Journal of General Internal Medicine

, Volume 26, Issue 8, pp 894–899 | Cite as

Intimate Partner Violence Identification and Response: Time for a Change in Strategy

  • Karin V. RhodesEmail author
  • Catherine L. Kothari
  • Melissa Dichter
  • Catherine Cerulli
  • James Wiley
  • Steve Marcus
Original Research



While victims of intimate partner violence (IPV) present to health care settings for a variety of complaints; rates and predictors of case identification and intervention are unknown.


Examine emergency department (ED) case finding and response within a known population of abused women.


Retrospective longitudinal cohort study.


Police-involved female victims of IPV in a semi-rural Midwestern county.


We linked police, prosecutor, and medical record data to examine characteristics of ED identification and response from 1999–2002; bivariate analyses and logistic regression analyses accounted for the nesting of subjects’ with multiple visits.


IPV victims (N = 993) generated 3,426 IPV-related police incidents (mean 3.61, median 3, range 1–17) over the 4-year study period; 785 (79%) generated 4,306 ED visits (mean 7.17, median 5, range 1–87), which occurred after the date of a documented IPV assault. Only 384 (9%) ED visits occurred within a week of a police-reported IPV incident. IPV identification in the ED was associated with higher violence severity, being childless and underinsured, more police incidents (mean: 4.2 vs 3.3), and more ED visits (mean: 10.6 vs 5.5) over the 4 years. The majority of ED visits occurring after a documented IPV incident were for medical complaints (3,378, 78.4%), and 72% of this cohort were never identified as victims of abuse. IPV identification was associated with the day of a police incident, transportation by police, self-disclosure of “domestic assault,” and chart documentation of mental health and substance abuse issues. When IPV was identified, ED staff provided legally useful documentation (86%), police contact (50%), and social worker involvement (45%), but only assessed safety in 33% of the women and referred them to victim services 25% of the time.


The majority of police-identified IPV victims frequently use the ED for health care, but are unlikely to be identified or receive any intervention in that setting.


intimate partner violence police incidents health care screening risk identification interventions emergency departments 



The authors wish to thank Patricia Smith, Director, Violence Against Women Prevention Program, Michigan Department of Community Health; the Kalamazoo County Prosecutor’s Office, all members of the Community Advisory Board, the YWCA Domestic Violence Program, and the many research assistants who worked on this project. This project builds on data collected for the MEDCIIN Projects under the CDC cooperative agreement U17/CCU551067.

Conflict of Interest

None disclosed.

Research support was primarily provided by a grant from the National Institute of Justice: NIJ 2006-WG-BX-0007; additional support for investigator time was provided by NIMH K23 MH64572 (Rhodes) and K01MH75965-01 (Cerulli) and the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center (Dichter). Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice the Department of Veterans Affairs or the United States Government.


