Domestic violence is a threat to physical, sexual, maternal, psychological, and economic health

My recent article on domestic violence and physical health in Dr. Todd Shackelford's upcoming Encyclopedia of Domestic Violence has been published!

Here are some excerpts and information learned from my research for this project:

What is domestic violence?   

According to the United Nations, domestic abuse "can be defined as a pattern of behavior in any relationship that is used to gain or maintain power and control over an intimate partner. Abuse is physical, sexual, emotional, economic or psychological actions or threats of actions that influence another person. This includes any behaviors that frighten, intimidate, terrorize, manipulate, hurt, humiliate, blame, injure, or wound someone. Domestic abuse can happen to anyone of any race, age, sexual orientation, religion, or gender. It can occur within a range of relationships including couples who are married, living together or dating. Domestic violence affects people of all socioeconomic backgrounds and education levels." https://www.un.org/en/coronavirus/what-is-domestic-abuse 

Domestic violence can be perpetrated by a family member or intimate partner, and can include child abuse, intimate partner violence, and elder abuse. 

DV is connected to health problems

Domestic violence (DV), (and intimate partner violence (IPV), a type of DV), are significantly associated with numerous physical health issues (Wuest et al. 2008; Campbell, 2002), that can persist for years after the abuse has ended (as cited in Dillon et al. 2013).  DV causes health problems in both males and females (Campbell, 2002; Coker et al. 2002), however, women exposed to physical violence report poorer health outcomes (Sillito, 2012; Bosch et al. 2017).  In fact, a longitudinal study of 16,761 Australian women found significant associations between women who experienced IPV and consistently poorer physical health reports across a span of 16 years (Loxton et al. 2017).  Physical, emotional and sexual abuse, threats of violence, and risk of homicide have been significantly associated with increased reports of physical health problems and post-traumatic stress symptoms in women.  Several systematic reviews have found health issues throughout areas of: gynecological, neurological, gastrointestinal, metabolic, respiratory, musculoskeletal, cardiovascular, kidney, urinary tract or genitals, reproductive, cancer, chronic pain (Riedl et al. 2019), and endocrine or rheumatological issues (Loxton et al. 2006).

Who is at greatest risk?

DV-related physical health problems are most prevalent in women.  Women of color, especially older women, women with disabilities, and LGBTQ+ populations are at highest risk for DV and health-related problems.  Furthermore, systematic review of several studies has shown that women of color are at highest risk of domestic violence and health-related consequences due to increased adversity and limitations from racism and structural discrimination along with numerous inequities (as cited in Lacey et al. 2013, p.362).  African American women, in particular, face the most significant racial disparities in health care in the United States including limited access to quality medical care (Haider et al. 2013), and being systematically undertreated for pain compared to Caucasians (Hoffman et al. 2016).  Accordingly, in a study of 8,000 women through a National Violence Against Women survey, results found that psychologically abused Hispanic women and physically abused African American women reported poorer perceived health than Caucasian women who experienced abuse (Lacey et al. 2013).

Women who are immigrants, unemployed and/or experiencing financial problems (Dufort et al. 2014), or living with low or mid household-level income (Lacey et al. 2013), women living with children (Emandi et al. 2021), women that have low social supports (Sanz-Barbero et al. 2019), younger women (Lacey et al. 2013), women that have lower education and parity (Kaye et al. 2006), women living in rural areas (Peek-Asa et al. 2011), women with disabilities, such as those who are deaf or hard of hearing (Anderson et al., 2010; Crowe, 2013), and women of color above age 50 (Pathak et al. 2019) are especially at risk for DV or IPV and subsequent health-related problems.  Lesbian, gay, bisexual, transgender, and non-binary individuals in the United States are at higher risk for DV and IPV as well, similar to rates for cisgender women (Peitzmeier et al. 2020; Huecker et al. 2022).  Among this group, highest rates of IPV have been reported in bisexual women (Modi et al., 2014) and transgender individuals.  Actually, one systematic review and meta-analysis of 85 articles on IPV in transgender populations across the world reported that transgender individuals were 1.66 times more likely to experience any form of IPV than the cisgender individuals in the studies (Peitzmeier et al. 2020).

The ultimate consequence: death

The most severe consequence of DV and IPV is mortality; women are at highest risk of death from DV or intimate partner homicide. In 2018, intimate partner or family-related homicide accounted for approximately 64% of female deaths worldwide; intimate partner homicide alone accounted for 82% of female deaths compared to 18% of males (UNODC, 2018).  The United Nations study of 2020, which gathered data from various continents around the world, found that a woman or girl is killed by an intimate partner or family member every 11 minutes; 47,000 females were killed worldwide in 2020 (UNODC, 2021).

DV has worsened during the pandemic

Another important variable to address is the impact of the COVID-19 pandemic on DV since it began in early 2020.  A systematic review and meta-analysis of studies in multiple countries between 2020-2021 found that DV significantly increased during the COVID-19 pandemic (Piquero et al. 2021). Consequently, a report by the United Nations (2021) referred to domestic violence as a “shadow pandemic.”  At least 13 countries across the world reported significant increases in DV during the pandemic, while access to community resources and supports were significantly limited or halted for extended periods of time, exacerbating isolation, vulnerability, and reduced access to health care (Emandi et al. 2021).

