Description

• Domestic violence (DV) is behavior in any relationship that is used to gain or maintain power and control over an intimate partner.
• May include physical, sexual, and/or emotional abuse, economic or psychological actions, or threats of actions that influence another person
• Although women are at greater risk of experiencing DV, it occurs among patients of any race, age, sexual orientation, religion, gender, socioeconomic background, and education level.
• Synonym(s): Intimate partner violence (IPV); Spousal abuse; Family violence

Epidemiology

Incidence
8% in the US; women are more likely to report partner violence than are men.

• DV occurs in 1 in 4 American families. Nearly 5.3 million incidents of DV occur each year among US women ≥18 years, and 3.2 million incidents among men.
• DV results in nearly 2 million injuries and up to 4,000 deaths annually in the US.
• 30% of women and 22% of men have experienced physical, sexual, or psychological IPV during their lifetime in the US.
• 14–35% of adult female patients in emergency departments report experiencing DV within the past year.
• Costs of DV are estimated to exceed $5.8 billion annually, of which $4.1 billion are for direct medical and mental health services.
• DV survivors have a 1.6–2.3-fold increase in health care use compared with nonabused population.

• 4–6% of elderly are abused, with ~2 million elderly persons experiencing abuse and/or neglect each year. In 90% of cases, the perpetrator is a family member.
• Elder abuse is any form of mistreatment that results in harm or loss to an older person; may include physical, sexual, emotional, financial abuse, and/or neglect.

• >3 million children aged 3–17 years are at risk of witnessing acts of DV.
• ∼1 million abused children are identified in the US each year.
• Children living in violent homes are at increased risk of physical, sexual, and/or emotional abuse; anxiety and depression; decreased self-esteem; emotional, behavioral, social, physical disturbances; and lifelong poor health.

Pregnancy Considerations
DV occurs during 7–20% of pregnancies. Women with unintended pregnancy are at 3× greater risk of DV. 25% of abused women report exacerbation of abuse during pregnancy. There is a positive correlation between DV and postpartum depression (1).

Risk Factors

• Patient/Victim risk factors:
  • Substance abuse
  • Poverty/financial stressors/unemployment
  • Recent loss of social support
  • Family disruption and life cycle changes
  • History of abusive relationships or witness to abuse as child
  • Mental or physical disability in family
  • Social isolation
  • Pregnancy
• Abuser risk factors:
  • Substance abuse (e.g., heavy drinking)
  • Young age
  • Unemployment
  • Low academic achievement
  • Witnessing or experiencing violence as child
  • Depression
  • Personality disorders
• Relational risk factors:
  • Marital conflict
  • Marital instability
  • Economic stress
  • Traditional gender role norms
  • Poor family functioning

Geriatric Considerations
Factors associated with the abuse of older adults include increasing age, nonwhite race, low-income status, functional impairment, cognitive disability, substance use, poor emotional state, low self-esteem, cohabitation, and lack of social support.

Pediatric Considerations
Factors associated with child abuse or neglect include low-income status, low maternal education, nonwhite race, large family size, young maternal age, single-parent household, parental psychiatric disturbances, and presence of a stepfather.