  1. 1.
    Cascardi M, Langhinrichsen J, Vivian D. Marital aggression: Impact, injury, and health correlates for husbands and wives. Arch Intern Med. 1992;152:1178–84.PubMedCrossRefGoogle Scholar
  2. 2.
    Vivian D, Langhinrichsen-Rohling J. Are bi-directionally violent couples mutually victimized?: A gender-sensitive comparison. Violence Vict. 1994;9:107–24.PubMedGoogle Scholar
  3. 3.
    Bachman R, Salzman, LE. Violence against women: Estimates from the redesigned study. Washington, DC: US Department of Justice, Bureau of Justice Statistics; 1995. BJS Publication No. 154–348.Google Scholar
  4. 4.
    Sutherland C, Bybee D, Sullivan C. The long-term effects of battering on women's health. Women’s Health. 1998;4:41–70.PubMedGoogle Scholar
  5. 5.
    Catalano SM. Criminal Victimization, 2004. Data from the National Crime Victimization Survey. Washington, DC: Bureau of Justice Statistics, Office of Justice Programs, US Department of Justice; 2005.Google Scholar
  6. 6.
    Tjaden P, Thoennes N. Prevalence, incidence, and consequences of violence against women: Findings from the National Violence Against Women Survey. Washington, DC: National Institute of Justice and Centers for Disease Control and Prevention; 1998.Google Scholar
  7. 7.
    Stein M, Kennedy C. Major depressive and post-traumatic stress disorder comorbidity in female victims of intimate partner violence. J Affect Disorders. 2001;66:133–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Campbell J. Health consequences of intimate partner violence. Lancet. 2002;359:1331–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Coid J, Petruckevitch A, Chung W, Richardson J, Morrey S, Feder G. Abusive experiences and psychiatric morbidity in women primary care attenders. Brit J Psychiat. 2003;183:332–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. Am J Prev Med. 1998;14:245–58.PubMedCrossRefGoogle Scholar
  11. 11.
    Coker A, Davis KE, Arias I, et al. Physical and mental health effects of intimate partner violence for men and women. Am J Prev Med. 2002;23:260–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Abbott J, Johnson R, Koziol-McLain J, Lowenstein SR. Domestic violence against women: Incidence and prevalence in an emergency department population. JAMA. 1995;273:1763–7.PubMedCrossRefGoogle Scholar
  13. 13.
    McCloskey LA, Lichter E, Ganz ML, et al. Intimate partner violence and patient screening across medical specialties. Acad Emerg Med. 2005;12:712–22.PubMedCrossRefGoogle Scholar
  14. 14.
    Neilson HD, Nygren P, McInerney Y, Klein J. Screening women and elderly adults for family and intimate partner violence: A review of the evidence for the US Preventive Services Task Force. Ann Intern Med. 2004;140:387–96.Google Scholar
  15. 15.
    American College of Obstetricians and Gynecologists. ACOG issues technical bulletin on domestic violence., accessed, 2-7-11
  16. 16.
    Violence position paper: American Academy of Family Physicians Website. accessed, 2-7-11
  17. 17.
  18. 18.
    The Joint Commission Accreditation Program: Hospital: Provision of care, treatment, and services, 2008. Joint Commission Website. Accessed September 23, 2008.
  19. 19.
    MacMillan HL, Wathen CN with the Canadian Task Force on Preventive Health Care. Prevention and Treatment of Violence Against Women. In: Systematic Review & Recommendations. London, Ontario: Canadian Task Force; 2001. CTFPHC Technical Report No. 01–4.Google Scholar
  20. 20.
    United States Preventive Services Task Force (USPSTF). Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: Recommendation statement. Ann Intern Med. 2004;140:554–6.Google Scholar
  21. 21.
    MacMillan HL, Wathen CN, Jamieson E, et al. Screening for intimate partner violence in health care settings: A randomized trial. JAMA. 2009;302:493–501.PubMedCrossRefGoogle Scholar
  22. 22.
    Kothari C, Rhodes KV. Missed opportunities: Emergency department visits by police-identified victims of intimate partner violence. Ann Emerg Med. 2006;47:190–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Rhodes KV, Frankel R, Levinthal N, Prenoveau E, Bailey J, Levinson W.“You’re not a victim of domestic violence, are you?” Ann Intern Med. 2007;147:620–7.PubMedGoogle Scholar
  24. 24.
    Houry D, Feldhaus K, Peery B, et al. A positive domestic violence screen predicts future domestic violence. J Interper Violence. 2004;19:955–66.CrossRefGoogle Scholar
  25. 25.
    Moracco KE, Cole TB. Preventing intimate partner violence: Screening is not enough. JAMA. 2009;302:568–70.PubMedCrossRefGoogle Scholar
  26. 26.
    Rhodes KV, Drum M, Anliker EA, Frankel R, Howes DS, Levinson W. Lowering the threshold for discussions of domestic violence: A randomized controlled trial of computer screening. Arch Intern Med. 2006;165:1–8.Google Scholar
  27. 27.
    Gerbert B, Abercrombie P, Caspers N, Love C, Bronstone A. How health care providers help battered women: The survivor’s perspective. Women Health. 1999;29:115–35.PubMedGoogle Scholar
  28. 28.
    Bien TH, Miller WR, Tonigan JS. Brief interventions for alcohol problems: A review. Addiction. 1993;88:315–35.PubMedCrossRefGoogle Scholar
  29. 29.
    World Health Organization Brief Intervention Study Group (WHOBISG). Cross-national trial of brief interventions with heavy drinkers. Am J Public Health. 1996;86:948–55.CrossRefGoogle Scholar
  30. 30.
    Glasgow RE, Whitlock EP, Eakin EG, Lichtenstein E. A brief smoking cessation intervention for women in low-income Planned Parenthood clinics. Am J Public Health. 2000;90:786–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Ogle RL, Baer JS. Addressing the service linkage problem: Increasing substance abuse treatment engagement using personalized feedback interventions in heavy-using female domestic violence shelter residents. J Interpers Violence. 2003;18:1311–24.PubMedCrossRefGoogle Scholar
  32. 32.
    Oxman TE, Dietrich AJ, Schulberg HC. The depression care manager and mental health specialist as collaborators within primary care. Am J Geriat Psychiat. 2003;11:507–16.Google Scholar
  33. 33.
    Gentilello LM, Ebel BE, Wickizer TM, Salkever DS, Rivara FP. Alcohol interventions for trauma patients treated in emergency departments and hospitals: A cost benefit analysis. Ann Surg. 2005;241:541–50.PubMedCrossRefGoogle Scholar
  34. 34.
    Hingson RW, Swahn MH, Sleet DA. Interventions to prevent alcohol-related injuries. In Doll L, Bonzo S, Sleet D, Mercy J, Haas E, eds. Handbook of Injury and Violence Prevention. Springer; 2006.Google Scholar
  35. 35.
    Nilsen P, Baird J, Mello MJ. A systematic review of emergency care brief alcohol interventions for injury patients. J Subst Abuse Treat. 2008;35:184–201.PubMedCrossRefGoogle Scholar
  36. 36.
    Burke P, Chapman C, Hohman M, et al. Guiding as practice: Motivational interviewing and trauma-informed work with survivors of intimate partner violence. Partner Abuse. 2010;1:92–104.Google Scholar

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Karin V. Rhodes
    • 1
    Email author
  • Catherine L. Kothari
    • 2
  • Melissa Dichter
    • 3
  • Catherine Cerulli
    • 4
  • James Wiley
    • 5
  • Steve Marcus
    • 6
  1. 1.Division of Emergency Care Policy Research, Department Of Emergency Medicine, Schools of Medicine and Social Policy and PracticeUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Michigan State University Kalamazoo Center for Medical StudiesKalamazooUSA
  3. 3.Philadelphia VA Medical CenterPhiladelphiaUSA
  4. 4.School of Medicine and DentistryUniversity of RochesterRochesterUSA
  5. 5.Public Research InstituteSan Francisco State UniversitySan FranciscoUSA
  6. 6.School of Social Policy and PracticeUniversity of PennsylvaniaPhiladelphiaUSA

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