References

Anderson, M.L., Leigh, I.W., & Samar, V.J. (2011). Intimate partner violence against Deaf women: A review. Aggression and Violent Behavior, 16, 200-206. http://doi:10.1016/j.avb.2011.02.006

Bosch, J., Weaver, T.L., Arnold, L.D., & Clark, E.M. (2017). The impact of intimate partner violence on women's physical health: Findings from the Missouri behavioral risk factor surveillance system. Journal

of Interpersonal Violence, 32(22), 3402-3419. 

Campbell, J.C. (2002). Health consequences of intimate partner violence. The Lancet, 359, 1331-1336.

Coker, A.L., Sanderson, M., Fadden, M.K., & Pirisi, L. (2000). Intimate partner violence and cervical neoplasia. Journal of Women's Health & Gender-Based

Medicine, 9(9), 1015-1023. https://doi.10.1089/15246090050200051

Crowe, T.V. (2013). Intimate partner violence in the deaf community. Journal of American Deafness and Rehabilitation Association, 46(2), 71-84.

Dillon, G., Hussain, R., Loxton, D., & Rahman, S. (2013). Mental and physical health and intimate partner violence against women: A review of the

literature. International Journal of Family Medicine, 2013, 1-15. https://doi: 10.1155/2013/313909

Emandi, R., Encarnacion, J., Seck, P., & Tabaco, R.J. (2021). Measuring the shadow pandemic: Violence against women during COVID-19. United Nations

(UN) Women. 

Haider, A.H., Weygandt, P.L., Bentley, J.M., Monn, M.F., Rehman, K.A., Zarzaur, B.L., Crandall, M.L. Cornwell, E.E., & Cooper, L.A. (2013). Disparities in trauma care and outcomes in the United States: A

systematic review and meta-analysis. Journal of Trauma and Acute Care Surgery, 74(5), 1195-1205. http://doi.10.1097/TA.0b013e31828c331d

Hoffman, K.M., Trawalter, S., Axt, J.R. & Oliver, M.N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about

differences between blacks and whites. PNAS, 113(16), 4296-4301. http://doi.10.1073.pnas.1516047113

Huecker, M., King, K.C., Jordan, G.A., & Smock, W. (2022, July 1). Domestic violence. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK499891/ 

Lacey, K.K., McPherson, M.D., Samuel, P.S., Sears, K.P., & Head, D. (2013). The impact of different types of intimate partner violence on the mental and

physical health of women in different ethnic groups. Journal of Interpersonal Violence, 28(2), 359-385.

Loxton, D., Schofield, M., Hussain, R., Mishra, G. (2006). History of domestic violence and physical health in midlife. Violence Against Women 12(8), 715-

731.

Loxton, D., Dolija-Gore, X., Anderson, A.E., & Townsend, N. (2017). Intimate partner violence adversely impacts health over 16 years and across generations: A longitudinal cohort study. PLOS One, 12(6).

https://doi.10.1371/journal.pone.0178138

Peek-Asa, C., Wallis, A., Harland, K., Beyer, K., Dickey, P., & Saftlas, A. (2011). Rural disparity in domestic violence prevalence and access to resources. Journal of Women's Health, 20(11), 1743-1749.

https://doi.10.1089/jwh.2011.2891

Sanz-Barbero, B., Barón, N., Vives-Cases, C. (2019). Prevalence, associated factors and health impact of intimate partner violence against women in different life stages. PLOS One, 14(10): e0221049.

https://doi.10.1371/journal.pone.0221049

Piquero, A.R., Jennings, W.G., Jemison, E., Kaukinen, C., & Knaul, F.M. (2021). Domestic violence during the COVID-19 pandemic- Evidence from a systematic review and meta-analysis. Journal of Criminal

Justice, 74, Article 101806. https://doi.org/10.1016/j.jcrimjus.2021.101806

Riedl, D., Beck, T., Exenberger, S., Daniels, J., Dejaco, D., Unterberger, I., & Lampe, A. (2018). Violence from childhood to adulthood: The influence of child victimization and domestic violence on physical

health in later life. Journal of Psychosomatic Research, https://.doi.10.1016/j.jpsychores.2018.11.019

Sillito, C.L. (2012). Physical health effects of intimate partner abuse. Journal of Family Issues, 33(11), 1520-1539.

United Nations Office on Drugs and Crime (UNODC). (2018). Global study on homicide: Gender-related killing of women and girls. Vienna, Austria.

United Nations Office on Drugs and Crime (UNODC). (2021). Killings of women and girls by their intimate partner or other family members: Global estimates 2020.  Vienna, Austria.

Wuest, J., Merritt-Gray, M., Ford-Gilboe, M., Lent, B., Varcoe, C., & Campbell, J.C. (2008). Chronic Pain in Women Survivors of Intimate Partner Violence. The Journal of Pain, 9(11), 1049-1057.