Description

• Domestic violence (DV) is the 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.
• Synonym(s): intimate partner violence (IPV); spousal abuse; family violence

Epidemiology

Prevalence

• DV occurs in 1 of 4 American families. In the United States, lifetime estimates of DV are 22–39% for women. DV affects both sexes, but women are more likely to be victims and report partner violence than men.
• Each year, nearly 5.3 million incidents of DV occur among U.S. women ≥18 years old and 3.2 million incidents among men.
• DV results in nearly 2 million injuries and up to 4,000 deaths annually in the United States.
• Costs of DV are estimated to exceed $5.8 billion annually.
• DV survivors have a 1.6- to 2.3-fold increase in health care use.
• DV incidents increased by 8.1% in during lockdown restrictions in the COVID-19 pandemic.

Geriatric Considerations
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.

Pediatric Considerations

• >3 million children aged 3 to 17 years are at risk for witnessing acts of DV.
• ~1 million abused children are identified in the United States 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, and/or physical disturbances; and lifelong poor health.

Pregnancy Considerations

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

Risk Factors

• Patient/victim risk factors
  • Substance abuse (drug or alcohol), high-risk sexual behavior
  • Poverty/financial stressors/unemployment/less education
  • Recent loss of social support, family disruption and life cycle changes, social isolation
  • Prior history of abusive relationships or experiencing abuse as child
  • Mental or physical disability in family
  • Pregnancy
  • Attempting to leave the relationship
• Perpetrator risk factors
  • Substance abuse, depression, personality disorders
  • Young age
  • Unemployment, recent job loss or instability, low academic achievement
  • Witnessing/experiencing violence as child
  • Threatening to self or others, violence to children or outside the home
  • Owns weapons
• Relational risk factors
  • Marital conflict or instability, economic stress, traditional gender role norms, poor family functioning, obsessive/controlling relationship

Geriatric Considerations
Factors associated with geriatric abuse: 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: 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