, and use of medical care in women in population-based and clinical studies has shown poorer overall mental and physical health, more injuries, and more consumption of medical care including prescriptions and admissions to hospital in abused than non-abused women.5, 6, 7, 22 In a Canadian population-based study,2 battered women sought care from accident and emergency departments and saw a medical professional about 3 times more often

Conclusions

Battered women present in all health-care settings with many different physical and mental-health problems and demographic characteristics. Women may present to health-care settings before they present to criminal justice or social service agencies, and if abuse is identified they can receive interventions that increase their safety and improve their health. Thus, assessment for intimate partner violence of all women should be done in all health-care settings;77 several studies have validated

References (82)

  • MP Koss et al.

    Deleterious effects of criminal victimization on women's health and medical utilization

    Arch Intern Med

    (1991)
  • CL Wisner et al.

    Intimate partner violence against women: do victims cost health plans more?

    J Fam Pract

    (1999)
  • J McCauley et al.

    The “battering syndrome”: prevalence and clinical characteristics of domestic violence in primary care internal medicine practices

    Ann Intern Med

    (1995)
  • MR Rand

    Violence-related injuries treated in hospital emergency departments. Bureau of Justice Statistics special report

    (1997)
  • JA Grisso et al.

    Violent injuries among women in an urban area

    N Engl J Med

    (1999)
  • DN Kyriacou et al.

    Risk factors for injury to women from domestic violence against women

    N Engl J Med

    (1999)
  • R Bachman et al.

    Violence against women: estimates from the redesigned survey

    (1995)
  • M Crawford et al.

    Intimate femicide in Ontario, 1991–1994

    (1997)
  • K Brock et al.

    When men murder women: an analysis of 1997 homicide data—females murdered by males in single victim/single offender incidents

    (1999)
  • R Gartner

    The victims of homicide: a temporal and cross national comparison

    Am Soc Rev

    (1990)
  • LL Heise et al.

    Ending violence against women

    Popul Rep L

    (1999)
  • DA Counts

    Female suicide and wife abuse in cross cultural perspective

    Suicide Life Threat Behav

    (1987)
  • B Bergman et al.

    Suicide attempts by battered wives

    Acta Psychiatr Scand

    (1991)
  • JM Golding

    Intimate partner violence as a risk factor for mental disorders: a meta-analysis

    J Fam Viol

    (1999)
  • C Diaz-Olavarrieta et al.

    Domestic violence against patients with chronic neurologic disorders

    Arch Neurol

    (1999)
  • J Leserman et al.

    Selected symptoms associated with sexual and physical abuse among female patients with gastrointestinal disorders: the impact on subsequent health care visits

    Psychol Med

    (1998)
  • Campbell JC, Dienemann J, Jones AS, et al. Intimate partner violence and physical health consequences in a sample of...
  • AL Coker et al.

    Physical health consequences of physical and psychological intimate partner violence

    Arch Fam Med

    (2000)
  • SB Plichta

    Violence and abuse: implications for women's health

  • PW Sharps et al.

    The role of alcohol use in intimate partner femicide

    Am J Addictions

    (2001)
  • DA Drossman et al.

    Sexual and physical abuse and gastrointestinal illness: review and recommendations

    Ann Intern Med

    (1995)
  • C Sutherland et al.

    The long-term effects of battering on women's health

    Womens Health Res Gen Behav Pol

    (1998)
  • JC Campbell et al.

    Forced sex and intimate partner violence: effects on women's health

    Violence Against Women

    (1999)
  • B Schei et al.

    Gynaecological impact of sexual and physical abuse by spouse: a study of a random sample of Norweigian women

    Br J Obstet Gynaecol

    (1989)
  • BJ Collett et al.

    A comparative study of women with chronic pelvic pain, chronic nonpelvic pain and those with no history of pain attending general practitioners

    Br J Obstet Gynaecol

    (1998)
  • Champion JD, Shain RN. The context of sexually transmitted disease: life histories of woman abuse. Issues MHN 19:...
  • AL Coker et al.

    Violence against women in Sierra Leone: frequency and correlates of intimate partner violence and forced sexual intercourse

    Afr J Reprod Health

    (1998)
  • K Wood et al.

    Violence, rape, and sexual coercion: everyday love in a South African township

    Gender Dev

    (1997)
  • G Wingood et al.

    The effects of an abusive primary partner on the condom use and sexual negotiation practices of African-American women

    Am J Public Health

    (1997)
  • C Watts et al.

    Women, violence and HIV/AIDS in Zimbabwe

    SAfAIDS

    (1997)
  • SL Martin et al.

    Sexual behaviors and reproductive health outcomes: associations with wife abuse in India

    JAMA

    (1999)
  • Cited by (2859)

    View all citing articles on Scopus
    View full text