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The “Battering Syndrome”: Prevalence and Clinical Characteristics of Domestic Violence in Primary Care Internal Medicine Practices

Jeanne McCauley, MD; David E. Kern, MD, MPH; Ken Kolodner, ScD; Laurie Dill, MD; Arthur F. Schroeder, MD; Hallie K. DeChant, MD; Janice Ryden, MD; Eric B. Bass, MD, MPH; and Len R. Derogatis, PhD
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From the Johns Hopkins University School of Medicine, Baltimore, Maryland; the Montgomery County Health Department, Montgomery, Alabama; and Hahnemann University, Philadelphia, Pennsylvania. Acknowledgments: The authors thank Walter Stewart, Darilyn Rohlfing, Susan McFeaters, Maxine Largie, Joanne Millar, and Sandra Linz for help in manuscript preparation; the nurses and receptionists of the Community-Based Practices, Johns Hopkins Bayview Physicians, PA, for their help in recruiting patients; and the staff of the House of Ruth, a Baltimore Center for Domestic Violence, for their aid in the study design. Grant Support: In part by grant 03600 from the Chesapeake Educational Research Trust. Current Author Addresses: Drs. McCauley and Kern: Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(10):737-746. doi:10.7326/0003-4819-123-10-199511150-00001
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Objectives: To determine the prevalence of domestic violence among female patients and to identify clinical characteristics that are associated with current domestic violence.

Design: Cross-sectional, self-administered, anonymous survey.

Setting: 4 community-based, primary care internal medicine practices.

Patients: 1952 female patients of varied age and marital, educational, and economic status who were seen from February to July 1993.

Measurements: The survey instrument included previously validated questions on physical and sexual abuse, alcohol abuse, and emotional status and questions on demographic characteristics, physical symptoms, use of street drugs and prescribed medications, and medical and psychiatric history.

Results: 108 of the 1952 respondents (5.5%) had experienced domestic violence in the year before presentation. Four hundred eighteen (21.4%) had experienced domestic violence sometime in their adult lives, 429 (22.0%) before age 18 years, and 639 (32.7%) as either an adult or child. Compared with women who had not recently experienced domestic violence, currently abused patients were more likely to be younger than 35 years of age (prevalence ratio [PR], 4.1 [95% CI, 2.8 to 6.0]); were more likely to be single, separated, or divorced (PR, 2.5 [CI, 1.7 to 3.6]); were more likely to be receiving medical assistance or to have no insurance (PR, 4.3 [CI, 2.8 to 6.6]); had more physical symptoms (mean, 7.3 ± 0.38 compared with 4.6 ± 0.08; P < 0.001); had higher scores on instruments for depression, anxiety, somatization, and interpersonal sensitivity (low self-esteem) (P < 0.001); were more likely to have a partner abusing drugs or alcohol (PR, 6.3 [CI, 4.4 to 9.2]); were more likely to be abusing drugs (PR, 4.4 [CI, 1.9 to 10.4]) or alcohol (PR, 3.1 [CI, 1.5 to 6.5]); and were more likely to have attempted suicide (PR, 4.3 [CI, 2.8 to 6.5]). They visited the emergency department more frequently (PR, 1.7 [CI, 1.2 to 2.5]) but did not have more hospitalizations for psychiatric disorders. In a logistic regression model into which 9 risk factors were entered, the likelihood of current abuse increased with the number of risk factors, from 1.2% when 0 to 1 risk factors were present to 70.4% when 6 to 7 risk factors were present.

Conclusions: In a large, diverse, community-based population of primary care patients, 1 of every 20 women had experienced domestic violence in the previous year; 1 of every 5 had experienced violence in their adult life; and 1 of every 3 had experienced violence as either a child or an adult. Current domestic violence is associated with single or separated status, socioeconomic status, substance abuse, specific psychological symptoms, specific physical symptoms, and the total number of physical symptoms.





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