Study Finds Domestic Violence Leads to Many Health Problems

SEATTLE — Women abused by intimate partners suffer higher rates of a wide variety of doctor-diagnosed medical maladies compared to women who were never abused, according to a new study of more than 3,000 women at Group Health. The Archives of Internal Medicine published it on Oct. 12, 2009.

Many of these health problems are not commonly understood as being associated with violence, such as abdominal pain, chest pain, headaches, acid reflux, urinary tract infections, and menstrual disorders.

"Roughly half of the diagnoses we examined were more common in abused women than in other women," said Amy E. Bonomi, PhD, MPH, lead author of the study, an associate professor of human development and family science at Ohio State University and affiliate investigator at Group Health Research Institute. "Abuse is associated with much more than cuts and bruises."

Compared with never-abused women, victims had an almost six-fold increase in clinically identified substance abuse, a more than three-fold increase in receiving a depression diagnosis, a three-fold increase in sexually transmitted diseases, and a two-fold increase in lacerations.

Dr. Bonomi led the study, co-authored with researchers from the Group Health Research Institute and the University of Washington. Their research examined data from 3,568 randomly selected women patients at Group Health Cooperative. All women in the study consented to giving researchers confidential access to their medical records.

Women in the study were surveyed by telephone about whether they experienced any physical, sexual, or psychological abuse from intimate partners, including husbands and boyfriends, within the past year. Researchers checked their medical records from the past year to see the diagnoses they had received from doctors in primary, specialty, and emergency care settings. The researchers then compared the diagnoses of the 242 abused women with the remaining women who had never been abused.

While other research has found a link between intimate partner violence and health, this is among the first major studies that has not relied on self-reports by women about their health status.

"We were able to go to the medical records and find out what abuse victims had been formally diagnosed with in the past year," Dr. Bonomi said. "These women are not just saying they are depressed or have cuts and bruises," she stressed. "They are going to the doctor and having their problems diagnosed."

In addition, the study improves on past work because it includes a random sample of women enrolled in the health plan, and not just women who were already seeking some kind of health services.

Dr. Bonomi noted that many of the doctors involved in treating these women probably didn't know of their abuse history. "For most women, abuse likely never enters into the conversation with their doctors," she said.

The results suggest that physicians should use a targeted screening approach with their female patients to determine if they are being abused. Any women who come to the doctor with complaints of depression, substance abuse, sexually transmitted disease, or cuts and bruises should be interviewed about the possibility of abuse.

"Many women may not volunteer that they are in abusive relationships, so health care providers should be suspicious if their female patients have any of these diagnoses and symptoms that occur much more often among abuse victims," Dr. Bonomi said.

She said these results may be conservative, and many abused women may suffer even higher rates of some health problems than the study suggests. That's because the participants in this study all had health insurance, and research shows that women who are not consistently insured have higher rates of intimate partner violence and may have worse health overall.

The Group Health Foundation and the federal Agency for Healthcare Research and Quality (AHRQ) funded the study. Dr. Bonomi's Group Health Research Institute co-authors were Biostatistician Melissa L. Anderson, MS; Associate Investigator and Group Health Family Physician Robert J. Reid, MD, PhD; Analyst/Programmer David Carrell, PhD; and Senior Investigator Emeritus Robert S. Thompson, MD, of in Seattle. They conducted the study with Frederick P. Rivara, MD, MPH, of the Harborview Injury Prevention and Research Center at the University of Washington, who is also an affiliate investigator at Group Health Research Institute.

Founded in 1947, Group Health Cooperative is a Seattle-based, consumer-governed, nonprofit health care system. Group Health Research Institute changed its name from Group Health Center for Health Studies on Sept. 8, 2009. Since 1983, the Institute has conducted nonproprietary, public-interest research on preventing, diagnosing, and treating major health problems. Government and private research grants provide its main funding.